| No one yet knows precisely how it will all play out. One thing for certain is that the removal of the ERISA exemption is a major positive change for chiropractors and their patients.
Core Benefits Package
 At the beginning of the health reform debate, chiropractors recognized that if Congress were to include a specifically defined benefits package in its reform legislation, inclusion of chiropractic services was crucial. However, it quickly became apparent that Congress wished to avoid this degree of policy micromanagement, which they accurately perceived would anger at least as many people and groups as it would please. Though the reform law includes certain broad parameters regarding types of services to be covered, Congress essentially punted on this issue, deciding to focus on other matters and leaving the details of any possible core benefits plan to later decisions by the Department of Health and Human Services.
In this and likely in many other ways, the Affordable Care Act is just the beginning of the health reform process. Executive branch regulatory language matters a great deal. The profession’s leadership understands this and is acting in accord with the long-term needs of chiropractors and their patients. We are in a far stronger position now than when chiropractors first gained statutory inclusion in Medicare in 1973, and were soon blindsided by a harshly discriminatory set of regulations from the federal health bureaucracy.
Other Key Provisions
Two other helpful, though not game-changing, provisions in the new law are noteworthy for their specific mention of chiropractors:
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Doctors of chiropractic are specifically included as potential members of interdisciplinary community health teams.
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The legislation establishes a National Health Care Workforce Commission to examine current and projected needs in the health care workforce. The commission specifically includes doctors of chiropractic by defining them as part of the health care workforce, and includes them in the definition of health professionals.
A Milestone Moment and an Ongoing Process
Passage of the Patient Protection and Affordable Care Act is a milestone moment. Under its provisions, tens of millions of uninsured Americans will be able to attain coverage. Moreover, insurance companies are banned from (1) discriminating on the basis of preexisting conditions; (2) dropping people from coverage when they get sick; (3) implementing lifetime or annual caps on coverage; and (4) spending less than 75 percent of premium dollars on medical costs (rather than profits, advertising, and administration) for individual plans or less than 80 percent for group plans.
There are literally hundreds of moving parts in this comprehensive legislation, which seeks to lower currently unsustainable cost increases while improving the quality of care. This is a tall order and all predictions must be taken with a grain of salt. Over time, as the facts on the ground show what is working and what is not, further changes will be forthcoming. The chiropractic profession must continue to be vigilant.
Daniel Redwood, DC, is Associate Professor at Cleveland Chiropractic College–Kansas City, and Editor-in-Chief of Health Insights Today and
The Daily HIT. |
