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Table of Contents

BREAKING NEWS 11/19/13: ACS releases 2014 Legislative Information Proposal and Documentation Part One and TwoWe respectfully request that all state legislators read these vital documents in anticipation of meeting with our lobbyists, doctors, and patients. Read a short description of each document below under #14.

  1. Arizona Chiropractic Society Legislative Mission Statement

  2. Arizona State Legislature: Link to homepage and how to find legislators

  3. ACS Message to Arizona Legislature: Chiropractors are part of the solution and here is the evidence

  4. Attorney General issues legal opinion about copays and deductibles

  5. Link to video of Dr. Immerman's legislative testimony defending chiropractic

  6. Mandate Lite Bills must remove provider sections -- ACS takes action at the Legislature

  7. ACS works to pass new insurance equality legislation and to enforce existing law

  8. Key letters from leading legislators from 1990 to 2000 about ACS and chiropractic laws

  9. ACS 2008 Legislative effort to reduce chiropractic copays and deductibles from specialist to PCP levels

  10. 2007 Legislative Session Wrapup: First legislative compaign to reduce copays and deductibles and to reign in abusive Arizona Chiropractic Board of Examiners

  11. 2004 Legislative Session: Partial Repeal of Insurance Equality. Read this fully documented story of betrayal and treachery by AAC Silver Member Arlan Fuhr, DC and AAC lobbyist Barry Aarons as they helped UHC pass an anti-chiropractic law against the express position of both the AAC and ACS. Passage has caused an explosion of chiropractic medical necessity reviews, with no AAC action against Dr. Fuhr or Mr. Aarons, still the AAC lobbyist Oct., 2010.

  12. Comprehensive Review of the 2012 Legislative Session and all Chiropractic-Related Bills

  13. Comprehensive Review of the 2013 Legislative Session and all Chiropractic-Related Bills

  14. ACS releases 2014 Legislative Information Proposal and Documentation Part One and Two. We respectfully request that all state legislators read these vital documents in anticipation of meeting with our lobbyists, doctors, and patients. 

1. Arizona Chiropractic Society Legislative Mission Statement

If a health insurance policy covers reasonable and necessary services provided by a medical or osteopathic physician then the policy must cover reasonable and necessary services provided by a chiropractor if the patient's problem is within the scope of practice of a chiropractor. No discrimination should be allowed against the usual and customary procedures employed by a chiropractor including adjustments, physiotherapy, rehabilitation, dietary measures, exercise, etc. This mission statement has been at the root of the Arizona Chiropractic Society's successful passage of four insurance equality laws since 1990, and is the basis of the Society's continuing efforts at the present time.

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2. Arizona State Legislature 

Homepage for the Arizona State Legislature

How do I find my legislators?

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3. ACS Message to Arizona Legislature: Chiropractors are Part of the Solution and Here is the Evidence to Prove It

What happens in a typical BCBS plan when chiropractors are the first contact provider for patients with low back pain compared to MDs? There is a 40% cost savings. Click here to read the results of a peer-reviewed medical journal study which reported these striking findings.

What happens when you add chiropractic care to a large health plan like AHCCCS? This has been thoroughly researched and you can find the answer by clicking here which will open a new page full of scientific proof.

What happens when chiropractors become primary care physician (PCP) gatekeepers? This has also been thoroughly researched with results published in peer-reviewed medical literature. Click here to open a new page with all the scientific evidence.

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4. Arizona Attorney General Issues Legal Opinion About Insurance Equality Law

In November 2009, ACS lobbyist Ed Wren sent a letter to Arizona Attorney General Terry Goddard requesting action on the request for a legal opinion made by Arizona State Senators Linda Gray and Rebecca Rios. Read his letter in PDF format by clicking here.

Shortly thereafter, the Attorney General's Office responded to Mr. Wren. You can read the entire letter in PDF format by clicking here.

Finally, on June 16, 2010, the AG issued the long awaited legal opinion. It is partially unfavorable and partially favorable. Therefore, ACS is going to the courts to get a final interpretation. Click here to read the AG's legal opinion.

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5. Live Video Testimony from the Arizona Legislature of Dr. Immerman

View live streaming Arizona Legislative video testimony of Dr. Immerman on 02/16/09 to the Arizona House of Representatives House Banking and Insurance Committee regarding why chiropractic must be included in all health insurance policies. Click here and the hearing on HB2323 Small business health insurance will begin. Advance the cursor to the 50:30 minute mark to see Dr. Immerman speak.

