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background resources in PDF |
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some CAM/IM publication links |
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Beltway Battle Over Patients' Rights to Integrative Medicine and Health |
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Written by John Weeks
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Beltway Battle Over Patients' Rights to Integrative Medicine and Health
This article was first published here in the Huffington Post.
A battle inside Congress and the Executive branch over the right
of patients to choose care from the types of practitioners they prefer
is erupting inside the Beltway.
At stake is the meaning and potential revocation of "non-discrimination in health care," Section 2706 of the Affordable Care Act. The requirement is due to become law in January 2014.
Congress and the Executive, in the form of the US Health and Human
Services, are sparring over congressional intent. Now seven medical
specialties have backed H.R. 2817 to entirely gut the non-discrimination section.
A key dimension to Section 2706 is patient access to covered services
from licensed doctors of chiropractic, practitioners of acupuncture and
Oriental medicine, naturopathic physicians, massage therapists, and to
home births via non-nurse, certified professional midwives.
The potential for medical doctors to offer integrative medicine and
health strategies in which a patient has access to covered services of
licensed integrative health practitioners is also on the line.
U.S. Senator Tom Harkin (D-Iowa), the key sponsor of the non-discrimination section, was urged to include this language by the Integrative Healthcare Policy Consortium (IHPC) and the American Chiropractic Association. Each represents integrative health professions typically red-lined out of appropriate insurance coverage.
Another profession to whose lobbying Harkin and his colleagues were
responsive was the optometrists. These eye-care specialists were
concerned with the exclusionary practices of their competitors, the M.D.
ophthalmologists.
The "non-discrimination" section would help level the playing field in the Affordable Care Act era.
The first touch came as integrative health and medicine activists,
such as IHPC, began witnessing the general disregard of the
non-discrimination clause in much state action to meet the Affordable
Care Act's requirements. (Some of this wariness was captured in this
blog on The Huffington Post: "Non-Discrimination: A 'Big Honking Lawsuit' to Advance Integrative Medicine and Health?")
The Advisory Group on Prevention, Health Promotion, Integrative and Public Health pushed back in their April 5, 2013 annual report to
U.S. Surgeon General and USHHS. They urged the agency to "issue
guidance to states regarding compliance with Section 2706 ... and its
relationship to all plans offered through the states' health insurance
exchanges." They also urged "appropriate use of the health care
workforce as defined in Section 5101 of the ACA."
Notably, Section 5101-National Healthcare Workforce Commission,
specifically includes "licensed complementary and alternative medicine
providers [and] integrative health practitioners" in the U.S. health
care workforce. The inclusion was historic.
On April 29, 2013, USHHS responded. The agency published Affordable Care Act Implementation FAQs -- Set 15.
It doesn't take a legal expert to read this document as a declaration
that the plans and states can use "reasonable medical management
techniques" to essentially blow off the section.
U.S. Senator Harkin and his fellow members of the U.S. Senate
Appropriations Committee, which sets funding levels for HHS, are among
those who found the language disingenuous. They challenged USHHS in a July 11, 2013 committee report.
In it, the committee expressed "concern that the FAQ document issued by
HHS, DOL, and the Department of Treasury on April 29, 2013, advises
insurers that this nondiscrimination provision allows them to exclude
from participation whole categories of providers operating under a state
license or certification."
The report also took USHHS to task for allowing discrimination in
payment rates. They directed the agency to "correct the FAQ to reflect
the law and congressional intent."
The call to re-align action on non-discrimination with congressional
intent stimulated those who favor of continuing discriminatory practices
against all non-M.D. practitioners to go on the offensive. Within
weeks, the seven medical specialties sent their July 23, 2013 letter letter to Congressman Andy Harris (R-Maryland).
They wrote to Harris in support of a bill called the Protect Patient Access to Quality Health Professionals Act of 2013 (H.R. 2817).
The bill's simple purpose is "to remove the non-discrimination
requirements relating to health care providers." The one page missive
from the medical groups hangs their hats on everything from comparative
educational qualifications to states rights.
The cell of pro-discrimination activists includes professional
organizations representing family doctors, ophthalmologists,
dermatologists, anesthesiologist, plastic surgeons, obstetricians and
otolaryngologists.
These organizations' stab to the heart of Section 2706's
revolutionary, inclusive shift in U.S. health policy came as no surprise
to close watchers of the non-discrimination effort. The action, and
Harris' responsiveness, followed a commitment from the American Medical
Association House of Delegates just three months after of the March 2010
passage of the Affordable Care Act. The resolution urged the AMA to "immediately condemn and work to repeal" non-discrimination.
The chiropractic doctors were quick to respond. "The alarm bills
ought to be going on here," states Richard Miller, lobbyist for the
American Chiropractic Association, in this video
regarding the bill and the backers. Their arguments of the medical
specialty associations are "outrageous and disingenuous." He continues:
"It's really a sickening exercise, a knee jerk attack against the
freedom of the people."
Miller continued: "It's hugely significant. I am not sure our members
fully know the value of Section 2706 but I'll tell you who does -- the
AMA and organized medicine." The introduction of 2817, said Miller,
"tells me that they'll fight back in the regulatory arena, in the
legislative arena," everywhere.
One would assume, with a title led by "Protect Patient Access," that
Harris was responsive to pressure from major national patient groups.
Now, picture if you will increasingly informed and Web-empowered modern
patients, who are known to have led, for instance, the movement for
integrative health options, begging to be hand-cuffed and put back into
chains.
I don't think so. The bigger issue is that each of the members who
promote this medical organization reaction are threatened economically.
Despite the title of this blog, the challenge is not mainly about
inclusion of the distinctly licensed so-called "complementary and
alternative medicine" or integrative health practitioners.
The more significant concern to the financial status and cultural
authority of medical doctors is from advanced practice nurse midwives,
nurse anesthetists, primary care nurses, optometrists, and others.
The leaders of these M.D. organizations know that the safety and
effectiveness of the care by independently practicing nurses was
profoundly endorsed by the powerful 2010 study from the Institute of
Medicine of the National Academy of Sciences and the Robert Wood Johnson
Foundation. The title speaks volumes: "The Future of Nursing: Leading Change, Advancing Health."
That 2010 report, published the year in which the Affordable Care Act
was passed, officially ended the era of medical doctor hegemony. The
reaction is against sea-change toward the horizontal, shared authority
represented by the present, federal government-backed movement toward interprofessional education and team care.
Many of their colleagues are affirmatively engaged in such new-era
actions. Notably the medical doctors plus five other professions in the Interprofessional Education Collaborative posts the logo of the Academic Consortium for Complementary and Alternative Health Care as a supporting organization.
All medical doctors are not aligned with this repressive activity.
This is rear-guard activity from a set of leaders from a set of
specialty organizations engaged in the lowest form of guild behavior.
Miller, the lobbyist for the chiropractic doctors, urges renewed
vigilance against efforts to maintain the status quo: "We've gotta
bottle it up. If we don't, this will, for all practical purpose,
legalize discrimination."
The issue is bigger than discrimination. What is at stake is more
significant than patient choice. To follow congressional intent with a
broad, progressive implementation of Section 2706, "Non-Discrimination
in Health Care," will free up the best minds of our time, from whatever
disciplines, to apply the optimal solutions to the horribly costly and wasteful medical outcomes that are the residue of the past century of empowering medical doctors with sole authority of over our health.
It's long past time to give collaboration, inclusion and shared leadership a chance.
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