Two of AANP’s most important policy initiatives aim to give NDs the opportunity to participate in health insurance if they so desire. One initiative strives to ensure full implementation of the Affordable Care Act provision that prohibits insurers from discriminating against licensed health care professions. The second, newer initiative aims to enable NDs to participate in Medicare.
At the same time, it’s clear that many NDs have no interest in participating in health insurance, even if the barriers to doing so are removed. That perspective is understandable given that many NDs operate highly successful practices without insurance and that insurance inevitably brings with it a lot of administrative headaches. Of course, insurance participation will always be voluntary, so if you don’t want to participate, you’ll never be required to.
...these insurance initiatives can profoundly advance both the nation’s health and the health of our own profession, even if it’s not everyone’s cup of tea...
The larger question is whether having the ability to participate in insurance is good for the future of naturopathic medicine as a whole. We learned at the previous two AANP leadership summits that NDs have a wide range of views about whether naturopathic medicine should become “mainstreamed” or whether it should operate at a distance from the conventional medical system. On the one hand, some believe that becoming mainstreamed could lead to diluting the practice of naturopathic medicine, causing doctors to incorporate parts of conventional medicine that don’t fit seamlessly with their philosophy and training. Others believe that becoming more integrated into the medical system offers the potential to move health care in general in the direction of whole person, patient-centered care. They also believe it offers the potential to become more financially successful.
My own view is that success in these insurance initiatives can profoundly advance both the nation’s health and the health of our own profession, even if it’s not everyone’s cup of tea. The strongest arguments revolve around the benefits to patients. Most important, including NDs in health insurance will give prospective patients who would otherwise not have the means to be cared for by an ND the opportunity to do so. In fact, I already have an inkling that many new patients would seek care from an ND given the opportunity. That’s based on a survey AANP is conducting of individuals age 65 and above to assess their interest in having access to NDs in Medicare. Complete survey results will be released at the end of the month.
Another important reason we need to give NDs the opportunity to participate in insurance is simply that soon we won’t be able to afford our health care system. Per capita health spending in the U.S. now exceeds $9,000 per person and rises every year. We need to find ways to reduce the need for repeated, expensive and often ineffective symptomatic treatment. Few approaches will succeed as dramatically as naturopathic medicine.
Another little discussed problem is that laws affecting care for people 64 and under are seriously out of sync with Medicare, which governs care for people 65 and older. Many patients, upon becoming eligible for Medicare, are likely to face serious disruptions in care. Millions of people in the pre-Medicare population will have access to an ND as a result of naturopathic medicine’s growing popularity and as a result of the ACA’s non-discrimination provision. But when they turn 65, under current law their naturopathic physicians will not be able to participate in Medicare.
AANP member surveys show that recent graduates of naturopathic medical schools are especially interested in participating in health insurance. Younger graduates, burdened by staggering amounts of school loans while at the same time facing the challenge of building a new practice, are understandably eager to find ways to become financially successful.
There is one final reason why I believe ND participation in insurance can be transformational. Simply put, the fastest way to increase the nation’s emphasis on patient-centered, whole person care is to work within the system. Not only does that provide access to the largest number of patients, but it gives NDs the opportunity to demonstrate to the conventional medicine establishment that naturopathic medicine works.
Each ND must decide for herself or himself whether to participate in insurance. At a system-wide level, though, we need NDs working side-by-side with other health care professionals and with payers in order to secure and grow naturopathic medicine’s place in the health care system.