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

See live streaming video of Dr. Immerman's 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.

In 2009, SB 1325, HB 2323 and HB 2324 were introduced to give uninsured individuals and small businesses the option to buy health insurance policies free of many “mandates’ including the requirement to be fair to chiropractic. Certain well-intentioned but misinformed individuals believed that removing chiropractic will lower health insurance costs when the reverse is the truth.

ACS joined the fray and lobbyied heavily to get these bills amended or killed. Unfortunately, they were passed and signed into law. Below are excerpts from our position papers.

Health Insurance Coverage Exemption Legislation



Sections of SB 1325, HB 2323 and HB 2324 will increase insurance premiums and should be removed.

SB 1325, HB 2323 and HB 2324 are intended to lower health insurance premiums by exempting certain policies from so-called “mandated benefits.” These bills unfortunately contain flaws that will have the opposite effect. Amendments are needed to remove the sections which will increase premiums. Here are the facts:

  1. All experts acknowledge that the main cause of increased healthcare spending is high technology, inpatient, surgical and hospital-based care. See attached from the CBO.

  2. SB 1325, HB 2323 and HB 2324 will shift treatment for back care from less expensive low technology, out-patient care to costly high technology, in-patient surgical care, thus increasing costs.

  3. This flaw can be remedied with a simple amendment to each bill.


    There is a misperception that chiropractic is an “add-on” to health insurance policies when in fact it is a “substitute” for more expensive forms of care like epidural injections and surgery for covered back conditions. It has been proven scientifically that when chiropractic is added to a health care plan there are fewer surgeries, hospitalizations, MRIs and x-rays, and overall costs for back care decrease.


SB 1325, HB 2323 and HB 2324, as currently drafted, will increase health insurance costs by eliminating a less costly alternative treatment for back conditions leaving patients only able to access a more expensive alternative consisting of high technology and in-patient, surgical solutions. Therefore, the sections in the bill exempting plans from chiropractic coverage are counterproductive and should be removed.

Also sent before the hearing and forming the basis of our testimony was the following letter:

Dear Members of House Banking and Insurance Committee,

These bills will exempt certain health insurance plans from mandates for some coverages for benefits and some coverages for providers. The Cato Institute states that when there are more providers in the marketplace, there is more competition and lower healthcare costs. Therefore, the sections of HB 2323 and HB 2324 which would eliminate providers from the marketplace who compete with MDs would foster a medical monopoly, decrease competition and increase costs.

It is true there are certain 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. Please do not undo their work. They were just as concerned about cost containment as you are today.

Please read the very brief Cato Executive Summary below and then consider appropriately amending these bills to eliminate all reference to providers. Cost reduction efforts should increase the different types of providers involved in the marketplace, not reduce the number as would be the impact of HB 2323 and HB 2324. This is the conclusion of The Cato Institute.

December 15, 1995
Policy Analysis no. 246

The Medical Monopoly: Protecting Consumers or Limiting Competition?

by Sue Blevins

Sue A. Blevins is a writer and health policy consultant based in Boston.

Executive Summary

Nonphysician providers of medical care are in high demand in the United States. But licensure laws and federal regulations limit their scope of practice and restrict access to their services. The result has almost inevitably been less choice and higher prices for consumers.

Safety and consumer protection issues are often cited as reasons for restricting nonphysician services. But the restrictions appear not to be based on empirical findings. Studies have repeatedly shown that qualified nonphysician providers--such as midwives, nurses, and chiropractors--can perform many health and medical services traditionally performed by physicians--with comparable health outcomes, lower costs, and high patient satisfaction.

Licensure laws appear to be designed to limit the supply of health care providers and restrict competition to physicians from nonphysician practitioners. The primary result is an increase in physician fees and income that drives up health care costs.

At a time government is trying to cut health spending and improve access to health care, it is imperative to examine critically the extent to which government policies are responsible for rising health costs and the unavailability of health services. Eliminating the roadblocks to competition among health care providers could improve access to health services, lower health costs, and reduce government spending.