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Dynamic Chiropractic – June 20, 1990, Vol. 08, Issue 13

Key Senator Introduces Medicare Reform Bill at the May ACA-ICA Joint Legislative Conference

By Editorial Staff

At the urging of the two national chiropractic associations, the American Chiropractic Association and The International Chiropractor's Association, Senator Thomas A. Daschle of South Dakota has introduced legislation in the United States Senate to reform the chiropractic portion of the current Medicare program.

Senator Daschle, who is a member of the Senate Finance Committee, which has jurisdiction over the Medicare program, was joined by North Dakota Senators Quentin Burdick and Kent Conrad and senior Louisiana Senator Bennett Johnston as initial co-sponsors of the bill.

The objective of this legislation is to expand and clarify the role of the doctor of chiropractic in the Medicare program. Presently, chiropractic services are limited to "manual manipulation of the spine to correct a subluxation, as demonstrated by x-ray to exist." Even though x-rays are required, they are not reimbursed by the Medicare program. The Daschle bill, S. 2616, would change the present law and authorize reimbursement for "diagnostic x-rays, appropriate physical examinations and adjustments of the spine."

In his May 11, 1990 statement on the floor of the U.S. Senate, upon introducing the bill, Senator Daschle said:

I hope to correct an inequity in current law that discriminates against the chiropractic profession---I grew up in a community in which chiropractors performed a valuable service by providing an alternative to allopathic medicine---I am convinced that competition between health care providers is essential if we are ever going to get control of our spiraling health care costs. And yet, this competition is virtually impossible when federal reimbursement policies are written in such a way that entire groups of licensed professionals are denied payment for the services they provide. This shortsighted policy limits freedom of choice for health care consumers, and may force them to seek out more expensive care than is actually required.

This important legislation represents a first step in a joint effort by the International Chiropractors Association (ICA) and the American Chiropractic Association (ACA) to correct the discriminatory and hurtful elements of the chiropractic portion of the Medicare program. The language of the Daschle bill was agreed upon by the legislative committees and the governing boards of the ICA and the ACA prior to seeking congressional sponsorship.

"Our profession is at a crisis point under the current federal Medicare program," said Dr. Fred H. Barge, ICA president. "The harassment of doctors of chiropractic and their patients via such devices as the 12-visit screen, 'medically unnecessary' letters to our patients, frequently changing rules, the review and denial of claims by non-DCs, sometimes even computers, and the crushing burden of paperwork all combine to make Medicare our number one problem. This bill, represents a means for our profession to fight back."

The two national associations urge all doctors of chiropractic, chiropractic patients, students, and friends of the profession to write their United States senators today and urge them to co-sponsor S. 2616, and work for the quick passage of this desperately needed Medicare reform legislation.

National Chiropractic Legislative Conference Draws The Highest Number Of Attendees In Its Seven Year History

For the seventh consecutive year, the International Chiropractors Association (ICA) jointly sponsored the National Chiropractic Legislative Conference with the American Chiropractic Association (ACA). Held in Washington, D.C., May 9-10, this year's conference brought together hundreds of doctors of chiropractic from across the nation, including representatives of nearly all state chiropractic associations, to promote the chiropractic legislative agenda in Congress.

This year's top priority was legislation to reform the chiropractic portion of the federal Medicare program. (Please see article which begins on page one.) This is an issue the ICA has been actively working on for some time with key legislators.

The second priority issue was legislation to authorize the commissioning of doctors of chiropractic in the U.S. Armed Forces as health care officers. In 1985, Congress instructed the Department of Defense to study the utility of adding DCs to the list of commissioned health care officers in the uniformed services. After a lapse of almost five years, the Defense Department has still not produced the report. The ICA felt enough time had passed and strongly felt it was time to go back to Congress with their own legislative initiative.

In 1989, the ICA board of directors voted unanimously to instruct the Legislative Committee to draft legislation to commission doctors of chiropractic in the military, and invite other chiropractic associations to participate in a joint effort to secure congressional passage of such a bill. Senator Strom Thurmond, senior senator from South Carolina, a long-time chiropractic advocate, has introduced legislation to commission chiropractors in the military, S. 2590. The ICA and ACA are cooperating in this effort.

During the two day conference, attendees met with their senators, representatives, congressional members, and staff. During these face to face meetings, chiropractors had the opportunity to educate and influence these policymakers on the crucial needs and concerns of the profession.

On May 10, in an official address to the conference attendees, Congressman Lane Evans (D-IL) announced his intention to sponsor companion legislation to S. 2590. Indeed, on May 17, one week after the conference, he introduced H.R. 4849 as "commonsense legislation." Congressman Evans told his colleagues that, "[i]t is time that the Department of Defense got in line with the rest of the federal government" regarding the recognition of chiropractic. "As somebody who has personally enjoyed the benefits of chiropractic services, I think it is long overdue," he explained.

Two of the most powerful health care lawmakers in Congress, Congressman Pete Stark (D-CA) and Willis Gradison (R-OH), the chairman and ranking minority members of the powerful Ways and Means Subcommittee on Health respectively, reminded the crowd of the importance of remaining a player in the nation's health care debate. To ensure participation of federal programs, all health professions must be prepared to produce evidence of their ability to contain costs. This is especially critical in the current budget-cutting atmosphere they stressed.

Towards this end, both lawmakers expressed their willingness to assist the profession in obtaining federal research funding. Congressman Gradison offered to "explore the feasibility of obtaining federal funding for chiropractic research through the government's medical outcome assessment program. (As the author of legislation that expanded the federal outcome assessment program last year, this pronouncement represents the profession's best chance in years to secure federal research monies.) Congressman Stark stated his readiness to investigate the prospects of expanding the Office of Technology's Assessment's (OTA) mission to include investigations into chiropractic.

These remarks coincide with a jointly orchestrated campaign to win congressional appropriated -- or "earmarked" money for chiropractic research. Each attendee was given a letter cosigned by Presidents Dr. Fred Barge (ICA) and Dr. Vincent Lucido ( ACA) urging Congress to end years of government discrimination which has resulted in a situation where total chiropractic awards ever received amount to five ten-thousandths of one percent (.0005%) of the funds received annually by the U.S. medical community.

The conference stressed other issues as well. A bill to provide federal employees the freedom to select a chiropractor for covered benefits was also supported, and the list cosponsors to that measure continues to grow. Additionally, the joint agreement and legislative language on correcting the limited reimbursement policies under the Federal Worker's Compensation Act were also highlighted.

The advances realized during this important week may never have come to pass if the two national associations were not presenting a consistent message. Congress takes every opportunity presented it to delay action, and a profession espousing a disjointed message makes it easy for Congress to suggest "getting your act together" as a prerequisite to positive action. The National Chiropractic Legislative Conference once again has demonstrated the power a unified message can have in advancing a range of significant legislative measures.

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