When the Affordable Care Act passed, the Obama administration originally planned to define a set of essential benefits nationwide, to be offered in individual and small-group policies that will be available through health insurance exchanges starting in 2014. Acupuncturists mounted a national campaign supporting acupuncture as an essential benefit. The American Association of Acupuncture and Oriental Medicine (AAAOM) partnered with many other organizations throughout the country. Practitioners, schools, students, and a wide variety of people who value acupuncture sent letters to the Department of Health and Human Services (HHS) describing its benefits.
"I spoke at continuing education courses and membership meetings," says Jeannie Kang, LAc, immediate past president of AAAOM. "In California of course there are a substantial number of people from Asian backgrounds, who have a cultural familiarity and interest in acupuncture. That meant we needed to develop educational materials about essential benefits in several languages. For about 10 months, I spoke at a different meeting every week."
Kang calls Congresswoman Judy Chu "the heroine in this picture." Chu set up face-to-face meetings that included Oriental medicine professionals, her staff, and Herb Schultz, regional director for HHS's West Coast region, which includes Arizona, California, Hawaii, and Nevada.
"She chaired one meeting in San Francisco and another in L.A." Kang recalls. "I represented AAAOM and gave a 15-minute presentation on improved health, increased quality of life, and lower health-care costs associated with acupuncture. I don't think they had ever heard that research previously."
AAAOM and its partners submitted 27,000 letters detailing the life-changing effects of acupuncture to HHS in support of including acupuncture as an essential health benefit. At about this point, to increase flexibility within the new health-care law, HHS decided to allow each state to choose its own guaranteed benefits (instead of having the same benefit package throughout the country.) Every state must include coverage for 10 broad categories of care, such as emergency services, maternity and newborn care, hospitalization, preventive care, and prescription drugs. However, there is room for variation within those categories; coverage for specific services and medications will vary significantly by state.
"We digitized the letters, so we were able to share the database with any state that wanted to work on the issue," Kang says. "We also developed a position statement and white paper that was made available to many other organizations."
At present, five states (Alaska, California, Maryland, New Mexico, and Washington) have decided to provide coverage for acupuncture for specific conditions. Illinois and New Hampshire have decided to offer coverage, but only under certain health plans. "While we're delighted with the progress we've seen to date, we still have a long way to go to ensure our citizens have access to high quality health-care options," says Michael Jabbour, MS, LAc, current AAAOM president, and immediate past president of the Acupuncture Society of New York (ASNY). "We are confident these advances will have a snowball effect and the number of states covering acupuncture will grow over the coming years."
The situation in New York is an anomaly. New York has a substantial number of acupuncture professionals and patients, but the state decided not to cover acupuncture, even though acupuncture was included by either coverage or rider in all the state-reviewed plans. "The state acknowledges the error in their data." Jabbour says. He encourages Townsend Letter readers who live in New York to check the ASNY website for updates and directions on how to contact their state officials about the importance of including acupuncture.
AAAOM has drafted proposed legislation to be introduced in Congress that would include coverage for acupuncture in federally funded health-care programs such as Medicare. "This legislation has the potential to advance the much-needed integration of acupuncture within mainstream health-care settings," says Jabbour. "When we are successful, tens of millions of people will be able to access this essential service."
Chiropractic Profession Prepares for Long-term Efforts
Right now, the vast majority of the states that are developing their own health insurance exchanges have decided to include chiropractic coverage, according to Gerard Clum, DC, who served as president of Life Chiropractic College West for over 30 years, and is now a member of the board of the Foundation for Chiropractic Progress. "As we look across the country, the states have used varying strategies for chiropractic services," he says. "Some have set a cap on the number of visits per year, some have set dollar caps. Some are generous and broad, while others are rather restrictive."
The most significant concern for chiropractors now is that California has adopted as its benchmark plan a Kaiser Permanente plan that does not include chiropractic coverage, and that has become its baseline for essential benefits. California is the most populous state, and Clum estimates that 20% to 25% of the US chiropractic profession practices in California, so it is strange to think that this state will not include chiropractic. "While many states have determined essential benefits by policy or by recommendation from the insurance commissioner, California is one of the states where essential benefits were defined by the state legislature. This is a matter of concern, because it is obviously more difficult to change a decision at that level," he says.
At the same time, the chiropractic community expects to continue working on this issue."This subject is not over and done," Clum says. "This is an ongoing issue that we think will be supported by consumer demand. When people realize what is and is not in the benefits package, we think there will be a growing impetus for change."
In addition, Clum and other chiropractic practitioners are awaiting guidance from HHS to the states on what should be included in essential benefits. "We think and hope that HHS guidance will take issue with a plan that does not include chiropractic, when the majority of the states have included it, and particularly looking at a state where chiropractic is so much a part of the fabric of health care as it is in California."
Clum believes that the most important thing is for people who care about these issues to become more engaged in the process. "Many people don't understand all the details, and they need to seek out information. Not just seek it out but actually mine for it. Just read everything you can about this, and look especially for sources that don't have a political axe to grind."
He emphasizes that we need to look at this as a long-term process. "One of the great hallmarks of the Affordable Care Act is a transition away from a focus on acute care medicine, to changing lifestyles to support a healthier population. Conventional medicine does a wonderful job in many, many areas, but when it comes to the basics of diet, nutrition, motion, and activity, it doesn't do so well," Clum says. "We need to look at the full impact of our health-care decisions, and what they mean to the life and health and productivity of the patient over time. In this environment, we believe the CAM disciplines, and particularly chiropractic, are well positioned to contribute greatly to the system."
Foundation for Chiropractic Progress: www.f4cp.com.
Visit AAAOM at www.aaaomonline.org for updated information, including a state-by-state analysis on essential health benefits. Follow AAAOM on Facebook for announcements on proposed national legislation. For more information regarding participation in state and federal initiatives, contact Denise Graham, AAAOM's executive director, at firstname.lastname@example.org.
AAAOM Position Statement in Support of the Designation of Acupuncture Services as an Essential Health Benefit: www.aaaomonline.org/resource/resmgr/EHB/AAAOM_EHB_Position_Paper-FIN.pdf.
The Integrative Healthcare Policy Consortium (IHPC) has set up an action network to alert people to new developments related to integrative health care. To sign up for e-mail alerts, go to http://capwiz.com/ihpc/mlm/signup.
Elaine Zablocki has been a freelance health-care journalist for more than 20 years. She was the editor of Alternative Medicine Business News and CHRF News Files. She writes regularly for many health-care publications.