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Coalition Kills S.1955, Saves Hard-won CAM-IM and Other State Insurance Mandates PDF Print E-mail
Written by John Weeks   

Allied Health/CAM-IM Coalition Kills S.1955, Saves Hard-won State Insurance Mandates

Chiro colleges lobbyist and executive director David O'Bryon, JD
On May 11, US Senate Democrats, following the wishes of a broad coalition, put an end to a push in the US Congress which could have terminated a significant coverage for CAM services in the United States. The bill was S. 1955, the Health Insurance Marketplace Modernization and Affordability Act. In an bill aimed at lowering the cost of health care for small businesses, the Act would have allowed certain employer groups to disregard state legislated insurance coverage mandates.

Image "This was a huge coalition," states David O'Bryon, executive director and lobbyist for the Association of Chiropractic Colleges: "All the providers that have any mandated benefits or benefits from freedom of choice laws were there." (Freedom of choice laws typically state that if a service is offered in a plan, the beneficiary can receive that
Some Associations
Working to Preserve
Hard-Won State
Insurance Mandates by
Opposing S 1955:

Missing in Action: The AMA

American Academy
of Physicians Assistants
American Association for
Marriage and Family Therapy
American Cancer Society 
American Chiropractic Association
American Diabetics Association
American Nurses Association
American Optometric Association
Americn Pediatric Society
American Podiatric Medical Association
American Psychological Association
Association of Chiropractic Colleges
National Association of State
Attorneys General
Washington Association
of Naturopathic Physicians
plus scores more

Note: This list is not inclusive
of all associations.

service from their choice of any provider whose licensed scope includes that service.) Among the professions most forceful in the campaign against S.1955, besides the chiropractors, whose effort was led by the American Chiropractic Association, were the psychologists, according to O'Bryon. The coalition also includeed the AFL-CIO, AARP, the American Cancer Society (ACS), the American Dietetics Association (ADA) and the American Nurses Association (ANA). The concern of the  ACS was for maintaining mandated coverage of mammograms and other cancer screenings, of the ADA for mandates related to education and supplies, and of the ANA for protecting Advanced Practice Registered Nurses (APRN). The members all speak of hard-won advances for consumers.

The coup de grace, O'Bryon notes, was delivered by the National Association of State Attorneys General. He explains their interest: "Basically they were saying that states have been developing these laws for years and years. They were saying that (S. 1955) is trampling on states rights here." When Republican US Senator Bill Frist, MD brought up the vote for action, the Democrats, with some Republican cross-over, killed the bill on a procedural issue. O'Bryon adds: "This was a big vote in recognition of the role of the states in providing a safety net for consumers."
Ironically, the finally parry was thrust in the name of state's rights, historically associated with Reublican thinking.


"Basically the state
were saying that

S. 1955 is trampling
on states rights."

-David O'Bryon, JD
The ACA, whose members and their patients benefit from some kind of insurance mandate in 46 states, put S. 1955 front and center of their political work in early March. The ACA campaign, described on their website, included letters to governors, "action kits" to members and a major call, phone and email campaign. John Falardeau, an ACA spokesperson, told O'Bryon that at least 20,000 letters, emails or calls were generated through these efforts. On the critical, largely party-line vote, which needed 60% to hold off a threatened filibuster from Democrats, the Republicans failed 55-43, with 2 not voting.

O'Bryon was not aware of a significant level of activity from other CAM groups, admitting that he could easily have missed the actions of some coalition members: "Other CAM fields are normally not big players in all this. I didn't see them, but they might have been there." IBN&R is aware that the Washington Association of Naturopathic Physicians, whose members enjoy inclusion in insurance through the State's "every category of provider" legislation, is among the other CAM organizations which urged members to write letters, and get their patients to write letters, against the bill.

ACA President Richard Brassard, DC
The ACA, whose House of Delegates declared a "state of emergency" to stimulate their profession to action, has "breathed a sigh of relief," according to ACA president Richard Brassard, DC, who also serves as president of Texas Chiropractic College. Brassard, in an ACA release, urged members to remain vigilant, stating that a similar bill may yet turn up elsewhere.

"Mandate" is to politics as "compliance" is to clinical work. Both have an onerous charge in them. Targets of each do not respond well to the heavy-handedness. Wouldn't it be better if a person or institution voluntarily chose a course? Such as covering chiropractic for low back pain, as the AHCPR effectively recommended in the

Mandate may be a
word to some.
But so
were the 8-hour  
day, social security,
public health,
suffrage, worker safety
a host of other
social policies.

Given the AMA's strangle
holds, mandates
the way many in health
care are forced to
social - and
scientific - justice.

early 1990s? Or primary care services provided by APRNs? Yet US insurers have been anything but "compliant" when it comes to honoring either patient choice, or a good deal of scientific literature, by empowering them to have what they want in their benefit plans.

Opposition to S 1955 was not a CAM-IM issue, per se. That is evident from the breadth of the coalition.
These parties each have the experience of having to go to their state legislatures to gain coverage of something payers did not include. What one sees is basically every so-called "allied health" organization.

However, there is an absence on the list of the scores of S 1955 antagonists which is revealing: that to which these groups are purportedly "allied." With the exception of two pediatric organizations (representing, interestingly, the least well-paid of conventional MDs), the list is not graced by the name of the American Medical Association or any of its state or specialty societies. Not surprisingly: t
he battles for mandate or "freedom of choice" is a battle that is typically pitched against insurers and the AMA's control of healthcare purse springs. The AMA, behind the easy insurer target, is a wolf in wolf's clothing.
Mandate may be a dirty word to some. But so were the 8-hour work day, social security, basic public health, women's suffrage, and a host of other good social policy. Mandates are forced integration. They remain a necessary strategy for consumers and practitioners whose contributions are denied or under-utilized by a system leadership which can live in denial of killing 225,000+ a year while continuing to disrespect the services of hundreds of thousands who would like to have the chance to be better "allied" in creating health.

Firing the antagonism to S 1955 is that we don't actually know whether the global costs of health to an employer - including medical costs and functionality, presenteeism, absenteeism, etc. - would actually go up, or down, if all the mandates were removed.

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