On March 23, President Obama signed H.R. 3590, the Patient Protection and Affordable Care Act, into law. The road this bill traveled was filled with political pain and pratfalls, and its 15-month journey from inception to the president's desk was one of the most dramatic policy debates this country has ever witnessed.Many pundits and long-time Washington observers equated the bill's history and impact to that of Roosevelt's "New Deal" or Johnson's "Great Society" legislation.
In the coming months and even years, this landmark health reform legislation will continue to be dissected as many of the bill's provisions go into effect immediately, while others are not implemented until 2014. However, what many doctors of chiropractic are wondering now is, "How will this bill affect my profession?" Here is a breakdown of the three provisions we expect will advance the chiropractic profession, as well as three areas in which we must remain vigilant or risk being left out.
Non-Discrimination in Health Care (Sec. 2706 of the Act, Public Law 111-148)
The new law states, "No health plan or insurer may discriminate against any health provider acting within the scope of that provider's license or certification under applicable state law." This will ensure that insurance companies cannot unfairly exclude doctors of chiropractic from practicing under the capacity of their training and licensure on a federal level. This provision is a federal protection applicable to ERISA and other plans established or regulated under the bill. Just as the HIPAA protections now apply across the board, the non-discrimination provision will be applicable to all health benefit plans - both third-party insured and self-insured.
As readers know, national health care reform is estimated to eventually cover an additional 30 million uninsured Americans. The non-discrimination provision will, over time, apply to those individuals. However, that number pales in comparison to the approximately 55 percent of workers currently covered by the ERISA regulated self-insured plans that will also be affected. The potential impact in this regard cannot be overstated.
Community Health Teams (Sec. 3502)
In this provision, DCs are specifically named as potential members of Community Health Teams to support the development of "medical homes" (or coordinated care). These teams support the development of medical homes by increasing access to comprehensive, community-based, coordinated care. Community health teams are integrated teams of providers that include primary care providers, specialists, other clinicians and licensed integrative health professionals, as well as community resources to enhance patient care, wellness and lifestyle improvements. The language in the bill ensures that doctors of chiropractic can be included on these patient-centered and holistic teams.
National Health Care Workforce Commission (Sec. 5101)
DCs are specifically included as part of the National Health Care Workforce Commission's definition of "Health Care Professionals," and schools of chiropractic are also included in the definition of health professional training schools. The commission is tasked with providing comprehensive information to Congress and the Obama administration on how to align federal health-care workforce resources with national needs. Congress will use this information when providing appropriations to discretionary programs or in restructuring other federal funding. The language in the bill guarantees that the need for doctors of chiropractic will be addressed when considering federal health-care workforce programs.
These three provisions were deemed vital to the ACA because they demonstrate a forward movement by the profession. However, as with virtually any legislation emanating from Washington, much of the follow-up work will be completed in the rule-making process wherein federal departments and agencies charged with implementing the "legislative intent" of the bill establish regulations that providers, insurance companies, and even consumers must follow. We have also identified three areas in which chiropractic must remain watchful and continue to press for opportunities:
Developing the Essential Benefits Package
Under the new law, by 2014 states must create insurance exchanges where individuals who don't get insurance through their employer or the government will be able to shop for coverage plans that meet federal standards of "essential benefits." The big question is, "What will these essential benefits contain?" Congress was very careful not to fully define the federal essential benefits because this was an area where health care reform was bogged down and eventually derailed in the mid-'90s. This time around, Congress left the essential benefits question to the Department of Health and Human Services to sort out.
National Health Service Corps Expansion
The National Health Service Corps (NHSC) was deemed a "winner" by many in Washington, D.C., as the new law authorizes increased funding for the NHSC, much of which will go to helping defray student loans in exchange for doctors serving in NHSC community health centers. Aside from a brief demonstration project several years ago, DCs have never fully been able to access this program. However, given the fact that the NHSC is now viewed as a viable health delivery system, especially in medically underserved areas, DCs must be given the same opportunities to serve as other providers.
Repealing the Antitrust Exemption for Insurance Companies
In February, the U.S. House of Representatives passed, in a very unique bipartisan fashion, H.R. 4626, the Health Insurance Industry Fair Competition Act. For many years, insurance and managed care companies have enjoyed an exemption from the application of federal antitrust laws for the "business of insurance." This has led to an uneven playing field between these entities and professional associations that represent doctors.
While groups such as the ACA are subject to strict antitrust scrutiny in areas such as price fixing or communications with members on what insurance companies do or do not deal with, the insurance industry has been free to engage in collective price fixing and other anti-competitive activities, all under the rationale of the "business of insurance" exemption. This bill would remove that exemption and permit the application of the antitrust laws to the anticompetitive activities of these major insurance entities.
In the view of the ACA's Government Relations Department, this could have a far more important impact on the ability of doctors of chiropractic to compete in the health care marketplace than any other measure currently being reviewed by Congress. H.R. 4626 is currently in the Senate awaiting action. This would be a major win for the chiropractic profession if enacted, and we must work to ensure the Senate passes this legislation before it adjourns later this year.
So, while the impact of the health care reform legislation is still uncertain, the bottom line is that we have seen tremendous progress for the chiropractic profession, and there are even more areas in which we can grow if we dedicate ourselves to doing so.
John Falardeau is the ACA senior vice president for public policy and advocacy. He can be contacted at