Help Increase Coverage of Chiropractic Services in Medicare: Support H.R. 3654

For far too long, chiropractors have had one hand tied behind their backs when it comes to treating their Medicare patients. An antiquated statute, with no valid scientific or policy basis, has limited coverage of chiropractic under Medicare to one service — manual manipulation of the spine — since the profession was first included in the federal program almost 50 years ago.

The statute has negatively impacted patients, making it harder for them to access non-drug treatments for pain that could potentially steer them away from prescription pain medications and surgery.

With your help, that’s about to change.

After months of close work between the American Chiropractic Association (ACA) and the offices of Brian Higgins (D-N.Y.) and Tom Reed (R-N.Y.), the Chiropractic Medicare Coverage Modernization Act of 2019 (H.R. 3654) was introduced in the U.S. House of Representatives on July 9. This bipartisan bill would enable seniors to have access to all Medicare-covered benefits allowable under a chiropractor’s state licensure.

While it expands access for beneficiaries, the bill does not add any new services to Medicare (nor does it remove any current services covered by Medicare). It simply enables beneficiaries to choose which qualified provider they prefer to receive their covered services from.

At the same time, as several chiropractic cost-effectiveness studies have shown, the bill has the potential to reduce costs for many of the conditions that chiropractors address for their senior patients. It will also mean less out-of-pocket costs and logistical hassles for seniors — no more getting adjusted by your chiropractor and then having to schedule another appointment, on another day, with a different provider, for a service that their chiropractor is licensed to provide and could have effectively rendered at the time of the first appointment.

Moreover, the bill would fully recognize chiropractors as “physicians” in the Medicare program, acknowledging their level of education as well as the level of care they provide, and bringing coverage of their services in line with how other physicians in the Medicare program are treated. Chiropractors are the only physician-level providers in Medicare whose services are arbitrarily restricted by statute.

Introduction of the Medicare Bill is Only the Start

Now that H.R. 3654 has been introduced, the important work to gain cosponsors begins — the more cosponsors, the greater chance that the bill will pass. ACA aims to bring on 300-400 co-sponsors in the next 6-7 months. Our online legislative action center enables chiropractors to easily send a message to their elected representative in the U.S. House. Simply go to www.HR3654.org and click “Take Action.” And don’t stop there: talk to your family, friends and patients — especially your senior patients—and ask them to do the same, using the same link.

The Opportunity for Change in Medicare Is Now

Medicare’s impact on quality senior health care is significant — and will only increase as the baby boomer generation continues to age and enter its ranks. Various projections forecast the number of people age 65 or older, which stands at about 55 million now, increasing by one-third over the next decade. The fact that chiropractic has existed in Medicare with only one service covered for so long is surprising to many. While limited, however, that one service marked a crucial foothold in the federal healthcare program for chiropractic and contributed to success in ACA’s later efforts to integrate chiropractic into the U.S. Department of Veterans Affairs and Department of Defense health care systems as well as federal workers’ health plans.

While lawmakers have not viewed updating Medicare’s chiropractic statute as a priority in the intervening years, things changed dramatically with the emergence of the national opioid epidemic — which adversely impacts America’s senior population as much as it does younger people. Many seniors already take multiple medications for chronic conditions such as heart disease and diabetes, and by combining those drugs with prescription pain medications for their musculoskeletal conditions, they are left more vulnerable to not only negative interactions but also opioid addiction or overdose.

In fact, between 1993-2012, hospitalizations for opioid overuse increased fivefold among Americans age 45-85 and older, according to the Agency for Healthcare Research and Quality. In a 2018 hearing on the opioid crisis, Sen. Robert Casey Jr. (Pa.), ranking democrat of the Senate Special Committee on Aging, noted that, “In 2016, one in three people with a Medicare prescription drug plan received an opioid prescription. This puts baby boomers and our oldest generation at great risk.”

Congress is looking for out-of-the-box strategies to solve the opioid epidemic. Several bills have been passed in recent years, and more will come. Bolstered by new evidence such as the American College of Physicians’ low-back pain guidelines, which recommend the use of non-drug treatments such as spinal manipulation before turning to drugs and surgery, the chiropractic profession has an unprecedented opportunity with H.R. 3654 to help America’s aging population get better access to safe and effective care that will enable them to live healthier and pain free.

Join us in this landmark effort to improve American health care.

Learn more, and contact your member of the U.S. House of Representatives today at www.HR3654.org.

Dr. Robert C. Jones is the president of ACA, Dr. Keith Overland is chairman of ACA’s Legislative Advisory Board, and John Falardeau is ACA’s Senior Vice President of Public Policy and Advocacy.