What did Senator Barack Obama have to say about Chiropractic in his Presidential Campaign?
The following was a letter by the
American Chiropractic Association
2008 Federal Election
Candidate Questionnaire
Senator Obama Response
National Health Care Reform, Question #1:
The American Chiropractic Association (ACA) believes that no national health
care reform plan—no matter how well intended or structured—can realize its
maximum potential to benefit the American people unless it is coupled with, or
designed to achieve, a paradigm shift toward a health care delivery system
focused on wellness and disease prevention—as opposed to the current system,
which is mainly focused on treating patients after they become sick or chronically
ill. Doctors of chiropractic and their holistic approach would be fully integrated
into such a system, and viewed by the public as essential elements for achieving
good health. To what extent do you agree or disagree with this view? (Please
elaborate fully.)
Although we spend more than $2 trillion on medical care, an increasing number of
Americans are suffering and dying needlessly from preventable chronic diseases and
cancer. One in 3 Americans—125 million Americans—have a chronic condition, and
minority and low-income populations are especially affected. Covering the uninsured and
modernizing America’s health care system are urgent priorities, but they are not enough.
I believe that we can and must do more to instill a culture of wellness in this nation. As
part of this effort, we also must commit to strengthening our public health system, both to
promote health and to prepare and respond to emerging threats that include bioterrorism
and pandemic flu.
I will work to give all Americans the opportunity to live in communities where risks from
physical and environmental hazards are low, health and quality of life are high priorities,
and public health systems are prepared for emergencies. This effort is contingent upon a
strong primary care workforce. Primary care providers and public health practitioners
have and will continue to lead efforts to protect and promote the nation’s health. Yet, the
numbers of both are dwindling, and the existing workforce is challenged by newer health
threats such as bioterrorism and avian flu, inadequate reimbursement, and limited access
to real-time information and technical support. I will expand funding for programs at
HRSA—including loan repayment, grants for training curricula, and infrastructure
support to improve working conditions— to ensure a strong workforce that can champion
prevention and public health activities. Chiropractors have made important and valuable
contributions with regards to expanding access to preventive services and strengthening
public health, and would be integral to the effectiveness of my efforts in this area.
National Health Care Reform, Question #2:
National health care reform legislation could encompass the establishment of a
federally defined package of core health care benefits that would serve as a base
standard for all health care plans. Do you believe such a standard for minimum
benefits, if established, should include chiropractic care provided by doctors
of chiropractic as a guaranteed benefit?
My health care plan both builds upon and improves our current insurance system, upon
which most Americans continue to rely, and leaves Medicare intact for older and disabled
Americans. My plan also addresses the large gaps in coverage that leave 45 million
Americans uninsured. Specifically, the it will: (1) establish a new public insurance plan,
available to Americans who neither qualify for Medicaid or SCHIP nor have access to
insurance through their employers, as well as to businesses that want to offer insurance to
their employees; (2) create a National Health Insurance Exchange to help Americans and
businesses that want to purchase private health insurance directly; (3) require all
employers to contribute towards health coverage for their employees or towards the cost
of the new public plan; (4) mandate all children have health care coverage; (5) expand
Medicaid and SCHIP to cover more of the least well-off among us; and (6) allow state
flexibility for state health reform plans.
My public insurance plan will include comprehensive coverage, including all essential
medical benefits such as mental health care, maternity care and preventive services. Any
benefit that is evidence-based or meets the current accepted standard of care would be
covered, and as such, many if not all chiropractic services provided by doctors of
chiropractic medicine should be included in the public benefit package.
Medicare, Question #1:
Current Medicare law discriminates against doctors of chiropractic (DCs), and the
beneficiaries who wish to receive their treatment, because DCs are permitted to
provide only a single covered benefit (manual manipulation of the spine)—even
though doctors of chiropractic are trained and licensed in all 50 states to provide a
range of other Medicare-covered services (physical exams, X-rays, other
diagnostic services, etc.). Current law allows a variety of other providers to be
reimbursed for these services but arbitrarily and unfairly limits the services a
doctor of chiropractic may provide. Would you support the enactment of
Medicare legislation allowing doctors of chiropractic to provide, and be
reimbursed for, any existing covered Medicare benefit (provided that the
services are within a doctor of chiropractic’s licensed scope-of-practice)?
I am committed to prioritizing focus on health care quality improvement to ensure that
patients receive and providers deliver the best possible care. To assist patients, my plan
supports disease management programs, coordination of care initiatives and full
transparency about provider quality and costs. Efforts to improve health care delivery by
providers will include comparative effectiveness research, tackling of health care
disparities, patient safety activities and aligning incentives for excellence. With regards
to this latter effort, I recognize that both public and private insurers tend to pay providers
based on the volume of services provided, rather than the quality or effectiveness of care.
I support reimbursement reform that will reward all providers for meeting certain
performance thresholds on outcome measures. As such, I will not discriminate against
any class of providers, but instead reward and reimburse those who deliver high quality
care and whose patients achieve good health outcomes.
Medicare, Question #2:
The traditional Medicare program, Part B, is a fee-for-service-based program that
allows beneficiaries direct access to the eligible Medicare providers of their
choice. However, beneficiaries enrolled in Medicare managed care plans, Type C
(also known as “Medicare Advantage Plans”), are limited to treatment from the
managed care plan’s providers and may only receive the services offered by their
particular plan. Congress intended Medicare managed care plans to offer services
no less comprehensive than those provided under Medicare Part B. However, in
practice, Medicare managed care plans routinely fail to provide beneficiaries with
access to doctors of chiropractic. Would you support the enactment of
Medicare legislation that would correct this deficiency and require Medicare
managed care plans to offer beneficiaries access—without unreasonable
restriction—to the services of doctors of chiropractic?
