For most people, the holidays are a time of giving and receiving. Unfortunately, many residents of Massachusetts received the chiropractic equivalent of coal in their stockings on January 1, 2003, when a series of sweeping cuts went into effect against MassHealth, the state's version of Medicaid. Included in the cuts made by interim governor Jane Swift was the complete elimination of chiropractic from MassHealth, leaving thousands of people without access to chiropractic care, and incoming governor Mitt Romney with a potential health care crisis.
The cuts were made as part of an effort to reduce the state's widening budget gap, estimated at almost $2 billion. Among the other services eliminated from MassHealth was coverage for orthotics, prosthetics, eyeglasses and dentures.
Nicole St. Peter, a spokesperson for the state's Office of Administration and Finance, said the moves were difficult for Swift to make.
"They're important to people, and we realized that, but this allows us to preserve core health care services for children and the elderly," Ms. St. Peter said.1
But Allison Staton, a spokesperson for the advocacy group Health Care for All!, called Swift's cuts "incredibly shortsighted" and questioned why other changes weren't made, such as targeting fraud or using more generic drugs instead of brand-name items.
"People who are leading otherwise productive lives are now going to lose their independence and might end up needing more expensive care," Ms. Staton said. "Certainly there are acceptable levels of cost savings. But there are other ways to save costs without eliminating people's coverage or benefits."2
Approximately 500,000 people in Massachusetts use MassHealth. The program pays for health care for certain low- and medium-income people living in the state who are under age 65 and do not live in nursing homes or other long-term-care facilities.
Under the new regulations, all MassHealth members over the age of 21 will no longer be eligible for chiropractic services. According to a January 1 Boston Globe article, approximately 4,000 adults received chiropractic care through MassHealth last year.3 In all, more than 113,000 people used one or more of the services slashed by the Swift administration.
Members will retain eligibility for some services, depending on the circumstances. For instance, prosthetics and orthotics will still be covered, but only if they are provided as part of a medically necessary hospital stay, not on an outpatient basis. Dentures will still be covered, but only for people who risk suffering a life-threatening illness without them.
As if the current cuts haven't run deep enough, the state plans to shut an additional 50,000 residents out of the Medicaid program entirely, starting in April.
"It's a catastrophe in terms of patient health," said Dr. Madeleine Biondolillo, executive director of the Urban Medical Group in Jamaica Plain.4
The situation in Massachusetts is the latest in an alarming trend with regard to health care coverage in general, and chiropractic coverage in particular, as states and private enterprises struggle to deal with rising health costs and monetary shortfalls.
Last year, Vermont invoked an emergency budgetary rule that prohibited Medicaid beneficiaries over the age of 21 from receiving coverage for chiropractic. (Editor's note: See the Dec. 16, 2002 issue of DC, or visit www.chiroweb.com/archives/20/26/09.html.) And Wal-Mart, the nation's largest private employer, recently chose to remove chiropractic from its employee benefits package, claiming it was "forced" to make "tough choices" about its health benefit plan. This development came in despite the fact that more than half of all Wal-Mart employees claim to have joined the company because its benefits, and despite the company's reported $1.25 billion in sales on the day after Thanksgiving 2001 - a record broken with a single-day sales total of $1.43 billion on November 29, 2002.5,6
References
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Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
