Chiropractic News

Chiropractic Summit Legislative Group Offers Initial Analysis of the Patient Protection and Affordable Care Act

April 20, 2010, 1:36 pm

The U.S. House of Representatives voted 219-212 on Sunday, March 21, 2010

in a roll call vote on which every Member present went on record, to approve a

health care reform bill passed by the Senate in December. The bill, H.R. 3590

was passed after only two hours of debate, passing with no Republican

support. On Tuesday, March 23, 2010, President Obama signed H.R. 3590, the

Patient Protection and Affordable Care Act into law. Many DCs are wondering

how this bill will impact the chiropractic profession. The Summit has examined

the bill and reports that DCs can look to the following provisions to advance the

cause of the chiropractic profession.

With final Congressional action and the President’s signature in place on

national health care reform legislation, a health care overhaul is now an

accomplished fact. The House passed the Senate-enacted language (H.R.

3590) intact, with chiropractic’s status in the reform package anchored in a

number of remarkable achievements in terms of legislative language. In fact,

chiropractic has done far better in securing specific goals than anyone might

have expected. This has been the product of the unique level of mobilization

and cooperation within the profession through the Chiropractic Summit, along

with the support of many key Members of Congress.

The final version of reform legislation contains the all-important nondiscrimination

language championed throughout the entire process by Senator

Tom Harkin (D-IA) who has consistently sought to promote language that would

prevent discrimination against any provider including doctors of chiropractic, by

insurance plans, solely on the basis of their license.

Non-discrimination in health care; H.R. 3590, Sec. 2706:

No health plan or insurer may discriminate against any health provider acting

within the scope of that provider’s license or certification under applicable State

law. This will ensure that insurance companies cannot unfairly exclude some

doctors of chiropractic from practicing under the capacity of their training and

licensure on a federal level. Provision is a federal protection applicable to

ERISA and other plans established or regulated under the bill. Just as HIPAA

protections now apply across the board, the non-discrimination provision will be

applicable to all health benefit plans both insured and self-insured. With

national healthcare reform designed to eventually cover 30 million uninsured

Americans, the non-discrimination provision, will, over time, apply to those

individuals. However, that number pales in comparison to the approximately

55% of workers currently covered by self-insured plans that will be affected by

Sec. 2706. The potential impact in this regard cannot be overstated.

Community Health Teams; H.R. 3590, Sec. 3502:

DCs named as potential members of Community Health Teams to support the

development of “medical homes.” These teams support the development of

medical homes by increasing access to comprehensive, community based,

coordinated care. Community Health Teams are integrated teams of providers

including primary care providers, specialists, other clinicians and licensed

integrative health professionals as well as community resources to enhance

patient care, wellness, and lifestyle improvements. The language in the bill

ensures that doctors of chiropractic can be included in these patient-centered

and holistic teams.

National Health Care Workforce Commission; H. R. 3590, Sec. 5101: DCs

are specifically included as part of the National Health Care Workforce

Commission defined as “Health Care Professionals” and schools of chiropractic

are also included in the health professional training schools definition. The

Commission is tasked with providing comprehensive information to Congress

and the Administration about how to align federal health care workforce

resources with national needs. Congress will use this information when

providing appropriations to discretionary programs or in restructuring other

federal funding. The language in the bill guarantees that the need for doctors of

chiropractic will be addressed when considering federal health care workforce

programs.

The Impact of the New Law on Your Practice and Your Family

The basic outlines of the national health care reform program contained I the

two legislative packages representing the final legislation are being carefully

studied by the Summit Legislative Working Group. In addition to the exact

legislative language contained in those two bills, the implications for small

business and families will depend on when and how the various sections of the

new law are implemented. The exact details will take some time to emerge as

formal regulations and implementation rules and procedures now have to be

drafted and passed through a formal rule making process overseen by the

federal agency responsible for the administration or enforcement of a particular

provision. The full final implementation of all provisions is not scheduled to be

complete until 2014. What can be discerned from the statutory language at this

point indicates a number of key benefits and costs likely to impact most

chiropractic practices and all individuals and families in the nation.

· Health insurance must be available to all, renewable for all, and rate

differences, such as for age, are limited.

· Starting this year, insurers will be prohibited from placing lifetime dollar

limits on policies and denying coverage to children because of preexisting

conditions.

· Also starting this year, in September, parents will be able to keep

children on their coverage up to age 26.

