Alternative Health-Care Groups Push for `Choice' in Reform Bill A HURDLE FOR CONGRESS

Article excerpt

WHEN President Clinton introduced his plan for health-care reform, he stressed "freedom of choice" as a key goal. Many Americans took that to mean they would still be able to choose their own doctor or medical treatment.

But the word "choice" can have many meanings and apply to many aspects of reform, from the question of abortion coverage to the field of alternative medicine to the area of religious freedom.

As Congress struggles with the many issues of health-care reform and appears headed toward a key vote in August, advocates aiming to preserve freedom of choice are speaking out, hoping to influence the legislation.

Most audible, and most threatening to the entire reform process, are advocates on both sides of the abortion issue.

The legislation being considered includes abortion as a covered benefit. But a strong anti-abortion faction in Congress, backed by the National Conference of Catholic Bishops, threatens to sink reform if abortion is covered.

Equally adamant are some members of Congress who insist on keeping abortion as a basic benefit, but who do support a "conscience clause" that allows individual doctors to choose not to perform abortions.

In addition to the abortion debate there is a broader question: How much choice in selecting treatment and providers will Americans have under a federally mandated insurance program?

Already, a large number of Americans use alternative methods in place of or in addition to conventional medicine.

A study published last year in the New England Journal of Medicine found that in 1990, 34 percent of Americans used alternative medical techniques, such as acupuncture, chiropractic, homeopathy, and naturepathy, at a cost of $10.5 billion - a sum equal to the money spent out-of-pocket by Americans for hospitalizations. In most cases, these techniques were used along with mainstream medicine. Increasingly, insurance companies are covering some of the commonly used alternatives. Who decides benefits?

Health-care reform throws open the question of what should be in a basic benefits package - and focuses attention on the government's role in deciding which methods should be encouraged. Among the groups practicing alternatives, the most active lobbyists are chiropractors.

The American Chiropractors Association (ACA) has a two-part agenda: to ensure that a federal benefits package is defined to cover chiropractors and to advance consumer choice.

"If the benefits package broadly defines `services of health professionals' as those licensed by states, that would be fine with us, provided there is committee report language naming chiropractors by name," says Rick Miller, the ACA's chief lobbyist. Every state licenses chiropractors.

To promote consumer choice, the ACA is pushing for a so-called "any willing provider" provision. This would mandate that an insurer cover treatment by a provider who fits this criterion. The ACA also wants to prevent any bill from discriminating against types of providers.

At issue is how broadly the government will define "health-care professional." All the health-care bills provide for the creation of a national commission that will set up a system to define "medical necessity," but not to define the appropriate treatment.

Other alternative-medicine groups contacted said they were monitoring the progress of legislation by keeping in touch with members of Congress, such as Sen. Tom Harkin (D) of Iowa and Sen. Barbara Mikulski (D) of Maryland, who are advocates for alternative therapies.

Robert Duggan, director of the Traditional Acupuncture School in Columbia, Md., says his aim is to make sure no procedures are proscribed and that the question of who can provide treatment remains a state issue. …