November 16, 2010 — The dramatic shift in Congressional power, most definitively in the House of Representatives where the Republican Party has gained a significant majority, has created a new legislative landscape for chiropractic and the nation.

In the Congressional changes that just took place Nov. 2, 2010, the chiropractic profession lost several longstanding advocates, but fortunately retained a greater number of allies.

Thankfully, such strong supporters as Sen. Charles Grassley (R-IA), Sen. Patty Murray (D-WI), Rep. Leonard Boswell (D-IA), Rep. Bruce Braley (D-IA), Rep. Don Manzullo (RIL), Rep. Mike Ross (D-AR), and Rep. Jim Jordan (R-OH) all retained their seats.

In the House of Representatives, all committee chairs will change as will the voting balance of power. While retaining his seat, chiropractic’s strongest ally, Rep. Bob Filner (D-CA) will relinquish the Chairmanship of the House Committee on Veterans Affairs, a major step backward for chiropractic.

The new House committee chairs have yet to be officially determined and it may be weeks before the precise power structure is made known. The incoming House Republican leadership is contemplating bypassing the time-honored seniority system for determining committee chairs in favor of more partisan, election driven choices and thus many more positions are up in the air than would otherwise be the case.

The implications for the chiropractic profession of the election outcome may be quite significant. Coupled with the growing concern over the national debt and current budget deficits, it is clear that any new spending programs will face a harsh audience in Congress.

As well, pressure to cut existing programs, including Medicare, will be intense. There has been a great deal of talk among both newly elected and veteran Republican Members of Congress about targeting undoing the recent healthcare reform law as a top priority.

There have been numerous statements about using the appropriations process to “de-fund” health reform implementation and also talk of outright repeal of some or all of the law’s provisions. The outcome of the 2010 Congressional elections notwithstanding, the prospects of any legislative repeal of any of the provisions of the Patient Protection and Affordable Care Act are minimal to impossible (it would take 60 votes in the U.S. Senate to pass and 67 Senate votes to override a Presidential veto).

Thus, the chiropractic profession must proceed to address the implementation of the existing health reform legislative language with all its specifics and implications. This is ICA’s viewpoint as well as the unanimous opinion of the representatives of the 40 organizations comprising The Chiropractic Summit which met in early November to evaluate the political and legislative situation following the elections.

It will take many weeks for the full implications of the new Republican majority in the House of Representatives to become fully clear. In the meantime, chiropractic has a number of key issues that need to be addressed in the few weeks that remain in this current Congress.

There will be two so-called “Lame Duck” sessions before the new Congress is sworn in. During that time, it is logical to assume that the Democratic majority in both houses will use this limited time to clean up as much unfinished business on their agenda as possible.

Among issues to top concern to chiropractic are:

• Senate passage of Rep. Bob Filner’s chiropractic veterans legislation: Thanks to the courageous and determined efforts of Rep Bob Filner (D-CA), HR 1017 passed the U.S. House of Representatives on May 24, 2010.

This vitally important legislation requires the U.S. Department of Veterans Affairs (DVA) to place doctors of chiropractic on staff at no fewer than 75 major VA medical centers before the end of 2011 and at all major VA medical centers to have a doctor of chiropractic on staff by the end of 2013.

Following passage by the House, HR 1017 was sent to the United States Senate, where it has been held up by a number of Senators who have expressed concern about cost but who also have a history of not being supportive of chiropractic initiatives.

There are a total of 160 DVA facilities nationwide but under the present legislation chiropractic services are only available as 32 of those care centers. Senate passage of HR 1017 is a top ICA priority and urges all DCs to contact their U.S. Senators and secure their support for this long overdue improvement in care for the nation’s veterans.

• Repeal of insurance industry exemption to national antitrust laws: The McCarran–Ferguson Act, 15 U.S.C. §§ 1011-1015, is a United States federal law that exempts the business of insurance from most federal regulation, including federal anti-trust laws.

The McCarran–Ferguson Act was passed by Congress in 1945. This law is the basis on which, on the one hand doctors are currently prohibited from collectively bargaining with insurance carriers under antitrust laws, and on the other, also exempt the insurance industry from federal anti-trust enforcement.

The net result is a pattern of exploitation, price-fixing, predatory trade practices and the cheating of policy holders and providers alike, with little or no recourse for those who are injured.

Legislation in the current Congressional session to repeal the anti-trust exemption for the insurance industry is also stalled in the U.S. Senate despite passage of such legislation (HR 4626) by the U.S. House of Representatives by a massive margin of 406-19. ICA considers the repeal of this act a top legislative priority and will continue to aggressively lobby for this urgently needed national policy change.

ICA urges all DCs and all chiropractic organizations to immediately contact their United States Senators and urge an immediate vote to pass HR 4626 in the remaining sessions of the current Congress.

• Medicare fee cut postponement: On June 25, 2010, Congress, with Obama Administration support, postponed until Nov. 30 the looming 21 percent Medicare fee cut scheduled to take effect in 2010.

According to the Centers for Medicare and Medicaid Services (CMS), “Under Medicare's sustainable growth rate (SGR) formula, CMS' final physician fee schedule rule for 2011 requires physician payments to be reduced on Dec. 1, 2010, and then again on Jan. 1, 2011. The total reduction in [Medicare physician fee schedule] rates between November 2010 and January 2011 under the [SGR] system will be 24.9 percent, according to the rule.”

Congress has acted to apply the so-called "doc fix" 10 times in the past eight years, four of them this year alone. Efforts to enact a permanent fix for the mandated SGR formula have hung up on the expected cost since all parties agree that it would be expensive to implement a permanent fix or even a five year moratorium.

There is legitimate concern among all Members of Congress that doctors will en masse stop serving Medicare patients if their fees are cut so drastically.

At the present time, estimates are that 25 percent of all medical doctors and a growing number of doctors of chiropractic already no logger accept Medicare patients in their practices.

ICA supports a responsible postponement of the looming cuts and is urging Members of Congress to seek a bi-partisan, fair solution to this ongoing problem.

Visit www.AdjustTheVote.org to contact your U.S. Senators on these three key issues! ICA’s Legislative Committee and ICA-PAC will continue to work to secure these and other urgently needed policy changes on behalf of chiropractic providers and patients.

Source: International Chiropractors Association, www.chiropractic.org

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