- implementing the commissioning of DCs into the military services as provided in the Department of Defense's 1993 Authorization Bill passed by the 102nd Congress last year and signed by George Bush;
- bill H.R.
2092, introduced by Congressman Lane Evans (D-ILL) to expand chiropractic benefits under the Civilian Health and Medical Programs of the Uniformed Services (CHAMPUS) to military dependents and retirees.
Representing the chiropractic profession at the Washington D.C. hearings were: Dr. Jerome McAndrews, the ACA's vice president of Professional Affairs; Dr. John Hofmann, the ICA's chief witness who served in the Marine Corps in Vietnam; R. Jay Wipf, DC, a member of the ACA who served in Operation Desert Storm as a major in the U.S. Air Force Reserve Nurse Corps; and Michael K. Taylor, DC, president of the Joint Chiropractic Associations of Oklahoma.
The subcommittee on Military Forces and Personnel, chaired by Congressman Ike Skelton (D-Missouri), heard testimony of Dr. Hofmann's personal experience of being a DC drafted into the military and having his professional credentials and experience ignored.
Dr. Wipf of Harlingen, Texas, told the subcommittee of the curious experience of being a DC but only being officially recognized as an RN by the U.S. Air Force Reserves (see "We Get Letters" in this issue that explains Dr. Wipf's predicament). "My unique professional qualifications combined in a poignant and highly illuminating fashion during Desert Storm when I was called upon to spend all my available off-duty time providing chiropractic care to military personnel on a request basis," Dr. Wipf told the subcommittee: "My ability to provide chiropractic services was only a modest contribution towards meeting the needs and demand for chiropractic services among active duty military personnel. The full-time services of an additional dozen doctors of chiropractic would not have met the full demand for chiropractic care."
The tight military budget is one reason given by the DOD for not implementing the commissioning of DCs in the military or expanding the CHAMPUS coverage for chiropractic. Dr. McAndrews suggested that integration of chiropractic into the military would create long-term cost efficiencies.
Representing the Department of Defense at the hearing was Rear Admiral Harold M. Koenig, deputy assistant secretary for Health Services Operations at the DOD. Admiral Koenig informed the subcommittee that some regulations under which DCs might receive commissions have already been implemented, but those regulations have yet to be published. He noted that a task force had met to fully develop regulations. The qualifications for commissioning DCs would include:
- Candidates for officer status must be graduates of accredited U.S. chiropractic colleges.
- Candidates for commissioning must have successfully completed the national chiropractic board examination.
- Doctors seeking commission status must be licensed in one of the 50 states or other U.S. jurisdictions.
- Applicants for chiropractic commissions must fully document all of the above criteria.
- Applicants must have one year of experience in an allopathic model of health care delivery.
Dr. Hofmann censured the fifth criterion: "I would urge ICA to vigorously contest the fifth condition requiring a year of experience which is not remotely relevant to providing quality care."
Congressmen Arthur Ravenel Jr. (R-South Carolina) indicated he felt the fifth requirement was intended merely to obstruct the rapid implementation of commissioning DCs.
CHAMPUS Bill
The CHAMPUS bill drew eager support from the panel. The bill mandates the availability of chiropractic care and specifies "appropriate diagnostic activities, examinations, appropriate diagnostic imaging procedures, adjustments, and manipulations of the spine and its articulations and extremities, and appropriate follow up procedures" be made available to all CHAMPUS beneficiaries. Currently only active military personnel are eligible for chiropractic under CHAMPUS.
Congressman Evans told his colleagues that including chiropractic benefits under CHAMPUS for dependents and retirees was long overdue. Virginia Congressman Owen Pickett joined Rep. Evans as the prime sponsor of the CHAMPUS bill.
During the hearing, Admiral Koenig presented the first unofficial results of the CHAMPUS study Congress directed the DOD to conduct in the Defense Authorization Amendments of 1985. The study, which began April 1, 1990 and ended March 31, 1992, is still being in his words "finalized." The two-year, two million dollar pilot study monitored 2,400 patients in Colorado and Washington state who received chiropractic care.
Admiral Koenig reported that although patient satisfaction was reported to be "quite high," the overall cost of chiropractic care appeared to be higher than medical costs for similar conditions. While the per visit cost for chiropractic services was lower than the counterpart medical services, the number of doctor visits was noticeably higher for chiropractic patients.
Several representatives on the subcommittee demonstrated support for chiropractic. Congressman Arthur Ravenel Jr. told the panel that he has witnessed the benefits of chiropractic care on family and friends. Congressman John L. Kyl (R-Arizona) commented that the military could set an example for the rest of the country and national health care reform by giving its personnel the freedom to choose chiropractic care. He said, "... I like the idea of a wider choice, including chiropractic care."
The panel members felt heartened by the chiropractic support from the congressmen.
H.R. 2092 has been referred to the House Armed Services Committee for consideration and action.
"It's time for the DOD to recognize the legitimacy of chiropractic care, said Rep. Evans. "I hope we can now take the next logical step and offer this benefit."
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