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Pathways to healing: ObamaCare expands access to natural health providers: how will it be implemented?

During the debate over the Affordable Care Act, the CAM professions (particularly the chiropractors) lobbied in support of "nondiscrimination in health care," which means offering expanded access to non-MD providers. The law amends Section 2706 of the Public Health Service Act to say that health plans may not discriminate against any providers operating within their scope of practice. This doesn't require health insurers to contract with every available health-care provider; it does mean that insurers won't be able to exclude an entire category of providers from their network. This section of the Affordable Care Act will take effect on January 1, 2014.

Obviously, Section 2706 could substantially alter the health-care marketplace for licensed complementary and alternative medicine practitioners. Actually, the effect is broader than that. This is a significant step in the direction of team-based care and increased consumer choice. During the debate on Capitol Hill, Section 2706 was supported by non-MD providers such as nurse anesthetists and optometrists, as well as the CAM disciplines. The America Medical Association (AMA) has mobilized to condemn and work to repeal this provision through active lobbying and testimony on Capitol Hill. A resolution condemning Section 2706 has won support at each annual AMA House of Delegates meeting since the law was passed.

At the same time, many of the CAM disciplines are mobilizing their professional associations to lobby, on a state-by-state basis, supporting nondiscrimination in health care. Now the Integrative Healthcare Policy Consortium (IHPC) is stepping forward to develop a coordinated campaign supporting efforts throughout the country. IHPC has retained former Washington State Insurance Commissioner Deborah Senn, JD, to act as a pro-2706/ nondiscrimination spokesperson during the year.

IHPC represents the consensus views of 14 healthcare organizations that are committed to integrative health care (see Resources section for complete list). Its core membership includes professional organizations representing the six licensed and certified whole-person oriented integrative health-care disciplines: chiropractic, acupuncture, massage, homeopathy, midwifery, and naturopathic medicine, which together have 375,000 licensed practitioners in the US.

During the coming year IHPC will serve as a national clearinghouse and information channel on Section 2706 implementation for its membership base and the integrative health-care community nationally. On a state level it will prepare white papers, webinars, and information kits to share best practices and 'lessons learned" as the campaign gets under way and progresses.

"Section 2706 got through all the challenges of last year," says Alyssa Wostrel, IHPC executive director. "Now that the Affordable Care Act has been deemed constitutional, we are ready to go. Now we see that the insurance exchange implementation process is truly up to the states. There hasn't been much guidance yet from HHS, and there have been varied interpretations of the intent of Section 2706."

IHPC has developed a blog site specifically for licensed massage therapists who want to follow current developments in support of IHPC's focus on Section 2706 and what the nondiscrimination provision will mean for this profession. "We are working on expanding the blogging network in a similar fashion for the licensed disciplines of acupuncture, naturopathy, chiropractic, homeopathy and midwifery,"' says Wostrel.

Insurance Commissioner Senn Supports Patient Access to Natural Medicine

Deborah Senn served two terms as Washington State's elected insurance commissioner (1993-2001). In that role, she was responsible for implementing Washington's landmark "Every Category of Provider Law," which required insurers to cover every category of health-care provider licensed within the state. "Our experience shows that the public leads on this issue," Senn says. "The integration of health care increases exponentially every year. For example, a cancer patient here in Washington has a treatment team that includes an oncologist and in addition an acupuncturist or naturopathic physician. This is something people really want."

Based on her experience, Senn will be able to anticipate the issues and challenges that are likely to arise during the battle over implementation of Section 2706. In Washington she developed a "Clinician Workgroup," wherein insurance companies and CAM practitioners met in a series of facilitated discussions that led to informed dialog and promoted relationships of mutual respect. "We have actual experience in reaching out to the other side, forming coalitions and sitting down at the table to hammer out ways this initiative could develop successfully, for the ultimate purpose of helping patients," Senn says.

Working to implement Section 2706 will be an intricate, step-by-step process, she notes. Supporters of nondiscrimination will face widely different situations in different states.

For one thing, the CAM professions are licensed in some states but not in others. Their scope of practice varies from state to state. "You know what they say, the devil is in the details," Senn adds. "We face different regulatory and oversight configurations in every state. In Washington, as insurance commissioner, I was broadly responsible for all forms of health insurance. In California the insurance commissioner only has jurisdiction over traditional indemnity plans, which form a very small portion of the market. In California the benchmark plans to be offered on the health exchanges were adopted by the state legislature, while the Department of Managed Care has jurisdiction over the managed care plans. You can see how complicated implementation in all 50 states will be!"

An Enormous Challenge, and a Greater Opportunity

CAM practitioners, and people who value CAM services, face an enormous challenge during 2013 ... and an even greater opportunity. Just the fact that Section 2706 ended up in the final legislation, and that the Supreme Court upheld the Affordable Care Act ... who could have predicted this a few years ago?

But to move from possibility to actuality, to build upon the general "nondiscrimination" language of Section 2706 and transform it into actual access to natural health practitioners for actual patients ... that will take quite a bit of work. A lot of work, within a concentrated time frame. Plenty of work to go around.

"Pass the word along!" says Wostrel. "For these goals to be achieved, we need to make the public aware of the changes happening. Tell your friends. Tell your clients. Your voice matters! Tell your elected officials why having access to the provider of your choice and integrative health care is such an important issue for you."

IHPC has set up an "Action and Advocacy" Web page with contact information for elected representatives and media. Throughout the year, the focus will shift as various states begin to make decisions about their local health-care options. On the website, people can sign up for e-mailed "Action Alerts" to stay in touch with the latest developments and the most urgent needs. "Please consider volunteering," Wostrel says. "We need help from people with a wide range of skills. There are so many different ways people can be involved at the grassroots level."

Mounting a campaign like this requires significant support for marketing materials and all the varied tools that carry a message out into the world. "IHPC is building out its infrastructure in order to work effectively on a state level," Wostrel says. All donations are welcome, and there is a link for donations on the IHPC web page.


Integrative Healthcare Policy Consortium (IHPC): Click on "Action" to sign up for Action Alerts. Facebook at

IHPC sites for massage therapists:;;

Visit for continuing coverage of recent developments in US integrative health care.

Contact Wostrel at or 202-505-4472.

IHPC represents the consensus views of 14 "Partners for Health/' including the American Association for Acupuncture and Oriental Medicine (AAAOM), the American Association of Naturopathic Physicians (AANP), the International Chiropractic Pediatric Association (ICPA), the International Chiropractors Association (ICA), the American Institute of Homeopathy (AIH), the National Center for Homeopathy (NCH), the National Association of Certified Professional Mid wives (NACPM), the American Massage Therapy Association, (AMTA), the Naturopathic Medical Student Association (NMSA), the American Medical Student Association (AMSA), the MD-led integrative pain organization the American Academy of Pain Management (AAPM), Life University, Bastyr University, and the Palmer Center for Chiropractic Research. IHPCs Policy Council members include the Chanda Plan Foundation and Double Helix Water.

Elaine Zablocki has been a freelance health-care journalist for more than 20 years. She was the editor of Alternative Medicine Business News and CHRF News Files. She writes regularly for many health-care publications.
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Author:Zablocki, Elaine
Publication:Townsend Letter
Geographic Code:1USA
Date:May 1, 2013
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