On November 20, 1999, President Clinton signed the Veterans' Millennium Health Care Act into law. It went into effect Jan. 1, 2,000, and included a provision that required the Department of Veterans Affairs (DVA) to "establish a policy for the Veterans' Health Administration regarding the role of chiropractic treatment in the care of veterans under chapter 17 of title 38, United States Code."
On September 21, 2000, the House Committee on Veterans Affairs unanimously passed House Resolution 585 to H.R. 5109 (the Department of Veterans' Affairs Health Care Personnel Act of 2000) with no mention of chiropractic. Chiropractic was, again, left out in the cold.
Our national chiropractic associations had high hopes-expectations that were perhaps not realistic, given that VA patients do not have ready access to chiropractic care. VA patients must get a referral from a medical doctor to receive chiropractic care, and then only for low back pain.
The House VA Committee, according to representatives of the ACA, ICA, and the Association of Chiropractic Colleges, proposed chiropractic language that would require the VA to develop (but not fully implement) a program to improve access to chiropractic care. That language was provided to the chiropractic representatives less than a day before the bill was scheduled for a vote in the House. The chiropractic representatives were told that there would be no further modifications to the committee's proposal and were left with a "take it or leave it" situation.
Chiropractic not only didn't get direct access; it got nothing. And as the ACA's Michael Pedigo pointed out in online commentary, "It will be at least another year before we have another opportunity to get chiropractic included in VA legislation."
"It is time that the Department of Veterans' Affairs and the U.S. Congress do the right thing," asserted Dr. Michael McLean of the ICA's legislative committee. He suggested they "put their prejudice and medical tunnel vision aside and make chiropractic care available to our nation's veterans as a part of the routine services available to that very special population."
One aspect of the VA committee's proposal was to further study chiropractic's role in the VA. Many chiropractors saw that as just another delaying tactic.
"There is no need to demonstrate anything, no need to study the safety or effectiveness of chiropractic," asserted Dr. McLean. "Those issues were addressed and proven decades ago. It is time to act to secure direct access to chiropractic care, employ DCs as professional doctor level caregivers in VHA facilities and accept the powerful contribution chiropractic has to make to the health and well-being of all people."
Dr. Michael Pedigo has a theory why the VA Committee did not address the needs of the chiropractic profession: "I can't prove it, but I suspect the last-minute letter-writing campaign by the WCA to legislators to muddy the waters about what chiropractors do confused some members of Congress, causing them to back away from their prior support."
The WCA, the World Chiropractic Alliance, called for its members to "counteract the American Chiropractic Association's efforts to include the provision as part of the VA bill." The "provision" was direct access to VA patients.
There was support by some members of Congress for direct access to VA patients. During the brief debates on the resolution in the House, Bob Filner (D-San Diego) had some telling comments:
Despite a strong sentiment in the full Committee on Veterans' Affairs to move a chiropractic health care benefit amendment in this bill, we are apparently unable to reach an agreement to introduce direct access, full scope-of-practice chiropractic care into the VA health care system in this year. Chiropractic is the fastest-growing and second-largest primary health care profession. Chiropractors are a highly trained and licensed professional health care workforce. It is time to put VA health care on a par with other government health care programs and recognize chiropractic as a vital component of our health care system. In fact, we said that a year ago in our Millennium Health Care Bill. These are technical corrections to that bill. A year ago, we asked the VA to develop a chiropractic plan within 90 days to give chiropractic services to our veterans. The VA did not do this. I met with the Assistant Secretary for Health after the 90 days were up, (and) with various representatives of the national chiropractic associations. We stressed to the assistant secretary how important it was to act on this; and we got, frankly, bureaucratic inertia, bureaucratic resistance, and literally very little was done by a year later when we have the corrections for VA on the Millennium Health Care Bill.
I know this is not a simple issue, and I know the gentleman from Florida (Mr. Stearns) is as vitally concerned about this as I am; and he has promised, as I understand, to have hearings on this issue within our coming sessions, and I hope that we put a chiropractic health care provision that is meaningful at the top of our committee's agenda next year so that our veterans can have direct access to this important benefit as quickly as possible.
I certainly will be working toward that goal. I look forward to working with members of the committee. The gentleman from Illinois (Mr. Evans) has been a strong proponent of chiropractic care. The gentleman from Indiana (Mr. Buyer) on our committee has also put in a provision in the Defense Authorization Bill that moves the Defense Department more toward this. I hope that the Committee on Veterans' Affairs working with our members and the VA health care division will cooperate as we move to our full benefits to our veterans."
It is time that the Department of Veterans' Affairs and the U.S. Congress do the right thing, put their prejudice and medical tunnel vision aside and make chiropractic care available to our nation's veterans as a part of the routine services available to that very special population.
- Dr. Michael McLean, of the ICA's legislative committee.
The ICA is urging all other chiropractic organizations to "come back in the new Congress in January 2001 with a comprehensive, well developed plan that will secure a parity role for the DC in the Department of Veterans' Affairs."
Many in chiropractic feel that "all other chiropractic organizations" is just the problem: too many voices; too many associations representing the chiropractic profession and predictable, desultory results. Calls of "Wait 'till next year" wear thin and add to the general malaise begat by a profession beset with disunity, disharmony, and in dire need of direction.
