Presidential Election Brings New Challenges in National Health Policy

By R. James Gregg

The outcome of the recent presidential election should have been a surprise to no one. It certainly was no surprise to ICA. Early on in this political year, it was obvious to our political and legislative staff that this was going to be a year of great change, both in personnel and in direction for our nation. For many months, we've been working closely with the Clinton/Gore campaign staff and will continue this relationship as the transition to a Clinton administration gets underway.

The president-elect appears to be holding to his pledge to submit to Congress a national health care reform initiative within the first 100 days of his administration. The Clinton/Gore campaign platform was not very specific in this area. They have pledged to provide coverage for those in America who are presently uninsured. They have vowed to work to cap health care costs. They have expressed an interest in standardized billing and electronic claims filing to reduce administrative costs and improve service.

The president-elect how has his health care transition team in place, and the process of drafting detailed health reform initiatives as promised in the campaign is about to begin. Three working groups have been organized by Clinton and will operate under the direction of Judith Feder, who is on leave from her job as co-director of Georgetown University's Center for Health Policy Studies, and Atul Gawande, who directed health policy issues during the campaign:

• Group 1: policy development, headed by Prospective Payment Assessment Commission Chairman Stuart Altman;

   

• Group 2: budget and greater economic issues;

   

• Group 3: public outreach, and the long list of professional provider and other interest groups concerned with Clinton's health care agenda: headed by Christopher Jennings, who works for Arkansas Senator David Pryor.

Beyond the list of people working on these issues, little else is known about the direction the new administration will take in pushing health reform. Within the transition team, there appears to be little agreement and no consensus on how the promises made in the campaign should be turned into law. The main debate centers around plans to extend coverage to the more than 30 million Americans with no health insurance coverage.

Prior to assuming her new responsibilities, Judith Feder had written articles favoring strict government regulations and price controls for health care. There are concepts, however, that Mr. Clinton may not favor since he came out hard for "managed competition" in the closing days of the campaign. Managed competition is a rather vague approach in which the federal government mandates coverage and insurance plans compete in the marketplace to offer the most attractive package to employers who are obliged to provide coverage for their employees. The government will assume responsibility for the unemployed, either through an enhanced and revised Medicaid program, or through some new mechanism. This view is favored by conservative Democrats and many in the business community.

No matter what direction the Clinton team chooses, the difficult budget situation, coupled with a divided and uncertain Congress, will have far more to do with the final outcome, if there is one, than the president-elect. Already, groups within Congress are organizing to shape health care reform according to their respective visions. One influential group of conservative Democrats, lead by Texas Representative Mike Andrews and Louisiana Senator John Breaux, is planning to push the managed competition concept according to the outline of Tennessee Congressman Jim Cooper's bill from the last Congress, the Managed Competition Act.

Provider groups and some public interest groups are concerned that the planning process has already become too exclusionary and dominated by academics and theorists who have a limited understanding of how possible reforms will impact the patient and the actual delivery of care. In the final analysis, only an actual field test will tell what reforms are likely to be most effective. However, the inclination among most Clinton transition planners seems to be for universal, standardized solutions with little room for experimentation. Some groups and policy officials, particularly democratic governors, would like to see the federal government propose a series of options for covering the uninsured and then allow the states to select and implement the solution which appears to best fit local needs and conditions.

Does chiropractic have anything to fear from a Clinton administration? An inactive, self-isolated, politically ignorant and confused chiropractic profession certainly does. An aggressive, positive, well-informed and politically active profession does not. Every member of the chiropractic profession must play an active part in this process because success in national health policy is entirely dependent on the strength and nature of the message the grassroots of our profession sends to Washington.

In the months ahead, ICA will work to:

• Build on the relationships developed during the long and difficult political campaign, providing the Clinton/Gore transition team with a strong documentary case for full recognition and inclusion of chiropractic in all national health care programs.

   

• Meet with new administration officials as they assume their respective positions to educate them on the cost-effective nature of chiropractic care, the nature of chiropractic science and practice, and the vast number of citizens who rely on chiropractic as a primary source of health care.

   

• Prepare compelling documentary information regarding chiropractic for presentation to Congress and the new administration.

   

• Retain appropriate specialists and consultants to assist chiropractic in dealing with the more than 100 new members of Congress and the new administration policy officials.

   

• Organize regional task forces to mobilize delegations from states and Congressional districts to come to Washington and make the case for chiropractic face-to-face with members of Congress, new and old.

   

• Work with other chiropractic organizations and non-MD provider groups to convince the Clinton administration that maintaining competition and patient freedom of choice is the best way to ensure quality care and to keep health care costs down.

As ICA works to secure a fair deal for chiropractic in the upcoming wave of health care reform initiatives, here are some things you can and should do to assist in this effort:

• Write President-elect Clinton and congratulate him on his victory. Let him know that doctors of chiropractic from around the nation wish him the very best.

   

• Write your Congressional representative and senators with the same message and ask to be kept informed of health reform legislation as it moves through Congress.

   

• Identify the legislators who are responsible for health care issues and let them know that you are very concerned to see that health reforms preserve patient freedoms and will not lock out non-MD provider groups.

   

• Join a national chiropractic organization.

   

• Join your state association.

   

• Be prepared to make a trip to Washington, D.C. within the next three months to speak to your federal legislators on chiropractic issues.

   

• Ask your patients how they feel about proposed health reform legislation and be prepared to ask for their help in writing letters to your federal legislators.

The health reform debate is about to begin in earnest. With $800 billion at stake each year, it will serve as a lightening rod for the first year of the Clinton administration. Despite assurances from Democratic congressional leaders that prompt action will be taken on the Clinton reform proposal, few observers believe that health reform is likely to pass through the Congress quickly. This is a situation that calls for caution and also for aggressive research and complete objectivity. These are things that take time. Also, Congress was created to translate peoples' needs and concerns into laws and policies. President-elect Clinton should not be angry if congressmen and senators want to take a little time to see how Americans from their respective districts and states feel about what he has proposed. America cannot afford too many more big and expensive mistakes.

There will always be surprises in the legislative and political arenas where health care reform and national health policy will be forged. Some surprises will be good and some will be bad. Under all circumstances however, ICA has an obligation to provide each individual DC with the information, timely warnings, and a plan of action to turn every challenge into an opportunity and every opportunity into progress.

R. James Gregg, D.C.
ICA president

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