Bill to Expand Medicare’s Chiropractic Coverage Brings Momentum to Historic Effort
PERSPECTIVE
POLITICS
By N. Ray Tuck, Jr., DC, Keith S. Overland, DC, & John Falardeau
Breaking the barrier to chiropractic services for Medicare patients is more than 40 years in the making. In 1972, Congress first approved access to chiropractors in Medicare with the one and only covered service of manual manipulation of the spine. Recently, legislation championed by the American Chiropractic Association (ACA) to increase Medicare coverage of services provided by chiropractors was introduced in the U.S. House of Representatives. The political climate may finally be right for the chiropractic profession to achieve this important goal on behalf of America’s seniors.
H.R. 7157 would allow Medicare beneficiaries to access the chiropractic profession’s broad-based, nondrug approach to relieving pain and improving function. The bill does not take away or add any new services to Medicare; it only allows access to those current benefits that chiropractors are licensed to provide.
The fact that chiropractic has existed in Medicare with only one service covered for so long is surprising to many. While limited, however, that one service marked a crucial foothold in the federal healthcare program. Inclusion contributed to success in the efforts to include chiropractic in the U.S. Department of Veterans Affairs and Department of Defense healthcare systems as well as federal workers’ health plans.
Much has changed in the intervening years, most notably the rise of a national opioid epidemic that adversely impacts America’s senior population as much as it does younger people. In fact, between 1993 and 2012, hospitalizations for opioid overuse increased fivefold among Americans age 45 to 85 and older, according to the Agency for Healthcare Research and Quality. In a 2018 hearing on the opioid crisis, Sen. Robert Casey, Jr. (Pa.), ranking Democrat of the Senate Special Committee on Aging, noted, “In 2016, one in three people with a Medicare prescription drug plan received an opioid prescription. This puts baby boomers and our oldest generation at great risk.”
Medicare's impact on quality senior health care is significant, and it will become more so as the baby boomer generation continues to age and enter its ranks. Various projections forecast the number of people age 65 or older, which stands at about 55 million now, increasing by onethird over the next decade. However, the importance of the bill the ACA is working on goes far beyond Medicare and may impact all federal health programs and many commercial health insurance policies as well.
A few years ago, ACA embarked on a study of all federal programs that do, could, or should include the services of a doctor of chiropractic. Amazingly, the report that was initially thought to be a small review on Medicare ended up being more than 500 pages long, covering the vast majority of federal healthcare programs. While Medicare is indeed the largest, many others use the current limiting scope of practice language. These include well-known programs such as the Federal Medical Leave Act, Federal Workers’ Compensation, and Indian Health Care Services.
It is important to understand that the bill introduced in Congress focuses specifically on modifying the limiting statute that defines physicians under Medicare. In this section of federal law, we find language that limits coverage for a patient seeking care with a chiropractic physician. In the statute, it states that all healthcare providers will be guided by the scope of practice laws of their state except chiropractic physicians who are only covered for three of more than 15,000 procedure codes: manual manipulation of the spine.
Simply put, the purpose of the bill introduced in December is to remove the arbitrary and capricious restrictions placed only on doctors of chiropractic and, to our knowledge, no other healthcare professions.
This proposed bill, if passed, will be the initial gateway law that will guide other federal healthcare laws. While it will take time, we must also work through many current laws, rules, and regulations that will need to conform to the new full-scope coverage legislation. Some federal laws that limit chiropractic coverage include those that guide nutrition, wellness exams, and even one that allows providers to opt out of participation in Medicare.
We are encouraged by the progress the recent bill represents to our efforts to expand seniors’ access to the chiropractic profession’s safe and effective non-drug approach to relieving pain and improving function. We are committed to building on this momentum in the coming months. More than 45 national, state, and regional chiropractic organizations have joined this effort by signing an open letter to Congress urging change in Medicare. We believe this unity of effort will tip the scales and complete the journey that we began more than 40 years ago.
Because a new congressional session started in January, the bill will have to be reintroduced. We will remain vigilant in our lobby efforts, and in fact, last summer, ACA contracted with the Capitol Hill Consulting Group (CHCG) to add extra muscle to the Medicare initiative with a focus on activating and supporting current chiropractic champions in Congress. CHCG will also focus on breaking down any barriers among members of the House Ways and Means Committee, recruiting cosponsors, and finding other targets of opportunity that could bolster the chances of a pro-chiropractic Medicare bill being passed.
If you want to join this effort to increase access to safe, effective chiropractic sendees for seniors, you can help immediately in several ways. First, make sure you are a member of ACA. Simply visit acatoday.org/Join to become a member. Second, go to acatoday.org/ Medicare to learn more about the process and how you can get involved and support this historic effort. ACA has also compiled a list of “frequently asked questions ” about the Medicare initiative that can be accessed at acatoday.org/ medicarefaq.
N. Ray Tuck, Jr., DC, is the president of ACA.
John Falardeau is ACA ’.s' Senior Vice President of Public Policy and Advocacy.
Keith Overland, DC, is the legislative chairman of ACA.
