As you may know, on March 31, the ChiroCode Institute issued an advisory that S.1955 was not a bad bill for the chiropractic profession. This opinion contradicted the views of most health insurance market observers, including ACA, that S.1955 would preempt state mandate requirements, allowing health plans to market plans without chiropractic benefits.

ChiroCode’s initial opinion was derived through analysis of the bill as introduced by Senator Mike Enzi (R-WY) in November. However, Sen. Enzi and the Health, Education, Labor and Pensions Committee significantly changed the bill during committee hearings, and the resulting bill language, issued on March 3, is dramatically different than the text reviewed by ChiroCode.

After this error was brought to their attention, ChiroCode reviewed the new language, but reached the same conclusion; that S.1955 is actually a good bill for chiropractic because (they claim) it improves on ERISA law and because state insurance commissioners remain the final authority on benefit mandates.

ACA strongly disagrees with this assessment; we feel that this is a misinterpretation of the bill’s language and intent. ChiroCode cites analysis of three distinct AHP bills, including S.1955 prepared by the Congressional Research Service (CRS). Without engaging in a point-by-point refutation of their references, we believe that ChiroCode selected only those passages that could be interpreted in a manner supportive of their position. If, as they suggest, one reads the CRS report in its entirety, one will find the following:

“SBHP’s (small business health plans) would be allowed to offer a basic benefit plan that would be exempt from all states’ benefits requirements as long as the SBHP also offers an enhanced benefit option to participating employers. The enhanced benefit options must include at least those covered benefits, services and categories of providers as are covered by a state employee health benefit plan in one of the five most populous states (CA, TX, NY, FL, IL). The bill provides the SBHPs with the “sole discretion” to determine benefit plans….

“States’ laws in other the areas would be retained so long as they do not interfere with the plans’ “sole discretion” to determine the benefits provided. Those retained states’ laws could include consumer protections, grievance and appeals procedures, premium taxation, prohibitions on discrimination, fair marketing practices and solvency and funding standards.”

-- CRS Report, page 7

As stated above by CRS, a carrier can preempt any or all state mandates, provided it also markets a plan that offers access to the same benefits, services and providers as those included on one of the five most populous states. But nothing requires employers to offer that plan to its employees. Just as General Motors markets both the Chevrolet Aveo and the Cadillac Escalade, a carrier can market a basic plan and an enhanced plan, but unless an SBHP chooses to make both options available to its members, access to chiropractic or other forms of care included by mandate will be very limited.

ChiroCode’s most recent message also suggests that “If a bill could be amended to insure continued chiropractic benefits, all should labor to achieve that end.” ACA would agree in theory, but this is not a practical response to S.1955. A bill that would eliminate ALL mandates, including requirements for prenatal care, mental health coverage or other, more widely utilized and highly perceived state-mandated benefits, will not accept an amendment to explicitly include chiropractic. It’s just not logical. Other bills may be possible vehicles for pro-chiropractic amendments, but not S.1955. There’s just one acceptable outcome – defeat.

It is for these reasons that the ACA, along with hundreds of other provider, consumer and regulatory groups, have dedicated themselves to opposing S.1955. It is also why the Congress of Chiropractic State Associations (COCSA) Executive Committee voted to reject ChiroCode’s interpretation of S.1955 and to work for its defeat.

I regret that ChiroCode has adopted this position on S.1955; we would benefit from their energy and assistance in this fight, but I appreciate their willingness to stand by their interpretation in the face of opposition. However, ACA urges ALL doctors of chiropractic to actively participate in the effort to defeat S.1955. Please work through ACA or your state association to ensure that your voice, and the voices of your clients, are clearly heard on Capitol Hill. Many resources are available at www.acatoday.org/s1955; tools are also available from your state association or www.protectchiropractic.com.

The threat to chiropractic is very real and very serious – the next few weeks may determine the future of our profession. Please join the fight before it is too late.

Sincerely,

Kevin P. Corcoran CAE
Executive Vice President

P.S. Please contact ACA if you have questions about S.1955 or if you have news about your senator’s position on the bill. You can reach us at stop1955@acatoday.org.