ACA’s Legislative Conference to Focus on the Importance of Cultural Authority, Staying Essential in Health Care Reform Picture it: Washington, D.C., 2012. While much debate next year will focus on the upcoming presidential election, health care reform will continue to be a hot topic. As with the election, many questions about the implementation of the Patient Protection and Affordable Care Act (PPACA) hang heavy over the nation’s capital—and the chiropractic profession. Questions about the essential benefits package, filling gaps in our country’s primary care workforce and the establishment of health insurance exchanges on the state level are contentious and divisive across the country and inside the Beltway.
To ensure that the voice of the chiropractic profession is heard by lawmakers, the American Chiropractic Association (ACA) will host the 2012 National Chiropractic Legislative Conference (NCLC) with the Chiropractic Summit Feb. 15-18 in Washington, D.C. In a historic first, the 41 organizations that make up the Chiropractic Summit will come together to help set the direction of NCLC.
Immediately following the conference (Feb. 18-19), ACA’s specialty councils will present “The Ultimate Head, Shoulder & Neck Symposium.” Participants can earn 16 continuing education units (CEUs) while learning from leaders in the chiropractic profession.
The theme of this year’s conference, “The Power of Cultural Authority—Staying Essential in Health Care Reform,” will explore the challenges awaiting the chiropractic profession as implementation of the health care reform law continues on the national and state levels. Enhancing the cultural authority of DCs by getting individual DCs placed on key committees will help set the stage for the full inclusion of the profession as PPACA provisions are put into place.
NCLC is the chiropractic profession’s most important public policy and educational event. For more than 30 years, doctors of chiropractic and chiropractic students from across the country have gathered in Washington, D.C. annually to meet with members of Congress and discuss the issues that matter most to DCs and their patients. In addition to the advocacy on Capitol Hill, NCLC offers DCs information on new opportunities in Medicare, military and veteran’s health care, national health care reform and other federal initiatives.
Over the years, a list of political dignitaries and pundits have appeared at NCLC, including political strategist and CNN contributor Paul Begala; political pundit and Daily Caller owner Tucker Carlson; political strategist and media personality James Carville; Ret. Brig. Gen. Becky Halstead, spokesperson for the Foundation for Chiropractic Progress; and perennial chiropractic supporters such as Sens. Tom Harkin (D-Iowa) and Charles Grassley (R-Iowa); and Reps. Mike Rogers (R-Ala.) and Bob Filner (D-Calif.).
“So many important issues are vying for attention in Washington, D.C. right now,” said ACA President Dr. Keith Overland. “Our profession needs a particularly strong display of force and unity right now to ensure that we have the greatest possible impact on Congress. I urge every DC that can to come to Washington for NCLC and lend their voice on behalf the profession and our patients to do so.”
Chiropractic and Health Care Reform – the Current Landscape
In short, there is some good news and a lot of unknowns.
The good news is that the health reform law contains three important pro-chiropractic provisions, the first deals with provider discrimination and prevents health insurers from discriminating against any health care provider who is acting within the scope of their license or certification under applicable state law. The second provision specifically includes DCs as potential members of interdisciplinary community health teams. And the final provision establishes a National Health Care Workforce Commission to examine current and projected needs in the health care workforce.
The commission specifically includes DCs by defining them as part of the health care workforce, and includes them in the definition of health professionals. In addition, chiropractic colleges are included among the health professional training schools to be studied.
What don’t we know? Aspects of the law are still being written, and the chiropractic profession still has mountains to climb. Most notably, the contents of the essential benefits package—the benefits that all insurers will be required to cover once PPACA is fully implemented—is a critical issue for DCs and all provider groups. The inclusion of chiropractic care as an essential benefit would remove many artificial barriers in the way of patient access to DCs, and inclusion would help ensure that chiropractic physicians receive fair reimbursement for the services they provide.
Additionally, as PPACA is implemented the primary care workforce shortage in this country will have to be addressed. When the law is fully enacted, it is estimated that an additional 32 million previously uninsured Americans will begin seeking health care. Furthermore, the Institute of Medicine (IOM) estimates that between 2005 and 2030 the number of adults aged 65 and older will almost double from 37 million to more than 70 million. A 2008 IOM report also stated that “while this population surge has been foreseen for decades, little has been done to prepare the health care workforce for its arrival.”
To address this health care workforce shortage and to ensure that patients have access to the care they need, the IOM report recommended that “steps need to be taken immediately to increase overall workforce numbers and to use every worker efficiently (i.e., to each individual’s maximum level of competence and with an increased flexibility of roles).”
