The movement to integrate acupuncture into the current Health Care System was initiated by former President Bill Clinton who established the White House Commission on Complimentary and Alternative Medicine Policy (CAM). The recommendation of this committee was that the federal health plans, Medicare and Medicaid, commence insurance coverage of acupuncture. As a result, 47 percent of employees with PPO and Private Health plans had acupuncture coverage in 2004, up from 33 percent in 2002.The Wall Street Journal also cites that this increase in coverage represents “a trend …in which alternative medicine has gone more mainstream”, with employers seeing employee insurance benefits for Integrative therapies as reducing the cost of health care insurance coverage (1).
Even though acupuncture benefits are offered among private insurance programs, they remain limited; i.e., acupuncture coverage through one insurer may be limited for a circumscribed number of visits or spending or for only the “acceptable” (non-experimental) treatments of nausea and vomiting, and the pain associated with post-dental surgery (Current Procedural Terminology (CPT), American Medical Association, CPT Category II Codes, 2005)(2). Furthermore, limiting the visits or the conditions for which acupuncture therapy is offered is just one of the “ploys” by which private insurers can market themselves as covering acupuncture care, while in fact offering little or no coverage.
Congressman Maurice Hinchey has been a driving force supporting the integration of Acupuncture and Western Medical Treatment. In 1976, as a member of the New York State assembly, he wrote the landmark legislation that licensed Providers of acupuncture in the state. When elected to Congress, he authored the Federal Acupuncture Coverage Act. Congressional support for this bill has been moderate, but has grown with each successive Congress; i.e., Hinchey’s Bill gained only 5 co-sponsors during the first term it was introduced…but its support had grown to 63 at the end of the 108th Congress in December 2004.The Federal Acupuncture Coverage Act of 2005, HR 818, was re-introduced to the 109th Congress by Rep. Maurice Hinchey on February 15, 2005. With the bipartisan support of 25 co-sponsors, HR 818 seeks to amend title XVIII of the Social Security Act to provide for acupuncturist services under the Medicare Program, and to amend title 5, of the United States Code to provide for coverage of acupuncture under the Federal Employees Health Benefits Program (FEHBP).
Medicare is a national health insurance program for persons aged 65 years and/or older, and the disabled, providing coverage for more than 40 million American citizens (3). Part B is the “fee for service” component of the Medicare plan that insures for doctors’ services and outpatient care. It is administered by the Federal Government, specifically, the Centers for Medicare and Medicaid Services (CMS). CMS determines the reimbursement rates of an assigned (participating) provider. Health care providers that chose to accept “assignment” agree to charge no more than 15% of the Medicare-approved amount (limiting charge), and to accept the Medicare “approved amount” as full payment for covered services (4). Additionally, CMS annually determines the Usual, Customary, and Reasonable Fees (UCR’s) that are charged for a particular service and/or procedure by a Medicare Provider (MEDPAR) within a particular geographic region, establishing the allowable Medicare rate (s). A MEDPAR must accept this allowable rate; additionally, this rate will also determine the Medicare reimbursement schedule for a given treatment (5).
The FEHBP provides health insurance to federal workers, their dependents, federal retirees, and their survivors. The FEHBP is administered by the U.S. Office of Personnel Management (OMP) which negotiates its contracts with private health insurance companies to provide medical coverage to its beneficiaries. This Preferred Provider Organization (PPO) plan sets predetermined policies which are made available to each FEHB member. Unlike the Medicare Program, FEHBP policies are administered by individual insurance plans that which turn, establish their own policies that determine which Health Care Providers will be covered and their rate of reimbursement.
The Federal law currently mandates that all plans contracted by FEHBP’s include certain minimum benefits. If enacted, HR 818 would include acupuncture services in this list of minimum benefits. Additionally, acupuncture treatments would be a covered benefit under the National Medicare Program. According to Hinchey, “More than 40 million Americans regularly use some form of alternative treatment and more than 70 percent of the nation’s insurers already cover acupuncture. It’s discriminatory to prevent the one-fourth of Americans that are covered by federal health programs from choosing acupuncture as part of their health care regime”(6).
HR 818 does not, in of itself, specify the individual acupuncture procedures would be covered by this bill. Rather, these decisions are made after the legislation is signed into law by the CMS and OPM. Currently, the CPT (2005) has acupuncture codes…but they only benefit only those individuals having current acupuncture riders with private insurance companies. Since acupuncture is not covered by Medicare or the FEHBP, patients are often times striving for more health-care choices.
THE FUTURE FOR ACUPUNCTUR COVERAGE????
Acupuncture is not expensive; it does not rely on new medical technology, “pricy” equipment, or pharmaceuticals. It is not an invasive procedure; therefore acupuncture patients do not require prolonged hospital stays or long recovery periods. If enacted,
HR 818, The Federal Acupuncture Coverage Act, would mandate that acupuncture services be included as an insurance benefit of both Medicare and the FEHBP. Coverage of acupuncture under these federal health care programs would also significantly impact the private health insurance market; in particular, the Federal Governments’ coverage of acupuncture would act as a “seal of approval” that is needed to signal to the private insurance companies that acupuncture is a treatment worthy of coverage, and not “ just” an alternative/integrative rider policy.
Complicating this issue is the frustration that exists with the U.S. health care system. Specifically, Medicare beneficiaries and federal employees compose approximately 20 per cent of our population. With the current astronomical health care costs, seniors, the disabled, federal workers, and retirees are not likely to pursue treatments not covered by their insurance plan (s). Rather those 52 million people will seek Western medical treatments that are covered by their insurance.
Furthermore, does not feel he has “control” over his medical care. Most people who are insured are “shuffled” into managed care plans in which their choice of physicians, specialists, health care, and clinic facilities are limited. According to
Dr. Elliot Dancher M.D., and Dr. Arthur Kleinman M.D. (Harvard Medical School), the current allopathic health care system is composed of physicians who are “short on empathy, compassion, and moral engagement”. Thus, the quality of the Health Care Provider-patient relationship is dehumanized, especially for beneficiaries of Medicare and FEHBP searching for alternatives (7).