Health "Insurance" Reform Becomes Law ... What Now?The long awaited conclusion for health care reform is here. So just what have we accomplished for the naturopathic profession?
For the past several months, industry (meaning pharma, the AMA, and the insurers) spent more than $600,000 a day on lobbying and media to advance their causes. At the end of the day, through an historically complex and previously untried process, a new law has been signed that provides a moral victory for those who believe every American is entitled to health care coverage. It resulted in a bitter debate, ripe with vitriol that promises to further divide the Republicans and Democrats. And it dramatically expands our current insurance paradigm, one still focused on treating disease, not so much on getting to the root of the problem - systemically or personally. For information on when specific provisions of the law will be implemented, please click here.
As a profession, naturopathic medicine suffers defeat and shares in victory. The Indian Health Care Improvement Act was reauthorized in this process, a monumental celebratory event for the Native Americans and Alaska Natives for whom this Act is designed, having waited more than 10 years for this day. Unfortunately, our provision for inclusion in loan repayment was not a part of the final legislation that the President signed into law. In this case it was process, not politics, that failed us, and in May, during the DC FLI, we will proactively be declaring the absolute necessity of naturopathic doctors being a part of all federal loan repayment programs. While this is definitely a blow, I do believe the broad mandates of the Act set the stage for us to gain more given the shortage of conventional primary care physicians.
There are also several sections of the pending law that will provide opportunity for naturopathic medicine (as previously reported) and other licensed professions who practice outside conventional boundaries. I highly recommend taking a look at a video posted by American Chiropractic Association with a delightful summary of these provisions and more.
Nondiscrimination: Insurers will not be allowed to discriminate against providers who are licensed in their states. This is good news given the creation of state-based exchanges and the fact that it will also apply to ERISA-covered, self-insured employers.
Workforce Development: Health Care Workforce is defined to include licensed complementary and alternative medicine providers and integrative health practitioners.
Comparative Effectiveness Research (CER), designed to evaluate and compare health outcomes and clinical effectiveness, now includes the treatments and services of "integrative health practices."
The Tax Benefits for Wellness Program provides expanded opportunity for NDs to create and implement programs for employers who have new incentives to implement the programs.
Opportunity and Challenges
There are many ways to use this law to expand access to naturopathic medicine, and there are potential obstacles. Insurers may not discriminate, but they certainly can dictate the number of NDs who they empanel and the scope of care they provide. Opportunities may continue to be tied to the tightly defined provisions for Medicare and Medicaid. Regulations could be drafted by federal employees with little or no knowledge of naturopathic medicine. Boards and Commissions could be populated by those with strong political ties vs. strong consumer ties. Effectively battling the AMA SOPP becomes more important than ever. And yet - new doors are open and the real work of transforming our health care system can start! Funding bills, regulatory processes, appointments, and changes to insurance laws offer up the opportunity to influence. And influence we will.
Karen E. Howard
American Association of Naturopathic Physicians