“Congress needs to hear that the nation’s more than 70,000 chiropractic physicians are well-positioned to help fill the workforce gap that will exist in the coming years,” said John Falardeau, ACA’s vice president of government relations. “Congress needs to know that the chiropractic health care model has always been heavily focused on providing essential services and promoting healthy lifestyles for the prevention of disease and injury, and they need to hear it directly from passionate and informed members of the chiropractic profession.”
Crucial State Reform Initiatives Underway
In addition to the work being done in Washington, the implementation phase moves a lot of the action to the state level. Most notably, by 2014 states must create “American Health Benefit Exchanges.” An exchange cannot be an insurer, but will provide eligible individuals and small businesses with access to insurers’ plans in a comparable way. Falardeau explained that the exchanges would function much like “Orbitz” or other online airline booking services. Except instead of flights, people will go online and be able to compare and purchase insurance plans.
With ACA’s support, three bills were introduced in Congress last year to expand access to chiropractic care in the VA and the military.[/pullquote]
The exchange will consist of a selection of private plans as well as “multi-state qualified health plans” administered by the Office of Personnel Management (OPM). Individuals will only be eligible to enroll in an exchange plan if they are not enrolled in Medicare, Medicaid or acceptable employer coverage as a full-time employee. Based on income, certain individuals may qualify for a tax credit toward their premium costs and a subsidy for their cost sharing; the credits and subsidies will be available only through an exchange. States will have the flexibility to establish basic health plans for low-income individuals not eligible for Medicaid. Individual and small group coverage will be allowed to be offered through nonprofit, member-run health insurance companies. Such nonprofit insurers will be eligible for grants and loans distributed through the new Consumer Operated and Oriented Plan (CO-OP) program.
“We must open the door to these exchanges for DCs at the state level. Doctors of chiropractic must be included on provider panels so that fee parity is maintained. To do this, we must work with state agencies to ensure that chiropractic services are considered an essential component of any health care plan,” said Falardeau. “Talking about this issue with your representatives in Washington can also provide another foot in the door. This kind of work by doctors of chiropractic will really increase the cultural authority of DCs across the country.”
More Than Just Health Care Reform
Aside from health care reform, at NCLC doctors and lawmakers will talk about other pressing legislative issues, such as:
- Expanding access to chiropractic care for members of the military and for military veterans through the U.S. Department of Defense (DoD) and the Department of Veterans Affairs (VA). DCs are available at 60 military bases around the country; however, according to a 2005 Government Accountability Office report, only 54 percent of servicemen and women eligible for chiropractic care can reasonably access the benefit. Within the VA, chiropractic care is available at approximately 30 major VA treatment facilities within the United States. Unfortunately, the VA has taken no action to provide chiropractic care at approximately 120 of its major medical facilities.
With ACA’s support, three bills were introduced in Congress last year to expand access to chiropractic care in the VA and the military. They are:
- The Chiropractic Care to All Veterans Act (H.R. 329), which would require the VA to have a DC on staff at all major VA medical facilities by 2014. It would also ensure that chiropractic benefits are included in the U.S. Code of Federal Regulations and therefore cannot be denied.
A Senate companion bill to the House legislation was introduced in early June. S. 1147, mirrors H.R. 329, by requiring a DC on staff at all major VA medical facilities by 2014.
- The Chiropractic Health Parity for Military Beneficiaries Act (H.R. 409) would extend chiropractic care to U.S. military retirees, dependents and survivors as part of the TRICARE program. The legislation would require the Secretary of Defense to develop a plan to allow any beneficiary covered under TRICARE to select and have direct access to a DC. Currently, only active-duty members are afforded the chiropractic benefit.
- Including (via H.R. 6032) DCs as officers in the U.S. Public Health Service (USPHS) Commissioned Corps. The bill would require the president to appoint no fewer than six DCs to the Commissioned Corps. Although the Commissioned Corps includes representatives from many diverse health care professions, no DCs have ever been appointed to serve—ACA and the Association of Chiropractic Colleges have been working to advance this legislation, which specifically addresses this long-standing deficiency. The Commissioned Corps is an elite team of more than 6,000 well-trained, highly qualified public health professionals dedicated to delivering the nation’s public health promotion and disease prevention programs and advancing public health science. Officers in the Corps provide health care services in a variety of locations and venues, including care to members of the U.S. Coast Guard and at community health centers.
- Expanding access to chiropractic and providing an opportunity for DCs to work in exchange for student loan relief through H.R. 531, the Access to Frontline Health Care Act 2011. Many areas in the country lack providers of various health care services. H.R. 531 would establish a student loan repayment program that would ensure that medically underserved communities across America have access to a wide array of health care services and an expanded range of provider types from which patients in these communities can choose to receive their care.
