March 22, 2010 — The U.S. House of Representatives passed HR 3590, the Senate-passed version of national healthcare reform legislation. The final vote took place after a nearly 13-month battle, culminating in a contentious struggle to garner votes from undecided members of the Democratic majority in Congress.

This means the provisions contained in HR 3590 now only await President Obama’s signature to be enacted into law. These provisions include an important provider nondiscrimination provision long championed by the American Chiropractic Association (ACA).

Incorporation of this provider nondiscrimination provision, also known as the “Harkin Amendment,” was achieved primarily due to the efforts of Sen. Tom Harkin (D-Iowa), with help from other key players such as Sen. Chris Dodd (D-Connecticut). Although he did not support the final bill overall, Sen. Orrin Hatch (R-Utah) also lent his support for the advancement of the non-discrimination provision.

“Regardless of how you feel about this legislation and its overall impact on the nation, it has to be recognized as an historic first for the chiropractic profession. We now have a federal law applicable to ERISA plans that makes it against the law for insurance companies to discriminate against Doctors of Chiropractic and other providers relative to their participation and coverage in health plans. Such discrimination based on a provider’s license is inappropriate and now must stop,” said ACA president, Dr. Rick McMichael.

“While this does not fully level the playing field for doctors of chiropractic in our health care system, this is a highly significant step that has the potential for positive, long-range impact on the profession and the patients we serve. Congress has finally addressed the issue of provider discrimination based on one’s license, and they have said that such discrimination must stop.”

The provider nondiscrimination provision (Section 2706) to be enacted into law reads in part: “A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.”

Regarding this provision, John Falardeau, ACA’s vice president of government relations said, “The Harkin nondiscrimination language will be applicable to all health benefit plans both insured and self-insured. National healthcare reform is designed to eventually cover 30 million currently uninsured Americans. The nondiscrimination language will, over time, apply to those individuals as well. However, that number of covered individuals pales in comparison to the 55 percent of workers who are currently covered by self-insured plans that will be affected by the Harkin nondiscrimination language. The potential impact in this regard cannot be overstated.”

Additionally, the legislation passed by the House includes two other provisions that impact the chiropractic profession. Doctors of chiropractic are specifically included as potential members of interdisciplinary community health teams. These teams support the development of medical homes by increasing access to comprehensive, community based, coordinated care.

Community health teams are integrated teams of providers that include primary care providers, specialists, other clinicians, licensed integrative health professionals and community resources to enhance patient care, wellness and lifestyle improvements.

The language in the bill ensures doctors of chiropractic can be included in these patient-centered, holistic teams.

Dr. McMichael noted, “This language was a critical inclusion to give doctors of chiropractic increased opportunities to be fully engaged as part of the healthcare team.”

Furthermore, the legislation establishes a National Health Care Workforce Commission to examine current and projected needs in the healthcare workforce. The commission specifically includes doctors of chiropractic by defining them as part of the healthcare workforce, and includes them in the definition of health professionals.

In addition, chiropractic colleges are included among the health professional training schools to be studied. The National Health Care Workforce Commission is tasked with providing comprehensive, unbiased information to Congress and the Obama administration about how to align federal healthcare workforce resources with national needs.

Congress will use this information when providing appropriations to discretionary programs or in restructuring other federal funding. The language in the bill guarantees the need for doctors of chiropractic will be addressed when considering federal healthcare workforce programs, another very important inclusion.

Source: American Chiropractic Association,