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6. Mandate Lite Bills Must Remove Provider Sections - ACS Takes Action at Legislature

Back and neck problems are ubiquitous. When the pain is severe enough, patients will seek professional care. Their options are chiropractic and medical drugs (oral and injectable), and surgery. Some have argued that removing chiropractic from health insurance policies will save money. However, this directs all patients to receive drugs, injections and/or surgery. These options are more expensive than chiropractic. See Dr. Immerman argue these points in live streaming video of testimony on behalf of the entire chiropractic profession at the Legislature on February 16, 2009 by clicking here then scrolling down to the House Banking and Insurance Committee for that date. Click here to read the full ACS position papers and fact sheets provided to the Arizona Legislature regarding this issue. competition and increase costs.

There are certain Arizona laws in place which mandate presence of providers such as chiropractors in health plans. This was in direct response to the medical profession’s illegal “boycott and conspiracy” against the chiropractic profession which earned the AMA a permanent injunction order, see attached, still in force today, which forbids further efforts to destroy the competition. We need these laws. Previous Republican-controlled conservative legislatures back to the days of Senate President Bob Usdane, Senator Jan Brewer, Speakers Mark Killian and Jeff Groscost enacted these laws to allow medical freedom of choice and dismantle the medical monopoly.

The conservative Cato Institute has argued convincingly that health care cost reduction efforts should increase the different types of providers involved in the marketplace, not reduce the number. Click here to read the Executive Summary of the Cato Institute Report entitled: The Medical Monopoly: Protecting Consumers or Limiting Competition?"

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7. ACS Works to Pass new Insurance Equality Legislation and to Enforce Existing Law

ACS has consistently led the way in lobbying for powerful insurance equality legislation for chiropractic in the Arizona Legislature for the past twenty years. If you want such legislation to pass, join ACS. You can join by clicking here or you can donate by clicking here. Read testimonials written by Arizona chiropractors about ACS by clicking here.

No man's life, liberty, or property is safe while the legislature is in session.
Mark Twain (1866)

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8. Key Letter from Legislators About Chiropractic

These letters from elected leaders in Arizona document the ACS involvement with insurance equality legislation over the past twenty years. History tends to repeat itself so Arizona chiropractors count on ACS to pass new legislation in the future.

Letter from Rep. Bill English in 1989 to Dr. Immerman. Rep. English was the prime sponsor of 1989 and 1990 insurance equality law. The law was passed in 1990 and expanded in 1991 to become ARS 20-461(A)17 and ARS 20-461(B).

Letter from Senate President Bob Usdane in 1990 to Dr. Immerman regarding ARS 20-461.

Letter from Rep. Debra Brimhall regarding passage of HMO chiropractic legislation in 2000 and Dr. Immerman.

Letter from Rep. Debra Brimhall to the profession regarding passage of HMO chiropractic legislation in 2000

Letter from House Speaker Jeff Groscost to Dr. Immerman in 2000 regarding passage of HMO chiropractic legislation

Read all of these letters by clicking here.

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9.ACS Asked Legislature in 2008 to Reduce Chiropractic Copays and Deductibles from Specialist to PCP Levels

In January 2008, at the request of ACS, the Arizona Legislature considered a bill to reduce copays, coinsurance and deductibles for chiropractic care from specialist to primary care physician (PCP) levels. ACS lobbyist and former state representative Debra Brimhall Pearson met with legislators full-time for months in advance to prepare. In addition, Dr. Immerman and many ACS members met with legislators. Here is the link to the bill, SB 1152, as originally introduced.

Click here to open an entire new page describing the 2008 legislative campaign in great detail including the letter from the BCBS lobbyist to the House Health Committee Chairman which is posted here in which he states that chiropractic has no clinical benefit whatsoever.

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10. 2007 Legislation 

SB 1504 Chiropractors; Copays, Coinsurance, Deductibles

As of June, 2007, ACS is working very hard to get the language of this bill passed. Sponsored by chiropractic legislative champions Senators Linda Gray and Rebecca Rios, it has already passed the full Senate and almost passed the House in the conventional manner. If enacted, it would require insurers to charge copayments, coinsurance and deductibles for chiropractors that are the same as they are for medical and osteopathic primary care physicians. At the current time in Arizona, there are huge disparities creating burdensome financial barriers for patients when they seek chiropractic care. This bill would level the playing field and make it possible again for patients to use their insurance benefits for chiropractic care. Final outcome: Bill did not pass.