Although the Medicare managed care option has provided many seniors with greater
options, it has not achieved expected cost savings nor do many plans offer any additional,
meaningful benefits to enrollees. More recent investigation has highlighted a number of
problems with Medicare Advantage Plans including abusive marketing practices, variable
and sometimes harmful benefit design and excessive overpayment. As such, there is a
compelling need to conduct rigorous review and oversight of plan availability,
administration, benefit design, and financing. The study of comprehensiveness of benefit
design would help to clarify what additional standards and protections are needed for
seniors, such as guaranteed access to chiropractic care, which could be required as a
condition of participation for the insurers in the Medicare Advantage program.
Preservation of State Consumer-Protection Laws:
All 50 U.S. states have enacted laws intended to protect consumers accessing
health care services via insurance plans regulated at the state level. The portion of
the health care insurance marketplace regulated at the state level is sometimes
referred to as the health insurance “small market,” and the state-enacted consumer
protections that apply to this portion of the marketplace are often referred to as
“state mandates.” In the past, some in Congress have proposed the enactment of a
federal law(s) that would pre-empt, or otherwise abolish, the effectiveness of
these state-enacted consumer protections. ACA believes these protections serve a
valuable and useful purpose, and will continue to oppose their pre-emption until a
comprehensive set of federal protections is enacted to take their place. To what
extent do you agree or disagree with the ACA’s position on this matter?
(Please elaborate fully.)
I firmly believe that states should have maximal flexibility to implement state mandates
that meet the needs and preferences of its residents. I have opposed legislation, such as
Association Health Plan legislation, that would allow entities to circumvent state-enacted
consumer protections.
ERISA Reform and a Patients Bill of Rights:
Millions of Americans receiving their health insurance via plans organized as
federally regulated ERISA (Employee Retirement Income Security Act) plans are
deprived of consumer protections that exist at the state level and that are
applicable to state-regulated insurance plans. This is because plans organized
under the federal ERISA statute are provided with a pre-emption that allows them
to ignore state consumer-protection laws. This pre-emption continues even though
no consumer protections (comparable to typical state protections) have been
enacted at the federal level and made applicable to ERISA-organized plans. To
address this deficiency, and to help ensure that patients are not deprived of the
care they need, Congress may once again consider the enactment of a federal
“Patients Bill of Rights” that would apply to ERISA plans. ACA favors the
enactment of a comprehensive set of federal patient and provider protections.
Would you support the enactment of a comprehensive federal Patients Bill of
Rights, including (point-of-service) provisions that allow patients’ access to
the providers of their choice?
I firmly support the rights of states to determine and implement state-mandated benefits
and other protections that meet the needs and preferences of its residents. Accordingly, I
would support enactment of a federal Patients Bill of Rights to protect individual access
to providers and services in ERISA plans.
Antitrust Reform and Restraining Insurance-Company Power:
Current law allows a special exemption for the insurance and managed care
industries from certain provisions of federal antitrust law. This special treatment
gives the insurance industry a competitive advantage over other key participants
in the health care delivery system, including health care providers. ACA believes
such an advantage is anti-competitive in nature and harmful to the well-being of
providers and the patients they serve. It creates an uneven playing field in the
health care marketplace. This exemption allows a disproportionate level of market
power to accumulate in the hands of wealthy and highly profitable insurance
interests—to the detriment of providers and others. ACA supports enactment of
antitrust reform legislation that would restore balance to the marketplace by
allowing providers to collectively bargain with health insurance plans. Would
you support the enactment of such collective-bargaining legislation?
Yes.
Commissioning Doctors of Chiropractic in the Uniformed
Corps of the U.S. Public Health Service:
One remaining vestige of discrimination against the chiropractic profession at the
federal level is the ineligibility of doctors of chiropractic (DCs) to be
commissioned as officers in the Uniformed Corps of the U.S. Public Health
Service. No legitimate basis for this exclusion exists. In fact, doctors of
chiropractic are virtually the only provider group still excluded. The Corps is
comprised of a very broad range of providers; even doctors of veterinary medicine
may participate. Would you support legislation that would require the
commissioning of DCs as officers in the Uniformed Corps of the U.S. Public
Health Service?
The U.S. Public Health Service Commissioned Corps is comprised of approximately
6,000 public health professionals dedicated to delivering the nation’s public health
promotion and disease prevention programs and advancing public health science. Given
the critical role that doctors of chiropractic serve in each of these functions, I would
support commissioning of doctors of chiropractic as officers in the Uniformed Corps.
Integration of Chiropractic Care into the VA and DoD Health
Care Systems:
In recent years, the enactment by Congress of a series of laws has begun the
process of integrating chiropractic care into the health care systems of the
Departments of Defense (DoD) and Veterans Affairs (VA). However, full
integration is yet to be achieved. The services of doctors of chiropractic (DCs) are
available at less than half of the major DoD and VA treatment facilities, and no
DCs are in theater treating our troops overseas. Additionally, in the DoD system,
chiropractic care is only available to active-duty military personnel, and it is not
available—as are other benefits—to survivors, retirees and dependents. In the VA
system, meanwhile, veterans living in rural areas rarely receive permission from
the VA to obtain chiropractic care from DCs available in their local areas. Would
you support the enactment of legislation that would lead to the full
integration of chiropractic care into both the DoD and VA health care
systems?
I recognize that neither the VA nor DOD has achieved full integration of the services of
doctors of chiropractic into their health systems despite clear direction from the
Congress. I will support careful examination into the policy and practical barriers that
restrict access to such services in order to inform the development of legislation that can
remedy this problem.
