When the Medicaid budget came up with a shortfall of $18 million in Iowa, officials proposed one of their favorite solutions: eliminate coverage for chiropractic care. They've tried to delete this coverage on several past occasions, so it was no surprise that the same remedy emerged when financial problems popped up once again.

Medicaid, a state program supplemented with federal funds, is administered in a variety of ways in states across the nation. Chiropractic coverage is not mandated by the federal government the way it is in Medicare, even though federal funds are involved. Medicaid's function is to cover medically needy individuals, especially mothers and young children. It also provides funding for nursing home residents who lack other resources.

In Iowa, it covers chiropractic care under rules similar to Medicare, covering manipulation only, and usually under managed care rules, meaning that the number of visits are controlled. Medicaid also covers Medicare co-pays and deductibles for eligible recipients. X-rays may be covered under the managed care program for patients under contract.

Figures released by the state of Iowa show that chiropractic treatment accounts for just one percent of the Medicaid program's medical expenditures. Yet, the first proposal from the Iowa Department of Human Services (DHS) was to eliminate some of the smaller professions from coverage: chiropractic, podiatry and optometry, as well as adult dental services. This, of course, at a time when the number of people without medical coverage in Iowa is increasing markedly due to job losses from the poor economy. In fact, we haven't seen a good economy in this state since they stopped running the stage coaches through here.

As Director of Insurance Relations for the World Chiropractic Alliance (WCA), I contacted several state legislators concerning the proposed elimination of chiropractic services. The issue was brought to my attention by a number of chiropractors in my area, including Dr. Sid Carter of Burlington who has been in constant contact with other Iowa state legislators.

I recently interviewed Larry Carl of the Iowa Chiropractic Society (ICS) about its role in this matter. He informed me that the ICS had approached the problem on several levels.

First, the organization met with officials of Iowa DHS about the proposed budget cuts, noting that chiropractic was cost-effective and had provided services that should be considered alternative. In other words, patients choose chiropractic care as an alternative to medical care. If chiropractic were to be eliminated from the program, there would be no net savings, in that patients would seek medical care, which would probably be more expensive.

Mr. Carl encouraged me to call Dr. Terry Burk, the ICS Medicaid chairman, who noted that ICS had also worked with the optometric and podiatric professions to form a coalition to preserve services for the three professions. In essence, they had agreed to work together, making it more difficult to single out one of the groups for service cuts.

With final action on the budget being in the legislature, ICS also worked with a number of legislators to find other approaches to the budget shortfall and maintain chiropractic's place in the program.

The end result, reported in the Des Moines Register, is a proposal by DHS to institute a 13.2% cut across the board for all medical services, with no professions eliminated from coverage. This was an alternative to either the elimination of selected services (read chiropractic), or removal of 4,000 medically needy people from Medicaid.

There was concern that some doctors might choose to reject handling the state's 230,000 Medicaid patients, since the 13.2% cut was in addition to a 3% cut that began in 2001. Final approval will be handled by the legislature. ICS has informed me that it is continuing pressure on DHS to find other ways to reduce the budget cuts, although the present bill is not the worst possible scenario.

Most doctors in Iowa, especially chiropractors, have been handling Medicaid patients for marked discounts for a long time. In fact, increases in Medicaid fees for Iowa chiropractors only arrived about a year ago, and were the first in many years. In other words, if you think Medicare payments are paltry, check out this program.

On the other hand, chiropractors in Iowa have fought for the right to maintain their patients every time this issue has appeared. Plus, elimination from Medicaid coverage would send a bad message to other carriers.

The newest development is an announcement by the DHS that the planned cuts will not be effected until the end of the legislative session in April. Obviously, the legislature is still searching for answers to the budget shortfall. For the moment, chiropractic is still included for coverage under Iowa Medicaid.

I am creating a data base for the WCA, for chiropractic coverage in the various states, so I will be calling offices and associations around the country for information. In this way, the WCA can get a better handle on the needs of local chiropractors in cases like the one in Iowa.

By the time you read this, it will be spring. Spring in most of America is the time for renewal and the start of the growing season. In Iowa, it's when the blizzards stop and we can chop our friends out of the ice. It's when the roads open and we can see places we've dreamed about all winter (like Minnesota or Missouri). For me, it's the start of baseball season.

Now I can begin making trips to Chicago to watch White Sox games. The White Sox haven't been to the World Series since 1959, but that doesn't bother diehard fans like me who consider hot dogs the epitome of culture. During the season, I usually make the round trip drive to Chicago about twice a month – more than 400 miles.

For those not familiar with Chicago, there are two baseball teams, the Cubs and the White Sox – and an imaginary dividing line at Madison Street, with Sox fans on the south side, and Cub fans quarantined north of there (you can already tell I'm not a Cubs fan). While some fans mix in on both sides of town, that pretty well gives the demarcation.

The most exciting time for me was last year when I attended the city series, when the Cubs went to Comiskey Park on the south side for interleague play.

The series also includes games at Wrigley Field, the Cubs' home park, which has all the savoir faire of a soup kitchen. In spite of all the hype about Wrigley on television, it's decrepit and the seats look like they were bought on eBay. The media may portray the place as hallowed ground, but Bin Laden's caves are cleaner and have better lighting.

Note that Sox and Cub fans don't like each other, enjoying a relationship similar to that between chiropractic and the AMA. Sox fans, it should be noted, are convinced that the serpent actually offered Eve bleacher tickets to a Cubs game instead of an apple.

I caught the subway to the game on State Street. The cars were filled with fans coming from the north side. It reminded me of the bullet train in Japan, where the trains are so full that station masters push passengers in tightly so the doors can close. In this case, they were all wearing Sox and Cubs caps and pushed in face-to-face while screaming and pointing large foam fingers at each other.

At the ballpark, the fans were mixed indiscriminately, similar to mixing the cats into the dog cages at the humane society. It was interesting nonetheless. A series of fights broke out in the stands as the fans continued to scream – a number of them drunk and staggering around (probably from north of Madison). Ultimately, the Sox won on a home run in the 10th inning, with fans jumping the wall onto the field and giving high fives and hugging strangers (those wearing the right ball caps).

The trip back was just as interesting, with more

pushing, yelling and impromptu bands appearing around the park. All in all, an atmosphere that regressed Chicago's south side back to the Pleistocene era.

Note: I've already bought my tickets for the 2002 series.