I have never favored single-issue politics. Life and legislation are typically too complex for decision-making based on one position.
Yet as we wait on the U.S. Supreme Court's decision on the Patient Protection and Affordable Care Act, I find myself focusing on the meaning of full repeal to a limited but growing part of U.S. health care: integrative medicine.
Over the last 30 years, many so-called complementary and alternative medicine (CAM) or integrative health care practitioners have gained or advanced inclusion in state licensing, state-mandated insurance coverage schemes and other state policies such as pain commissions and loan forgiveness for serving the underserved. Among these are chiropractors, massage therapists, acupuncturists, direct-entry midwives and naturopathic doctors.
Yet mainly these practitioners remained excluded -- with rare exceptions outside of research at the National Institutes of Health -- from federal policy.
The Affordable Care Act changed all that. That law has powerful elements of historic conclusion in areas of workforce planning, payment, delivery, research and health promotion.
In Section 4001, U.S. Congresswoman Barbara Mikulski, D-Md., inserted concepts of "integrative health," and "integrative practitioners" in a major National Prevention, Health Promotion and Public Health Council. Two integrative medical doctors, a massage therapist researcher and a public health-oriented licensed acupuncturist now sit on an advisory group. The Affordable Care Act mandated that the advisory group have such representation.
Section 3502 of the law, on patient-centered medical homes (PCMHs), specifically denotes that these multidisciplinary practices may include chiropractors and licensed complementary and alternative medicine practitioners in their community-based, team care models.
In Section 2301 of the reform law, U.S. Senator Maria Cantwell, D-Wash., helped create access to one of these emerging, natural health-oriented provider types. Cantwell took the lead in giving Certified Professional Midwives (CPMs) their first formal federal inclusion as covered practitioners in birth centers.
A major, real world-oriented research initiative also showed historic embrace of integrative practitioners. Via Section 6301, U.S. Senator Kent Conrad, D-N.D., worked with Mikulski and others to ensure that state-licensed integrative health practitioners were in the leadership of the real world research initiative called the Patient Centered Outcomes Research Institute (PCORI). Chiropractor-researcher Christine Goertz, DC, Ph.D. now fills a mandated position for a licensed integrative practitioner on that Board of Governors. Goertz' appointment helped secure inclusion of integrative practitioners in PCORI's strategic plan.
Another area of inclusion, addressed in Section 5101, was the National Healthcare Workforce Commission. U.S. Congressman Bernie Sanders, I-Vt., required forecasters to include chiropractic doctors, naturopathic doctors, acupuncture and Oriental medicine practitioners, massage therapists, licensed midwives and other integrative health practitioners in the nation's planning. (This initiative was never funded.)
Last, but not least, Tom Harkin, D-Iowa, led an effort to insert the Section 2706 language entitled "Non-Discrimination in Health Care." The section requires insurance plans that cover services of a medical doctor to also cover such services if provided by another provider type whose license allows him or her to perform that service. Such coverage will facilitate interprofessional collaboration.
These are each significant for integrative medicine's vision of "a comprehensive and compassionate health care system offering seamless integration of effective complementary and conventional approaches to promote healing and health in every individual and community."
Perhaps even more supportive for integrative medicine's future under the Affordable Care Act are the new accountable care organizations and PCMHs promoted by the law. These begin to shift the perverse incentives in fee-for-service payments. They create context in which the CEO of Allina Hospitals and Clinics, Ken Paulus, states that "for the first time ever the payment will change toward keeping people healthy." Paulus and others view these as historic opportunities for integrative medicine.
So as the big ship of Obama's health care reform is blasted about by threatening winds -- with a decision anticipated this week -- I find myself huddled in the hold, clutching to these seeds of potential change. Planting and nourishing these elements of reform represents opportunity for a medicine that focuses on health.
If one is to be a single-issue voter, supporting changes that assist a reactive medical system to focus on health is not a bad banner. A full repeal by the U.S. Supreme Court will be a huge set-back for the integrative health care field.
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