The Federal Acupuncture Coverage Act, which is introduced every year, aims to implement coverage of acupuncture treatments for people receiving Medicare Plan B insurance and federal employees.
The general population may not realize this, but with each new year that this bill is introduced a huge debate begins in the acupuncturist community. There are many people on both sides of the issue, one side wanting Medicare coverage and the other group not wanting it. I thought it might be of interest to non-acupuncturists to learn more about this debate and how it might effect them.
Insurance coverage of acupuncture has some major pros and cons. Because the bill would make acupuncture treatments covered by insurance at the national level, many people believe that this step would be the first step to getting all other insurance companies to cover acupuncture. The most obvious pro is that more people would have access to acupuncture which can sometimes be too expensive for people to utilize. However, some practitioners fear that while more people would have access to acupuncture, the quality of the treatments may be compromised by the restrictions inherent in insurance systems. For example, insurance companies pay paltry amounts to the practitioner for treatments, and it is often standard for them to deny a first payment request. Because of the loss of income, a practitioner is more likely to see a greater number of patients in a shorter amount of time. This is exactly what happened to chiropractors and medical doctors under the insurance systems. Packing in more patients leaves practitioners less time to spend with those patients. Another fear that some acupuncturists have is that the reimbursement schedule from Medicare would be unreasonably low. This fear is valid if you look at Medical, the California state insurance system, which pays around only $9 per treatment. Due to huge cuts to public health on the federal and state levels, coverage is likely to be cut completely this year anyway. On the pro side of the debate, some basic acupuncture treatments that can be done quickly, orthopedic, pain or stress treatments for example, are perfect for the type of practice that would have to see 30+ patients a day to make ends meet. Acupuncturists on the anti-insurance side of the debate believe that this type of practice can be more effectively run without insurance interference, by charging reasonable fees directly to the patients without making large insurance companies richer. Community acupuncture is one option for such a practice. It typically involves a one room clinic with chairs or tables set up close together to facilitate quick and easy treatments at a low cost. The idea was born out of detox treatment clinics where many patients would sit around in the same room while receiving the standard acupuncture protocol for addiction. New clinics are sprouting up all the time based on this model with the purpose of providing acupuncture to people who would normally not be able to afford it. Having worked with this style of clinic in a few settings, I can say that it is a wonderful way to bring basic acupuncture to many people. On the other hand, without funding in some form, it is not something that most of the patients I saw would have paid for, even for only a few dollars out of their own pocket. This is where insurance coverage would really be of benefit to the population, helping people receive treatment who otherwise would not.
Another fear some acupuncturists have is that insurance companies will start having more influence over treatment protocols. This is also a valid fear based on how the current medical insurance system interferes with treatments that the company deems not “medically necessary”. When the insurance company begins deciding what treatments are appropriate, and how many are “necessary”, the quality of care suffers. Many acupuncturists do not want to be absorbed into and effected by the insurance machine that has already caused immense problems in the regular health care system. They believe that as a profession we should come together to ensure that all patients have access to care, through community and low cost clinics, and that practitioners should be able to make a living by charging fair rates to patients that can afford it.
As with each previous years’ acupuncture coverage bill, it will most likely not be approved. The federal government is looking for any way to cut costs, especially in the public health and human services sector. However, each year this bill’s incarnation sparks the debate anew, and our profession struggles to decide the best way that we can ensure quality natural health care for the public.