The American Association for Health Freedom (soon to be The Alliance for Natural Health-USA thanks to our merger with The Alliance for Natural Health) has worked for months to gain recognition for integrated healthcare in President Obama’s Comparative Effectiveness Research (CER) plan (part of the stimulus bill) and in multiple iterations of healthcare reform legislation. We have been assisted by many friends on the Hill ranging from Senator Harkin, a Democrat, to Congressmen Ron Paul, a Republican. We are now very grateful to Senators Mikulski and Conrad, who at our urging worked with other senators to modify the current senate healthcare bill to include representation for the integrative medicine community.
The CER Commission established by the bill would determine areas of national medical priority and commission research to evaluate the clinical effectiveness of various treatments for particular conditions. The stated intent is to determine the best treatments and then provide this information to policymakers, clinicians, healthcare payers, and the public to better inform healthcare decision making.
First established in the stimulus bill, CER is controversial for good reason. Any such government body will very likely be captured by special interests such as drug companies, medical equipment manufacturers, or the AMA. It may also lead to a one-size fits all system of medicine. Knowing that the CER program is a non-negotiable item for both President Obama and Congress, we have been working to ensure that any system created to fund and evaluate medical treatments will at the very least provide an even playing field for integrative medicine. In a best case, CER would also fund research about non-patentable and thus largely ignored natural treatments.
Thanks to Senators Mikulski and Conrad, along with other friends, the senate healthcare bill now requires that the CER board include at least one integrative healthcare practitioner along with healthcare consumers, physicians, private payers, and pharmaceutical and diagnostic manufacturers. It also includes, as appropriate, experts in integrative health and primary prevention strategies on the CER advisory panel. This marks the first inclusion of integrative medicine in any federally designed program. While we have miles to go, these are powerful first steps.
Other important provisions in the senate healthcare bill include the following:
- Inclusion of a “Sense of the Senate” that the Congressional Budget Office (CBO) should restructure their scoring of integrative medicine. Currently, when scoring legislation to determine the cost of a bill, the CBO assumes the cost of preventive services are realized initially and are not offset by later savings. For example, nutritional counseling is seen solely as a cost, not as a way to prevent and control diabetes, thereby saving billions. Although Sense of the Senate expresses the Senate’s opinion rather than creating law, this is a strong statement about the need to restructure CBO accounting, and one we hope the CBO will seriously consider.
- Establishment of a National Prevention, Health Promotion, and Public Health Council to develop a national preventive and integrative healthcare strategy. The council will be advised by a group of experts required to include diverse health professionals including integrative health practitioners who have expertise in preventive medicine. The national plan also mandates a list of national priorities on health promotion to address lifestyle behavior modification including proper nutrition. Again, the senate has mandated the inclusion of integrative health practitioners in yet another program that, should the bill pass in this form, will strongly influence the direction of our health system. We are also pleased to see true prevention, such as nutrition, included in the list of priorities.
- Group health plans and issuers offering group or individual health insurance coverage are required to report on whether coverage benefits under healthcare plans includes wellness and health promotion activities. The bill states that wellness programs may include personalized services that may be geared toward smoking cessation, weight management, stress management, physical fitness, heart disease prevention, healthy lifestyle support, and diabetes prevention. While there is no requirement these preventive services be covered by healthcare insurance, the suggested areas of inclusion within wellness coverage is a step in the right direction.
We wish these provisions were all there is to talk about in the Senate bill. Despite the victory described above, there are still many really bad features of the bill, features that we have discussed before, including:
- Electronic health records – All qualified health-benefits plans are required to use electronic health records set up in such a way as to gut your privacy and jeopardize doctors’ use of integrative therapies. The plan also includes unique health plan identifiers – each of us will have a cradle to grave unique ID number that will track medical history. Thanks to the electronic health records mandate, this information will be available with the click of a mouse.
- Cost-Sharing is prohibited for preventive services. A strict reading of the definition of “cost-sharing” may prevent out-of-pocket payment for medical services that are supposedly “available” under qualifying health insurance. This means that you may not be able to pay privately for what you want but is not specifically covered under the policy. This kind of restriction already exists with Medicare. If you want more than Medicare provides, it is illegal for your Medicare doctor to provide it.
- Mandated healthcare coverage – You can no longer choose the healthcare options that work best for you. You must now purchase coverage that is defined by the government. Individuals who do not have or buy this qualifying coverage will be taxed on their annual tax return. And, of course, those that fail to pay their taxes will go to jail.
- Catastrophic and similar packages will no longer be available to anyone over the age of 30. These packages have enabled people to buy natural healthcare on their own while still being covered for major medical. This vital option will disappear for many of us.
- Cap on Flex-Spending Account (FSA) contributions at $2,500 – Currently, the contribution level is unlimited. This is another way to make natural medicine more expensive for consumers.
- Medicine Cabinet Tax – Americans would no longer be able to purchase over-the-counter medicines with their FSA, Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA).
- Increase in the non-qualified HSA distribution penalty from 10 percent to 20 percent. This makes HSAs less attractive and paves the way for HSA pre-verification.
- Likely long-run elimination of HSAs – The Senate bill is confusing about HSAs, possibly intentionally so. The real intent may be for them to disappear completely because they won’t be able to comply with mandated policy requirements.
The Senate bill also uses various “smoke and mirrors” ways of appearing to pay for itself, but we will leave that part of the story for the financial experts.
The U.S. Senate is scheduled to begin debate on the merged healthcare bill this week. As always, we’ll keep you updated with the latest developments and opportunities to take action and make your voice heard in the healthcare debate!