August 2003

see also: Two paths to Medicare reform

ACA Medicare bill draws criticism from Washington Post, White House

The inclusion of the chiropractic demonstration project in the Medicare prescription drug bill ‑‑ a provision written by and supported by the American Chiropractic Association (ACA) ‑‑ has drawn fire from politicians and the Capitol press.

In an article for The Washington Post, staff writer Dan Morgan (July 14, 2003; Page A01) noted: "Tucked into the small print of the 1,043‑page Senate version, for example, is a 'demonstration project' allowing selected chiropractors to bill Medicare for many services not now covered." He lumped the provision in with other tacked‑on amendments that "would benefit marriage counselors, the weight‑management industry, rural ambulance services, Hawaii's Medicaid program and doctors in Alaska."

According to the article, the ACA provision has also been the target of criticism from the Oval Office. "The White House budget office has criticized 'provisions that would increase the cost of the program and that are unrelated to strengthening and improving Medicare.' It cited an expansion of payments to teaching hospitals that train clinical psychologists and the Senate bill's chiropractor demonstration project," Morgan stated.

The common perception is that the chiropractic provision was one of a slew of amendments added on at the last minute ‑‑ amendments which ultimately may help doom the bill to failure. The Washington Post article reflected this assessment when it noted that there was a "stampede by lawmakers to add unrelated provisions to the bill."

Morgan added that, "the legislation proved to be an irresistible target for an army of health care lobbyists lured by the first major Medicare bill to move through Congress in three years. Proposed changes in the basic Medicare program now consume about 200 pages in the Senate bill, one‑fifth of the total. Preliminary estimates suggest the special provisions will add tens of billions of dollars to the legislation's cost..."

A preliminary estimate of the Congressional Budget Office put the cost of the bill, should it pass, at about $500 million during the next two years. The escalating figure is particularly troublesome in light of the July prediction by the Congressional Budget Office that the U.S. deficit will soar to $455 billion.

"If the bill fails, many people will blame the chiropractic provision and other amendments like it," said Terry A. Rondberg, D.C., World Chiropractic Alliance President. "That's one reason the WCA, along with the International Chiropractors Association and Federation of Straight Chiropractors and Organizations, is working to support HR 2560, the 'Chiropractic Medicare Freedom Bill.'

"We think it will have a much better chance of passing since we can show that it will not mean additional costs to American taxpayers," Dr. Rondberg explained. "It will add value to the Medicare system, and position the chiropractic profession as health care heroes."

The bill will have to go through a negotiation process called a House‑Senate conference, which could take as little as two months but will probably last much longer according to most experts, possibly stretching well into 2004. Health care lobbyists have already begun working on legislators, trying to convince them to cut certain provisions and support others.