HB 2115 Professions; Disciplinary Action; Continuing Education

This law gives the Chiropractic Board the option of ordering chiropractors to take continuing education courses for minor violations of the Chiropractic Act instead of disciplining one's professional license. For example, if a doctor has been found in violation of the record keeping rules, the Board under the new law is able to order course work instead of imposing discipline. This bill was signed by the Governor on April 16, 2007 and became law ninety days after the end of the legislative session. This bill was a joint effort of ACS and AAC. Both associations and their lobbyists worked very well together to develop the bill and guide it successfully through the legislative process.

Final Notes On the 2007 Legislative Session

ACS' effort to pass SB 1504 copayments/deductibles failed on the second to the last day of the legislative session, although we were able to defeat Mandate Lite. Please read the July 2007 ACS News for complete information. ACS is the only state association in Arizona with an effective legislative program.

ACS 2007 LEGISLATIVE POSITION PAPER REGARDING COPAYMENTS AND DEDUCTIBLES -- COMPREHENSIVE: Click here to read

Read the ACS position paper supplied to support legislation to end discriminatory copayments and deductibles. It is a comprehensive and fully documented package of information that you do not want to miss.

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11. 2004 Legislative Session and Partial Repeal of Insurance Equality 

Arlan Fuhr, DC and Activator Methods International split from both the AAC and ACS and supported a United HealthCare and insurance industry bill which now allows all insurers to single out chiropractors and spinal adjustments for medical necessity reviews and post payment audit reviews. Read the full story in the American Journal of Clinical Chiropractic by clicking here.

The United HealthCare effort would have failed without the additional assistance of AAC lobbyist Barry Aarons who also helped pass this law. Here are the details as published in the August 2008 ACS Newsletter which was distributed to the entire Arizona chiropractic profession and is posted online at www.AZChiropractors.org. As of June, 2013, no one has ever accepted ACS' ongoing invitation to offer any corrections or rebuttals to this story. Therefore, this report stands as fact. Click here to open a new page and read the entire story which is fully documented in detail.

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12. 2012 Comprehensive Analysis of All Chiropractic Related Arizona Legislation

The following is a list of all major legislation that ACS has been working on or is continuing to work on this year at the Arizona Legislature that would impact the chiropractic profession. The ACS lobbyist is Tim LaSota. http://www.tblaw.com/attorneys/timothy-a-la-sota

SB 1250 Health Insurance; Interstate Purchase: This bill would have allowed out-of-state health insurance companies to sell their policies in Arizona. The dangerous consequence for the chiropractic profession if the bill passed was that if one policy was sold in Arizona without chiropractic coverage, then all Arizona insurance companies would have been allowed to sell policies without chiropractic coverage. ACS poured all of its lobbying resources into defeating this bill and was successful when Linda Gray voted no in the Senate Banking & Insurance Committee, thus killing the bill. The threat has hopefully passed for this session, although bills can be revived and so we will be vigilant.

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13. 2013 Comprehensive Analysis of Key Chiropractic Arizona Legislation

SB 1362 Chiropractic Insurance Equality: This bill would have clarified and strengthened the existing insurance equality law. It passed the Senate Health Committee and then failed to pass the full Senate. Senators voted against it because they believed the lie from the insurance industry that the bill would turn DCs into PCPs. Others want to see how national insurance equality works before they further change state law. Still others vote in concert with the wishes of the Arizona Chamber of Commerce and Industry that is dominated by BCBS which controls the Chamber's health policy positions. Here are the links to view streaming video of the Committee Hearing and the floor debates by the full Senate:

Senate Health Committee Hearing: Go to  http://azleg.granicus.com/MediaPlayer.php?view_id=21&clip_id=11846 to view the hearing. On the left side, scroll down to SB 1362 or advance with your cursor to 1:05.

3-4-13 Senate Third Read: First vote by full Senate can be viewed by clicking on the following link: http://azleg.granicus.com/MediaPlayer.php?view_id=21&clip_id=12001

3-6-13 Senate Third Read: Second vote by full Senate can be viewed by clicking on the following link: http://azleg.granicus.com/MediaPlayer.php?view_id=21&clip_id=12055

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14. 2014 ACS Legislative Information Proposal and Documentation Part One and Two

We have distilled thousands of pages of documents into seven separate short documents this year for your convenience. We would respectfully request that you take the time to read each one. Here are the titles with brief descriptions:

Complete 2014 ACS Leglislative Package and Proposal Part One and Two

Introduction to ACS Legislative Package and Proposal: This is the introduction to the entire package of the seven following brief but essential documents that make up the ACS Package.

