Schumacher Chiropractic Clinics

FAQs: How Health Care Reform Will Affect You

On Tuesday, March 23, 2010, President Obama signed H.R. 3590, the Patient Protection and Affordable

Care Act into law. Here are answers to some frequently asked questions about what reform will mean to

doctors of chiropractic and  patients.

What provisions begin soon?

Starting this year, children up to age 26 would be allowed to remain on their parents' health plan. People

with pre-existing medical conditions would be eligible for a new federally funded "high-risk" insurance

program. Small businesses could qualify for tax credits of up to 35% of the cost of premiums. Insurance

plans would be barred from setting lifetime caps on coverage and would no longer be able to cancel

policies when a patient gets sick. Health plans would also be prohibited from excluding pre-existing

conditions from coverage for children.

When do the main reform changes kick in?

In 2014. That’s when insurance marketplaces, or exchanges, would be set up in states to offer competitive

pricing on health policies for individuals and small businesses that don’t have coverage. People with a

pre-existing condition would no longer be denied coverage, and all lifetime and annual limits on coverage

would be eliminated. Medicaid would be expanded to cover more low-income Americans.

What are the requirements for individuals to buy insurance?

Starting in 2014, a person who did not obtain coverage would pay a penalty of $95 or 1% of income,

whichever is greater. That penalty would rise to $695 or 2.5% of income by 2016. The bill would exempt

the lowest-income people from that insurance requirement. Medicaid would be expanded to cover those

under age 65 with an income of up to 133% of the federal poverty level (below $29,327 for a family of

four). To make coverage more affordable, the legislation would offer premium subsidies for people with

incomes more than 133% but less than 400% of the federal poverty level ($29,327 to $88, 200 for a

family of four). In addition, people in their 20s would have the option to buy a lower-cost "catastrophic"

health plan.

How will small employers be affected by the changes?

Employers with 50 or more workers would face fines for not providing insurance coverage. Businesses

with smaller workforces, though, would be exempt. Companies would get tax credits to help buy

insurance if they have 25 or fewer employees and a workforce with an average wage of up to $50,000.

Does the bill affect the Medicare chiropractic benefit?

There is no inclusion of an expansion of services DCs may be reimbursed for by Medicare. Full

chiropractic parity in Medicare remains a signature issue for the ACA and we continue to work with the

Congress and the Administration in achieving this goal.

What changes will occur in Medicaid?

Individuals and families with incomes up to 133% of the federal poverty level (below $29,327 for a

family of four) will gain coverage. The federal government will pay all the states’ costs for the newly

eligible Medicaid beneficiaries for three years. And primary-care doctors treating Medicaid patients will

get an increase in their fees. Chiropractic availability is determined by the state and will remain a state by

state issue.

Will reform reduce health insurance costs?

Many health care experts say that while it contains some cost-cutting provisions and pilot programs, the

legislation doesn’t go far enough to tame rising costs. People with chronic medical problems, though,

generally would see their premiums decrease because of the new ban on pre-existing conditions.

How will the $940 billion price tag (over 10 years) be paid for?

Wealthier families will pay more in taxes. Starting in 2013, families with annual incomes above $250,000

(and individuals earning more than $200,000) would pay an additional 3.8% tax on investment income,

and also face a higher Medicare payroll tax. Expensive, "Cadillac" insurance plans would draw a new tax

starting in 2018. And the Medicare program would receive substantial cuts, including a $132 billion

reduction in funding for Advantage plans run by private insurers.

How was provider discrimination in health care addressed?

This was one of the premier issues for ACA. Section 2706 of the bill states that, “No health plan or

insurer may discriminate against any health provider acting within the scope of that provider’s license or

certification under applicable State law.” This is the first federal level non-discrimination clause to

protect doctors of chiropractic regarding participation in a health plan. This will ensure that insurance

companies cannot unfairly exclude doctors of chiropractic from practicing under the capacity of their

training and licensure on a federal level. This provision is also applicable to ERISA plans and other plans

established or regulated under the bill.

What are Community Health Teams and how do chiropractors benefit?

“Community Health Teams” were created to support the development of medical homes by increasing

access to comprehensive, community based, coordinated care. These teams are integrated provider

groups including primary care providers, specialists, and other clinicians and licensed integrative health

professionals as well as community resources to enhance patient care, wellness and lifestyle

improvements. The language in the bill specifically lists DCs as potential members of Community Health

Teams to support the development of “medical homes” and ensures that doctors of chiropractic can be

included in these patient-centered and holistic teams.

How does the law address the national health care workforce shortage?

The legislation calls for the creation of a “National Health Care Workforce Commission,” tasked with

providing comprehensive information to Congress and the Administration about how to align federal

health care workforce resources with national needs. Congress will use this information when providing

appropriations to discretionary programs or in restructuring other federal funding. DCs specifically

included as part of the National Health Care Workforce Commission; included in the definition of “Health

Care Professionals.” Also, chiropractic colleges are also included in the health professional training

schools definition. The language in the bill guarantees that the need for doctors of chiropractic will be

addressed when considering federal health care workforce programs.

Source: Public Law 111-148; www.speaker.gov.

For Additional Information Please Contact:

American Chiropractic Association

Department of Government Relations

1701 Clarendon Blvd.

Arlington, Virginia 22209

(703)812-0224

www.acatoday.org

gr@acatoday.org