New Leadership at the Helm
As ACA and the chiropractic profession storm Washington, D.C., they will do so under new leadership. Last fall, members of ACA’s House of Delegates elected a new president, Keith Overland, DC, of Norwalk, Conn., to lead the association during this pivotal period. Dr. Overland brings a wealth of political experience to the position, having served previously as ACA vice president and as chair of the ACA’s Political Action Committee. In his home state, he served as co-chair of the Connecticut Governors Committee on Physical Fitness, was a member of Sen. Joseph Lieberman’s (I-Conn.) Health Care Task Force and was also a member of Rep. Christopher Shays’ (R-Conn.) Task Force on Human Services. In his first remarks as president of the association, Dr. Overland called for continued efforts to unite the profession and urged HOD members to “recommit with passion and enthusiasm to ACA.” He stressed that “failure is not an option for this team.”
Joining Dr. Overland on the association’s Executive Committee are Vice President Anthony Hamm, DC, of Goldsboro, N.C., and Chairman of the Board of Governors Robert Mastronardi, DC, of Warwick, R.I. Both doctors also have a strong history of advocacy on behalf of the chiropractic profession on the federal level. Dr. Hamm was the first DC to be elected co-chair of the American Medical Association’s (AMA) Health Care Professionals Advisory Committee Review Board (HCPAC). In this role, he also serves on the AMA/Specialty Society Relative Value Scale Update Committee (RUC). The RUC makes annual recommendations on relative values regarding new and revised services to CMS and performs broad reviews every five years of the Resource-Based Relative Value Scale (RBRVS), which determines Medicare provider reimbursement. Dr. Mastronardi is an active member of ACA’s Health Care Reform Task Force and the chairman of the CHAMP (Chiropractic Health Advocacy and Mobilization Project) Committee.
Network with Colleagues, Lawmakers and Earn 16 CEUs
There will be no lack of opportunities to mingle with colleagues—and elected representatives—during NCLC. The congressional reception will be held on Wednesday, Feb. 15 on Capitol Hill in the Cannon Caucus Room. Previous congressional representatives in attendance include: Rep. Howard Coble (R-N.C.), Rep. Walter Jones (R-N.C.) and Sen. Tom Harkin (D-Iowa). On Thursday, Feb. 16 there will be a dinner and comedy show featuring the Capitol Steps for attendees and guests. Finally, on Feb. 18-19, ACA’s specialty councils will present “The Ultimate Head, Shoulder & Neck Symposium.”
Featured sessions and speakers:
- “Nutritional Support and Treatment in the Acute Stage of Healing” (presented by the ACA Chiropractic Board of Clinical Nutrition)–Juanee Surprise, DC, DCBCN, BCIM
- “Diagnosis and Treatment of Acute Shoulder Injuries” (presented by the ACA Council on Sports Injuries & Physical Fitness)–Guillermo Bermudez, DC, CCSP
- “Advanced Evaluation and Treatment of the Head, Neck and Shoulder: Movement Disorders of the Head, Neck and Shoulder” (presented by the ACA Council on Neurology)–Frederick Carrick, DC, PhD, DACNB
- “Congenital Torticollis: Chiropractic Management including Cervical and Thoracic Spinal Adjusting Techniques” (presented by the ACA Council on Chiropractic Pediatrics)–Elise G. Hewitt, DC, DICCP, FICC
- “Recognizing and Treating Organic Causes of Pain” (presented by the ACA Council on Diagnosis and Internal Disorders)–Philip Arnone, DC, DABCI
- “Rehabilitation of the Shoulder in the Chiropractic Practice” (presented by the ACA Council of Chiropractic Physiological Therapeutics and Rehabilitation)–George Petruska, DC &
- “Evidence Based Approach in the Assessment of Neck and Shoulder Disorders” (presented by the ACA Council on Chiropractic Orthopedics)–Larry L. Swank, DC, MS, FACO
NCLC is the chiropractic profession’s opportunity to tell its story to congressional representatives and to make them aware of how efficiently and cost-effectively DCs help their patients. Now more than ever, Congress needs to hear the profession’s message—and they need to hear it directly from doctors of chiropractic in their districts and states. Too many people in this country are sick and too many people can’t access the health care they need. It’s time to make sure Congress knows that the chiropractic profession has some of the answers that our health care system is looking for.
The Chiropractic Summit and its 41 member organizations, including the ACA, ACC, COCSA, and ICA encourage members and affiliates of each organization to join in the lobbying effort at this critical time in chiropractic and healthcare history. To learn more about the Chiropractic Summit, visit www.chirosummit.org. To learn more about attending this years NCLC conference in Washington D.C., (703) 276-8800 or go to www.acatoday.org.