Ronald M. Hendrickson
We, at the International Chiropractors Association (ICA), were not pleased by the recent federal court action ending hopes for a judicial solution to the problems created by Employee Retirement Income Security Act (ERISA), that great regulatory thorn in the side of the chiropractic profession. We were not, however, all that surprised. ERISA represents one of the most powerful intersections of special interests we have in our health care economy today. There appears to be agreement, among powerful and often otherwise conflicting interest groups, that despite its faults, ERISA ought not be tampered with. The legal basis has been consistently upheld, and I think it is fair to say that hope of a judicial remedy has been dispelled once and for all.
What then should be done? Those who argue that a legislative solution is within reach in the short or middle term are sadly mistaken. ERISA is as entrenched and as solid as a body of existing law can possibly be. The insurance industry sees it as a golden loophole to escape state regulation. Business sees it likewise. Organized labor values the special status this law gives the products of collective bargaining. Organized medicine sees it as a mechanism to restrict health spending to traditional medical providers. Insurance regulators and state and local public officials are turning away from mandated benefits as a way to address inequities in the health insurance system, and not just because of added costs such requirements usually bring with them.
As always seems to be the case, it is the consumer who suffers. Likewise, those health care providers, including the doctor of chiropractic, who would otherwise be called on for service, are cut out of the circle of options by the self-insurance process.
Having served as ICA's director of government relations for nearly a decade, I am intimately familiar with the players and the congressional process through which ERISA reform legislation would need to move. Despite encouraging statements from some quarters within the profession that specific ERISA legislation is possible, the realities of the day are simple, plain, and for the moment immutable. I have spoken face to face with all the key decision makers in both the House and the Senate and the answer is a clear "no go" on ERISA reform.
Why some persons within the profession would wish to unrealistically raise expectations on this matter is a mystery. We at the ICA do agree that ERISA is a problem that cries out for attention. However, it is a long-term problem and it will require a long-term solution.
ICA believes that public education and consumer support are essential elements in attacking this problem. The impact of ERISA is virtually unknown, even to many high-level policymakers. ICA is working to educate them and consumers who need to know they are being short-changed. For example, consider the impact of learning that a major industrial employer had contracted for a limited benefits, self-insured plan for its wage-earning employees, but provided a full-service, insurance plan for its executives. ERISA provides a legal means through which to provide second-class service. Public outcry based on such knowledge can change things.
A second major avenue of progress is the education or selling of chiropractic to health benefits planners. Chiropractic is a sound, often more economical alternative to traditional medical care. Effectively demonstrating the economic utility of the chiropractic alternative is the key to routine inclusion. Keep in mind that the ERISA exemption only allows the list of benefits to be kept short, it does not require the exclusion of any service.
Finally, the ICA will stand enthusiastically behind any legislative initiative to establish a free choice of providers provision in all health care delivery programs. Anti-discrimination language may offer a legislative means to address the specific problem presented by ERISA, without directly confronting the exemption language.
The chiropractic profession must be committed to a long-term multi-faceted effort, in the broadest possible spirit of cooperation, if this problem is to be solved. ICA is so committed. We recognize that we are in for a long, hard, expensive struggle, but it is a struggle chiropractic has to win.