1 -- Conservative Care First -- A Strategy to Reduce the High Cost of Health Care: The main driver of health care inflation is high technology medicine and in-patient care. When patients are first seen by chiropractors compared to MDs or DCs, the frequency of MRIs, CTs, surgeries and hospitalizations is lower and this reduces the overall cost of health care.

2 -- Chiropractic -- A Low Cost Solution to High Cost Healthcare: Back pain is the second most common reason that patients consult doctors. When patients see chiropractors rather than MDs or DOs, the overall costs of care are 20-40% less expensive, thus reducing the nation’s health care tab.

3 -- Wilk v. AMA Permanent Injunction Order: In 1987, a Federal District Court Judge issued a Permanent Injunction against the AMA banning it from continuing its effort to conduct an “illegal boycott and conspiracy” to “contain and eliminate the profession of chiropractic” because it was an economic competitor. The injunction was issued because there were still “lingering effects” of the boycott. The AMA convinced insurers not to cover chiropractic and that is the root of our problem today since it continues.

4 -- Wilk v AMA 25 Years Later Why It Still Is Not Over: Evidence that the AMA’s effort to “contain and eliminate” the chiropractic profession is ongoing. The most recent example is found in 2010 when AMA House of Delegates voted to have the AMA lobby to repeal the provider anti-discrimination clause in the Affordable Care Act, Sec. 2706, which protects chiropractic from discrimination. Nothing has changed since 1987. The AMA wants existing discrimination against chiropractors to continue. That is why the Arizona chiropractic insurance equality law is necessary.

5 -- Cato Analysis Executive Summary: The very conservative Cato Institute conducted a thorough analysis and concluded that the more types of health care providers in the marketplace, the more competition there would be with the result being lower prices. They found that the medical profession has continually tried to restrict competition through licensure and other laws in order to maximize business and reimbursement for MDs and DOs.

6 -- Provider Non-Discrimination Act:The existing Arizona chiropractic insurance equality law/freedom of choice law. This law must be moved from the Unfair Claim Settlement Practices Act which can only be enforced by the Arizona Department of Insurance (ADOI). In recent litigation, the courts have affirmed that ADOI has no duty to enforce this law even if there are clear violations. In the past six years, ADOI has refused to enforce the law and has misinterpreted the law compared to the way it was interpreted from the time it was passed in 1990 to 2007. The law must be moved elsewhere in Title 20 where it will be subject to the same legal recourse as all of the other 2,500 laws in Title 20. The stricken language was added in 2004 as a last minute amendment and allows insurers to discriminate against chiropractic when applying medical necessity review. No discrimination whatsoever should be allowed and so this line must be removed.

7- 2014 Fair Copayment Law: Most chiropractic and physical therapy patients need about 20-30 treatments over a 2-3 month period of time. When copayments are at specialist levels of $40-$60 per visits, the average patient is not able to afford the care. While chiropractors and physical therapists are clearly not primary care physicians (PCPs), and nothing in this law confers that privilege to them, they most certainly are not specialists either. Specialists complete medical school and then attend 3-7 years of post-graduate training. Chiropractors and physical therapists graduate from the equivalent of medical school and then go into practice with no additional training. It is clearly false to compare the education and training of a chiropractor or physical therapist to, for example, an MD neurologist or orthopedic surgeon. Practically speaking, patients simply are not getting the chiropractic care or physical therapy they need with copayments at specialist levels. Oftentimes, the copayment is close to or exceeds the total amount reimbursable for an entire visit and so the insurer actually pays nothing. Copayments for chiropractic care and physical therapy must be set at PCP, not specialist levels. This bill also covers occupational and respiratory therapy.

CONCLUSION

When you are fighting the forces of the monolithic medical monopoly, it is never too soon to begin the effort. Therefore, we would like to ask you now to commit to being a sponsor or cosponsor of two bills: one to move the chiropractic insurance equality law outside of the Unfair Claim Settlement Practices Act and strike the one designated single line at the same time, and the other to pass a law requiring copayments for chiropractic and physical therapy be at the same level as they are for primary care physicians (PCPs). Please contact Dr. Immerman at 602-368-9496 or ACS@AZChiropractors.org or our lobbyist Tim LaSota at 602-515-2649 or TAL@tblaw.com to discuss your thoughts. Thank you very much in advance for your attention to this matter.

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