| From the start of the health reform debate, chiropractors knew the high stakes. Depending on which provisions were present or absent, the prospect of health reform legislation invoked both a genuine sense of peril and an inspiring glimpse of possibility.
At worst, if chiropractic services were excluded from key programs and protections, a reform bill could significantly worsen the situation for chiropractors and their patients. At best, federal law would for the first time recognize the essential role of chiropractic in the health care system, through what would fundamentally be a national version of what are known at the state level as ‘insurance equality’ laws. In addition, chiropractors and their patients sought specific inclusion of chiropractic services in any core benefit plan that might be part of national health reform legislation.
All major chiropractic organizations cooperated in a major national organizing effort under the aegis of the Chiropractic Summit. In a series of Summit meetings, representatives of the American Chiropractic Association, International Chiropractors Association, Council of Chiropractic State Associations and dozens of other groups reached a unified position and then put in many months of unheralded but absolutely necessary legwork to bring this message to every Senator and Member of Congress. Tens of thousands of chiropractic patients and supporters used the Chirovoice (ACA) and Adjust The Vote (ICA) websites to make their voices heard.
Clear Legislative Victory on Nondiscrimination Policy
 The bottom line is that the profession and its patients, with critical help from Washington heavyweights such as Senators Tom Harkin (D-IA) (pictured, left) and Chris Dodd (D-CT), achieved resounding success—it is now illegal under federal law for insurance plans to discriminate against chiropractic. Section 2706 of the Patient Protection and Affordable Care Act of 2010 states: “… health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.”
Make no mistake—this is a major step forward. Without wading too deeply into the technical details of health insurance jargon, a key immediate effect of this provision is to eliminate a gigantic loophole through which insurance policies regulated under ERISA (the Employee Retirement Income Security Act of 1974) were allowed to evade state insurance equality laws. What was originally a small loophole eventually applied to the vast majority of health insurance policies, thus neutering decades of insurance equality progress at the state level. That is now over and done.
The full, long-term effects of a major policy change of this sort will be only become clear after executive branch decisions on how to implement it (i.e., regulatory language from the Department of Health and Human Services or other agencies, as well as state insurance regulators). Eventually, there may be court decisions on whether, for example, the “coverage” terminology in the Harkin nondiscrimination amendment applies to disparities in reimbursement rates, as when MD/DOs or physical therapists are paid more for certain services than chiropractors are paid for the same services. |
