ARLINGTON, Va. - On Dec. 8, 2004, President Bush signed into law House Resolution 4818, a new omnibus appropriations bill. Included in the legislation is a directive from Congress to provide $2 million in funding to expand and extend a pilot program that allows doctors of chiropractic to participate in the National Health Service Corps (NHSC) student loan repayment program. The chiropractic provision, contained in the conference report to accompany HR 4818, was sponsored by Sens. Tom Harkin (D-Iowa) and Arlen Specter (R-Pa.), and backed by the American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC).
"This is yet another important milestone in the ACA's battle to ensure that chiropractic care is fully included in all federal health care programs," said ACA President Donald Krippendorf, DC. "Doctors of chiropractic belong in the NHSC because we have a unique and important role to play in providing millions of Americans in underserved areas with the care they need." Dr. Krippendorf also thanked Specter and Harkin, calling them "two great leaders who understand the value of chiropractic to the nation's health care system."
"This is a great victory, particularly for the chiropractic college students who are ready, willing and able serve in the NHSC," added ACC President Jean Moss, DC. "This is an historic time on the campuses of our chiropractic colleges."
In October 2002, Congress approved the Health Care Safety Net Improvement Act, legislation backed by the ACC and ACA, which established "a demonstration project to provide for the participation of individuals who are chiropractic doctors" in the NHSC's loan repayment program. The idea behind the program was to assess the impact of making chiropractic care more available in communities served by the NHSC. In 2003, eight doctors of chiropractic who had entered into employment contracts with eligible community health centers around the United States and submitted applications to the government, were selected to serve as the first chiropractors to participate in the loan repayment program. These DCs began receiving tax-exempt student loan reimbursements of up to $25,000 per year, to continue during a two or three-year service commitment.
Following the selection of this initial group of DCs, from a pool of about 90 applicants, NHSC officials, in a surprise move, announced that the program was being closed and would be evaluated without additional groups of chiropractors being added. The ACA and ACC protested the decision and worked together to not only have it overturned, but also to support new legislation to expand and extend chiropractic participation in the NHSC and the student loan repayment program. A joint-advocacy effort, launched officially at the National Chiropractic Legislative Conference in March 2004, successfully secured support from Sens. Harkin and Specter, Rep. Charlie Norwood (R-Ga.), and other pro-chiropractic leaders in Congress.
On Sept. 15, 2004, the Senate Appropriations Committee voted to register its concern about the handling of the NHSC chiropractic pilot program, and approved a funding directive to expand and extend the program. The Appropriations panel's report to accompany the FY 2005 appropriations measure for the Department of Health and Human Services stated:
"... The committee is concerned that funding provided for this demonstration in fiscal year 2003 resulted in only eight chiropractic demonstrations nationwide. The purpose of the demonstration program was to collect data on comprehensive patient outcomes associated with community health centers that provided chiropractic services ... the committee believes that eight chiropractors is not a statistically significant figure and conclusions cannot be safely drawn from this part of the demonstration. Therefore, the committee expects HRSA to use these funds to conduct another demonstration on a cohort of exclusively chiropractors and report to the committee on the findings."
The NHSC, a federally funded program in existence since 1970, serves the health needs of underserved areas of the United States. It assists medically underserved communities by recruiting and retaining primary care clinicians, including dental, mental and behavioral health professionals, to serve in their community. More than 23,000 health professionals have served with NHSC since 1972. The NHSC currently has more than 2,700 clinicians and health care professionals practicing in the United States, all of whom are helping to influence the outcomes of underserved populations and communities.
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