Senate Majority Health Reform Draft Offers Important Chiropractic Protections- 
 Bitter Debate Now Underway on Senate Floor

The Majority Leader of the US Senate, Sen. Harry Reid (D-NV) has at last presented a working Senate version of health care reform legislation and an already bitter debate on its wide-ranging provisions is now underway.  That debate started after the Senate held a vote November 21st on the motion to proceed to the bill currently before the Senate, the Patient Protection and Affordable Care Act.  While heralded as a victory for the majority Democrats, all this motion does is signal the start of debate.  According to Nebraska Democrat Senator Ben Nelson, “The Senate owes Americans a full and open debate to try to improve our health care system,” and all he has personally voted to support is to have debate on the bill begin.  The acid test will be how they fare on a motion to close off debate (cloture) which is likely to be much harder to gather the 60 votes needed.

The exact outcome of this debate remains to be seen as the Senate considers such controversial issues as the inclusion of a so-called “public option” under which the federal government will actually become an insurance provider, as well as the exact status of abortion coverage and access to any new plans for illegal immigrants. 

The chiropractic profession has, through the determined efforts of The Chiropractic Summit and the more than 40 independent organizations that comprise its membership, including the ICA, secured an impressive number of legislative gains in the Senate version of health reform.  Chief among the provisions in the current Senate draft is a major non-discrimination section that has been supported with great effectiveness and determination by Senator Tom Harkin (D-IA) and other chiropractic allies including Connecticut Democrat Chris Dodd.    That provision, Section 2076, reads as follows:

SEC. 2706. NON-DISCRIMINATION IN HEALTH CARE. 
‘(a) PROVIDERS.—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.

Chiropractic is also specified in a key set of definitions as to the health care work force in Section 5101(i):

(1) HEALTH CARE WORKFORCE.—The term ‘‘health care workforce’’ includes all health care providers with direct patient care and support responsibilities, such as physicians, nurses, nurse practitioners, primary care providers, preventive medicine physicians, optometrists, ophthalmologists, physician assistants, pharmacists, dentists, dental hygienists, and other oral healthcare professionals, allied health professionals, doctors of chiropractic,…”

The Senate bill also includes doctors of chiropractic in the list of potential members of interdisciplinary community health teams established in Section 3502 of the bill. These patient-centered teams would support the development of “medical homes” which is a term that has evolved during the current health reform debate to mean something like an HMO in order to provide better access to comprehensive, community based, coordinated care.   The language in that section, which specifically includes doctors of chiropractic, reads as follows:

(b) ELIGIBLE ENTITIES.—To be eligible to receive a grant or contract under subsection (a), an entity shall…ensure that the health team established by the entity includes an interdisciplinary, interprofessional team of health care providers, as determinedby the Secretary; such team may include medical specialists, nurses, pharmacists, nutritionists, dieticians, social workers, behavioral and mental health providers (including substance use disorder prevention and treatment providers), doctors of chiropractic, licensed complementary and alternative medicine practitioners, and physicians’ assistants;

Section 5101 of the Senate bill also will create a National Health Care Workforce Commission to study current and future needs in the health care workforce. The Commission specifically includes doctors of chiropractic by defining them as part of the health care workforce, and including them in the definition of health professionals. Chiropractic educational institutions are included in the health professional training schools to be reviewed.  The Commission will be charged with objectively studying the nation’s health care personnel needs and recommending steps to make sure that there are appropriate numbers of trained professionals to meet national needs and demands in the decades ahead.  This Commission is an entity which ICA will encourage The Chiropractic Summit to collectively seek specific chiropractic representation on, if this provision survives the Senate floor and House-Senate conference process.  

Of concern to the ICA and a high priority for the Chiropractic Summit is the absence of any specific non-discrimination language in the House-passed version of reform legislation, HR 3962.  The fact that it is in the Senate version, unless amended out on the Senate floor, means that chiropractic will need to work to make sure that this, along with all other chiro-friendly sections, survive not just the floor debate but the all-important conference process between House and Senate leaders.

Also good news on the House side is the presence of legislative language designed to protect the applicability of state-enacted provider non-discrimination laws.

ICA is in daily contact with federal legislators and their staff to promote the interests of chiropractors and chiropractic patients, including the right under any new law to fully “opt out” and not participate in any federally established or recognized third-party insurance system.