11/24/03 SUCCESS IN MEDICARE After more than 10 years of effort to expand the chiropractic benefit under Medicare, ACA took a significant step toward this goal recently with the Senate-House conference committee's agreement on the Medicare Drug Reform Act, which includes a chiropractic demonstration project. The conference recommendations must now be sent to both the Senate and House for a vote. While it is considered close, most believe that there will be sufficient votes to get the measure out of both houses--particularly with the support of AARP. We should know for sure in the next couple of days. As an aside, the physical therapists were unsuccessful in including in the Medicare bill either a study of or demonstration project for direct access to physical therapy services--their legislative priority. Late breaking news: Over the weekend, the Medicare bill passed out of the House of Representatives. And today, it passed the Senate. The President is expected to sign the measure. The chiropractic demonstration pilot project will be conducted in four sites over a two-year period. The sites have not yet been determined. Under the pilot program, Medicare recipients will now be covered for the full scope of chiropractic practice paid by Medicare. Also to be tested is direct access to chiropractic care under Medicare Part C, where federally approved managed care companies administer Medicare benefits. Now we will have statistics from the government's own sources to counter the ridiculous projections from the Congressional Budget Office that have hampered our efforts in the past. Pilot programs under DoD made our point about the cost-effectiveness of chiropractic care and led to chiropractic being offered as a permanent benefit for the armed forces. We have the same confidence regarding the outcome of this pilot project. Also included in the Medicare bill, and backed by Senator Grassley and the ACA, is a provision aimed at ensuring that beneficiaries will continue to have access to chiropractors and other physicians by replacing a 4.5% physician payment cut -- scheduled to take effect on January 1, 2004, if the bill does not pass -- with two years of payment increases. Getting the chiropractic demonstration pilot project included in the Medicare bill was a very difficult fight, as two of the most powerful members of the House and Senate on health matters--Senate Majority Leader Bill Frist, MD, and Chairman of the House Ways and Means Committee Bill Thomas--maintained their opposition to the chiropractic provision to the very end. But chiropractic had a champion in Sen. Chuck Grassley from Iowa, who is chairman of the Senate Finance Committee. He was a major player in the Medicare drug bill and doggedly fought off both Frist and Thomas to achieve this victory. It is difficult to describe the significance of Grassley's efforts on our behalf. However, we can get a glimpse of it from comments he made at a press conference broadcast on CNN the day before the conference committee took its final action. In response to a question from a reporter asking about the status of the chiropractic demonstration provision, he read from an e-mail that he had sent to Sen. Frist the day before. In it, he used the strongest language possible to tell Frist to have his staff "back off" its opposition to the provision. Following is an excerpt from the e-mail: "I hope that this can be handled at the staff level...but your staff have been refusing my chiropractic demo...knock it off. I have been fighting AMA for years to get crumbs off the table for the chiropractors. I got $54 billion for the docs in January. You and they better not object to budgetary asterisks for chiropractors...so back your staff off of this demo." To listen to Sen. Grassley discuss his strong support for chiropractic and the chiropractic demonstration at this critical time (or read the transcript), please click on this link to the ACA Web site: www.acatoday.com . While Grassley was clearly the champion, there were others on the conference committee who also helped, including Reps. Billy Tauzin, Nancy Johnson, Michael Bilirakis and many other members of Congress outside of the conference committee who let the conferees know about their support of the demo. On the Senate side, we had many people who lent their support attempting to convince Frist to back off, including Sens. Norm Coleman, Orrin Hatch, George Allen, Tom Daschle, Ben Nelson, Chuck Hagel and others. One thing I won't forget is the strong opposition of both Thomas and Frist. Our provision was not a budget buster. We were simply trying to demonstrate our cost-effectiveness. Their opposition seemed to me to be mean-spirited. But every dog has its day; perhaps someday we will have an opportunity to express our opposition to both of them...on the campaign trail. On Sunday, the Washington Post ran a story in its "A" section on the Medicare bill, discussing the chiropractic provision and highlighting ACA's involvement. Here's a link to the article: http://www.washingtonpost.com/wp-dyn/articles/A6920- 2003Nov22.html