Health Care Reform: The Devil Is in the Details

In early May, I had the opportunity to spend two whirlwind days in Washington, D.C., as a part of the Silicon Valley Leadership Group. Speaker of the House Nancy Pelosi, Calif. Sens. Dianne Feinstein and Barbara Boxer, and California Reps. Anna Eshoo, Sam Farr, Mike Honda, and Zoe Lofgren all addressed our group. On the last day, we had a private briefing at the White House with Larry Summers, economic adviser; Carol Browner, energy adviser; Van Jones, green jobs adviser; Christina Romer, Council of Economic Advisers chair, and Vivek Kundra, chief information officer for the federal government. Finally, I had the opportunity to meet with Paul Dioguardi, director of the Office of Intergovernmental Affairs for the U.S. Department of Health and Human Services (DHHS). Not surprisingly, health care reform was a key topic of conversation.

In spite of the economy, war and other significant distractions, the White House remains committed to comprehensive health care reform. President Obama has established eight basic principles to guide the reform initiative. Having established the general boundaries, he has turned the matter over to Congress and requested that it develop appropriate legislation, ideally by the end of June. This will be no easy task. Although Democrats, Republicans, payers, policy-makers, labor leaders and trade associations attending the White House Health Care Summit on March 5 pledged support for comprehensive reform at the end of the meeting, there are a number of roadblocks.

First, many important stakeholders were not in the room; doctors of chiropractic, for instance. Second, the devil is in the details, such as what benefits should be covered. It is one thing for a representative from America's Health Insurance Plans (AHIP) to stand up during the meeting and state that they are ready "to play, to contribute, and to help pass health care reform this year." It is quite another for AHIP to support legislation that would require all insurers to pay for comprehensive wellness and prevention programs or provide direct access to doctors of chiropractic for all Americans at a fair level of reimbursement. Finally, there is a lack of clarity about how reform will be financed. This is going to be a very sticky issue.

As I write this column, key leaders in the Senate are meeting behind closed doors, reviewing and discussing a 40-page report issued on May 18 by the Senate Finance Committee. The report details "revenue-raising options" to produce the $1.5 trillion needed over the next decade to provide coverage for the 47 million uninsured Americans. One possibility on the list of options is to reduce taxes on alcohol consumption. (Another reason, in addition to the antioxidants, to feel good about that daily glass of pinot noir.)

I predict, based on my experiences in Washington, D.C., that any bill forthcoming early this summer will be strong on general principles upon which everyone can agree, and will only touch on the contentious details, such as exactly how those principles will be executed. More than one congressional staffer and one person at DHHS have indicated to me that the bill will be about 60 pages in length. If this is true, I think it is very unlikely that the word chiropractic will appear anywhere in the document.

Our continued chiropractic efforts on Capital Hill are critical, and I urge everyone to become familiar with and utilize the American Chiropractic Association's Legislative Action Center (www.chirovoice.org) or the International Chiropractors' Association advocacy site, www.adjustthevote.org. However, it is imperative that we also begin key conversations with those who will ultimately be filling in the details, such as payer groups, employers, senior administrators at state health departments and the U.S. Department of Health and Human Services.

To stay updated on White House health care reform efforts and events, go to www.healthreform.gov. This Web site includes the latest in health reform- related news and weekly video updates.