Naturopathic Physicians and Health Insurance
Jud Richland, MPH, AANP CEO
The White House Weighs In
Wednesday, January 22, 2014
by: Jud Richland, MPH, AANP CEO

Section: ED Update

The White House last week issued its response to the naturopathic community’s petition to include naturopathic physicians in the Affordable Care Act.  Many people who have read the response have asked me what it means, especially with respect to naturopathic physicians’ participation in health insurance.  Those are good questions.  With all the political infighting surrounding the Affordable Care Act, the White House decided that not taking a crystal clear stand one way or another was the safe way to go.  That’s not to say there isn’t value in the White House’s response, but we’ll get to that in a moment.
First, a couple of things need to be said.  Most importantly, the opportunity offered by the Affordable Care Act to participate in health insurance is a huge step forward for our profession.  Nobody is required to participate in insurance.  If implemented properly, though, the law opens the door for those who wish to participate to do so.  Based on our AANP membership survey, about half of our members would like to participate.  Certainly, patients who would like to visit a naturopathic doctor but cannot afford to pay out-of-pocket will benefit from expanded insurance coverage.
Second, the section of the Affordable Care Act (Section 2706) that relates to participation in health insurance by licensed health care providers is very clear.  It states that an insurer “shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.”  There’s not a lot of ambiguity there.  If a naturopathic physician is excluded from participating in insurance just because she’s a naturopathic physician, that’s not permissible.  That’s the clear meaning of the law, and we know from numerous discussions with Sen. Tom Harkin, the sponsor of the provision, that that’s exactly what was intended.
Unfortunately, anybody who’s familiar with how laws get implemented knows that it’s never that straightforward.  In the case of the Affordable Care Act, things really get messy because each state is responsible for deciding how to implement the law.  As a result, no two states are implementing the law in the same way.
That’s why AANP, in partnership with state associations in licensed states, has been so aggressive in advocating that Section 2706 be implemented as intended.  We hold conference calls with state leaders each month to discuss advocacy strategies and progress in each state; we’ve developed fact sheets and model letters for use by our associations; we’ve retained a consultant (the Hon. Deborah Senn, former Washington Commissioner of Insurance) to meet with state insurance commissioners as needed; we’re mobilizing patients in partnership with selected state associations to let state leaders know that patients want the law implemented as intended; we’ve met with congressional and federal agency leaders to encourage them to implement the law properly; and we partner with other national organizations to coordinate strategy and carry out action steps.
Our work is paying off.  More and more state leaders are welcoming our input.  Some states continue to waffle in their interpretation of Section 2706, but we’re optimistic most of those states will end up doing the right thing.
So, back to the White House response.  The White House statement doesn’t carry any legal weight.  Still, we’ll use the response as one more arrow in our quiver as we seek to make sure the law is implemented properly.  The White House acknowledged that indeed Section 2706 addresses what types of providers insurers must include in their networks, not just out of network.  For state officials who have not interpreted the law this way, we now have added ammunition to make our case that this is what the law intended.  While we had hoped the response would have clearly enumerated "naturopathic physicians" as a specific provider type that had to be included, the White House instead referred to the fact that Section 2706 addresses licensed providers generally.  It's up to us to connect the dots for officials in licensed states and educate them that naturopathic physicians are providers who are licensed to provide routine health benefits.
The successes we’ve achieved so far in our state advocacy for Section 2706 – with many more to come – are contributing to the transformation of the health system.  Those successes will give many more people the opportunity to maximize their health and well-being as a result of naturopathic medicine. 
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