ACA Legislative Update

Congress Votes to Fund HEAL

The appropriation committees of both the House and Senate have voted to fund $260 million to the Health Education Assistance Loan (HEAL) program for fiscal year 1992.

The Bush administration has called for a phase out of the federally funded HEAL program, due to the high default rate on these student loans. The administration has indicated a desire to replace HEAL with the Health Professions Student Loan (HPSL) program. The HEAL program provides chiropractic students with a last resort option for educational financing, but the HPSL program excludes chiropractic students. (See "Chiropractic Defends HEAL Program Before Congressional Committee in the July 5, 1991 issue of "DC.")

The ACA's governmental relations staff considers the 1992 congressional funding of HEAL as a positive step in the effort to preserve the program. They warn, however, that the "crucial authorizing committees have not yet acted." The ACA staff believes that both the House and Senate authorizing committees will be favorably disposed to the HEAL funding.

Richard Miller, ACA's director of governmental relations predicted: "Based on the work we have done, in cooperation with the Association of Chiropractic Colleges, we have a pretty good idea what the committees plan to do, but none of us can rest comfortably until this issue is completely resolved."

On August 1, 1991, the ACA held a second round of meetings with Johannes Kutter, senior health policy advisor to President Bush, and Andrew Card, deputy chief of staff of the White House.

The meetings were arranged by Mark Goodin, an ACA legislative strategist. In attendance with Mark Goodin were Dr. Louis Sportelli, immediate past chairman of the ACA board of governors; Dr. Reeve Askew, board liaison to the ACA's legislative commission; and Richard Miller, ACA director of governmental relations.

The discussions centered on national health care reform legislation.

"Some form of national health care reform is going to be forthcoming from the White House sooner or later, and we want to make sure the administration is aware of our views," said Dr. Askew following the meetings. "There's no guarantee our concerns will be fully addressed, but if you don't maintain a dialogue with these officials, you have no chance of being hard at all," he concluded.

The ACA has urged the Bush administration to rewrite its proposed rule on the Medicare physician fee schedule to provide "fair treatment of doctors of chiropractic deserving equitable payment for their services."

Dr. Charles Downing, ACA president, in 41 pages of official comments to the Health Care Financing Administration (HCFA), has objected to the proposed calculating of fees for chiropractic services under the new fee schedule.

Dr. Downing wrote: "According to HCFA's own data the proposed rule would result in a decrease of 14 percent in payment per chiropractic service by 1996. This would mean that in most cases, doctors of chiropractic would be treating Medicare beneficiaries at a financial loss. The potential effects this would have on beneficiary access are obvious.

"The ACA urges HCFA to eliminate the A2000 code series and to substitute... the use of service codes described by the subset of physical medicine CPT codes... The artificial segregation of these services by continued use of the A2000 code series in the new system is an unnecessary complication that can only reduce its efficiency."

The new payment method will assign relative values to all Medicare services and give them a dollar conversion factor (CF). Some estimate the proposed CF would cut $15 billion in physician payment by 1996.

Dr. Downing said the proposal would "transform the fee schedule into a budget cutting device, a result never intended by Congress or anticipated by the physician community."

The Medicare fee schedule is scheduled to be finalized by October 1, 1991 and implemented by January 1992.

Health Care for America, a bi-partisan group lobbying for passage of Senate bill 1227, "Health America," has invited the ACA to join its board of directors.

The "Health America" bill was introduced June 5, 1991 by Senate Majority Leader George Mitchell (D-Maine) et al. (See "Health America Act Proposed" in the July 5, 1991 issue of "DC.") The legislation is the culmination of two years of work by the Senate Finance and Labor Committees to prepare a national health care bill to guarantee health insurance to every American.

Co-chairman of Health Care for America, Dr. Harvey Sloane, M.D., gave the ACA a formal written invitation to join this grass-roots organization. Dr. Sloane said, in part: "First, we believe no single provider group can lay claim to fully addressing the needs of our nation's health care delivery system. All provider groups should have a role to play in providing quality and effective health care to our nation's citizens... Additionally, chiropractic's inclusion in the Senate leadership bill is a recognition of the major contributions the profession has made to the health and well being of this county's citizens."

Dr. David Redding, ACA board chairman said of Dr. Sloane's letter: "It's a remarkable letter really, especially as it comes from outside our profession. It reflects a very positive attitude about chiropractic. I would have to say it's the most positive letter I've seen in 20 years."