· Insurers may not arbitrarily cancel policies for risk and cost-containment

or other self-serving reasons. Under the new health law, (Section 2712)

health insurers are barred from retroactively cancelling coverage after a

patient gets sick, a practice known as “rescission,” unless the patient

committed fraud or made an intentional misrepresentation of a material

fact as “prohibited by the terms of the plan or coverage.”

· Insurers must publicly justify “excessive” rate increases, and federal

grants would encourage states to require full “prior approval” of such

increases. Section 2794 of the law provides that: (1) The Secretary of

Health and Human Services, in conjunction with the states, shall require

health insurance companies to justify unreasonable premium increases

prior to implementing them. Insurers are required to post the

justifications on their websites.

· Almost everyone will be required to be insured or else pay a fine, which

takes effect in 2014. The new law states: “SEC. 5000A.

REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL COVERAGE.

(a) REQUIREMENT TO MAINTAIN MINIMUM ESSENTIAL

COVERAGE.—an applicable individual shall for each month beginning

after 2013 ensure that the individual, and any dependent of the

individual who is an applicable individual, is covered under minimum

essential coverage for such month.

· There are both exemptions and subsidies for low-income people. Aid is

available on a sliding scale for households making up to four times the

federal poverty level, $88,200 for a family of four. Premiums for a family

of four making $44,000 will be capped at around 6 percent of income.

· The bills aim to make health insurance more affordable for small

businesses by creating more competition among plans through statebased

insurance exchanges. No later than 2014, states will have to

establish and have in full operation Small Business Health Options

Programs or “SHOP Exchanges,” where it is intended to offer small

business access to the kind of choices and discounts available to largescale

purchasers of health insurance.

· Effective in September of this year, small businesses with fewer than 25

employees and average wages under $50,000 will be eligible for tax

credits to pay up to 35 percent of their insurance costs.

· Companies with 25 or fewer employees may qualify for a tax credit

starting this year, as provided in Section 1421 of the law. The amount of

the credit will vary depending on the size of the company, and

employers must pay at least 50 percent of premium costs in 2014.

· Self-employed people will be able to buy coverage through the

exchanges, too, but will not qualify for the employer tax credit.

The new legislation also imposes new taxes. Individuals who make more than

$200,000 ($250,000 for married couples), which includes many professionals and

small business owners will have to pay higher Medicare payroll taxes. This also applies

the tax to unearned income, such as dividends and interest. The legislation also

imposes a 40 percent tax on high-cost insurance plans worth more than $10,200 in

premium payments annually for individuals and $27,500 for families. That new tax

would go into effect in 2018. The bill imposes new taxes on pharmaceutical companies

and medical device makers, costs which most analysis will be passed on to insurance

consumer.

The new law establishes penalties for companies with more than 50 employees if they

do not offer health insurance of if they do not offer affordable insurance and an

employee uses a federal subsidy to buy insurance individually. The penalty could be as

much as $2,000 for every employee after the first 30. Few chiropractic practices will be

impacted by the large employer requirements, however, but many companies serving

the chiropractic profession and all chiropractic colleges will be affected by these

provisions.

Source: Public Law 111-118; www.speaker.gov

In the coming weeks and months, the Summit Legislative Working Group urges all

doctors of chiropractic to keep in touch with their state and national chiropractic

organizations for objective information on the implementation procedures issued by the

various federal agencies for health care reform programs and initiatives. Caution is

also urged in dealing with individuals or companies offering to “certify” or otherwise

position individuals or companies as eligible for any health reform benefits and to deal

directly with the federal agencies, tax and accounting experts and through established,

recognized chiropractic professional organizations to avoid being taken advantage

The now-concluded massive national health care reform undertaking has stimulated an

historic common effort by the organizations of the chiropractic profession. Through this

effort, the chiropractic profession has developed an agreed set of goals, prepared

detailed and sophisticated educational materials for policy makers and has carefully

coordinated its lobbying efforts on a scale and at a level that has never before been

achieved. We urge all organizations and individual DCs to be familiar with and to utilize

the materials prepared by the Summit, including the landmark white paper The Path to

Change in the US Health Care System: the Chiropractic Perspective and it’s equally as

impressive Cost Effectiveness Supplement companion paper. These documents are

still highly relevant to any debate on chiropractic in any state, provincial, national or

third-party process. Copies of these documents are available from the Congress of

Chiropractic State Associations (COCSA), The American Chiropractic Association, and

The International Chiropractors Association.

 

Dr. Rob Hasse

701-282-2919 ph

701-282-2932 fax

rhasse@ndca.net

 

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