Current Medicare law limits reimbursement of chiropractic services to manual manipulation of the spine for correction of subluxation. Although the law explicitly requires a diagnostic x-ray before chiropractic treatments can be initiated, the DC is denied reimbursement for the x-ray itself. Medicare patients thus have the choice of paying for a DC's x-rays from their own pockets or going to a medical provider whose x-rays are covered under Medicare; given such a choice, common sense tells us that patients will generally opt for the reimbursed x-rays. In addition, as Senator Daschle pointed out to his colleagues, the "other" provider x-rays are typically far more expensive.
As with the Daschle bill, the House bill seeks to give Medicare patients the choice of less expensive forms of diagnosis and treatment. The physical exam by the DC is a case in point.
The ACA's governmental relations staff began their lobbying efforts in the House in May of this year. Dr. Kenneth Luedtke, the ACA's political action committee chairman, arranged a meeting between his staff and Congressman Moody. A subsequent meeting was held later that month with Congressman Moody's health staff. Richard Miller and Paul Kelly, both ACA governmental affairs officers, and former ACA Chairman of the Board, Dr. Louis Sportelli were present at the second meeting to discuss the specifics of the bill.
Seeking Congressman Moody's support was "part of a long-term strategy aimed at acquiring the best possible House sponsor," said Richard Miller.
Congressman Moody characterizes the bill as a fairness and access to health care issue. "It is unfair to senior citizens that a non-reimbursable x-ray is required prior to the initiation of chiropractic treatment. If Medicare is going to mandate that a service be performed, it is only reasonable that it provide the most convenient means to obtain it. The current policy erects an economic barrier for many Medicare recipients who want access to chiropractic treatment."
Congressman Moody is optimistic of the bill's chances: "I'm hopeful that from my position on the Ways and Means Health Subcommittee I will be able to advance this badly needed legislation."
Although the ACA is delighted with Rep. Moody's sponsorship of the bill, it is clear that passage of the legislation will not be easily accomplished. The major obstacle, according to ACA's Paul Kelly, assistant director of governmental relations, is the congressional budget requirement that any Medicare cost increases must be offset by a tax hike or spending cuts elsewhere in the program.
It will be the job of the Congressional Budget Office (CBO) to determine the projected cost of this Medicare legislation. Cost, as always, is a key factor in determining the passage of a bill. With this in mind, the ACA has provided the CBO with research materials that detail the cost and therapeutic advantages of chiropractic health care.
Steve Kelly
Assistant Editor