As the Affordable Care Act seeks to shift the focus of American health care from disease treatment to prevention, practitioners of complementary, alternative and integrative medicine (CAM) see new entry points for bringing their medicine to the public.
Like naturopathic doctors (NDs), other CAM providers have identified specific provisions in the law that may level the playing field between conventional and natural medicine. They also find opportunities in the law's overall thrust toward health fundamentals like better diet, exercise, stress reduction and lifestyle changes.
(See our comprehensive look at how naturopathic medicine will change under the health care law.)
As states rush to implement the far-reaching law over the next year, CAM leaders says it's a crucial time to organize and show how their professions can help solve the nation's health challenges.
Here's a look at how the law may expand access to acupuncture, nutrition, midwifery and other natural health disciplines.
As a low-intervention alternative to surgery and pharmaceuticals, acupuncture could be well-positioned to see an expanded role under health care reform, even though it has little recognition in existing federal law. The challenge for the profession is to make sure health officials understand acupuncture's benefits.
"We looked into hiring a lobbyist to get the attention of government officials," says Jeannie Kang, LAc, a Los Angeles acupuncturist and past president of the American Association of Acupuncture and Oriental Medicine. "But it was going to cost $10,000 a month. We don't have that kind of money."
The association began a national letter-writing campaign instead, attracting more than 20,000 signatures in support of expanded access to acupuncture. "The support came from our patients," says Kang. "It's very consumer-driven medicine. That should speak for itself."
The result so far: California, Maryland, New Mexico and Washington have included acupuncture for treating pain, nausea and other ailments in their essential-health benefit plans, the threshold that most insurance plans must meet under the law. Alaska and Nevada have indicated they may also include acupuncture. That will make millions of Americans eligible for acupuncture under their insurance plans.
"It's a very big deal for our profession," says Kang. "Our medicine is still quite young in this country. But we have been quickly recognized as effective."
Few professions fit the health care law's prevention focus as well as nutritionists, who understand that helping patients with diet changes can save them heart surgeries or cholesterol medications with unpleasant side effects.
The law specifically says nutritionists and registered dietitians (RDs) may be included in patient-centered medical homes, an arrangement designed to coordinate a multidisciplinary team. (Read more about medical homes.) The law also funds workplace wellness programs that reward employees for participation. (In one such program, Bastyr nutrition graduates help Microsoft workers form health goals and improve their eating.)
However, the law is less specific about reimbursing nutritionists and RDs and does not require medical homes to include them. So the burden rests on practitioners to show the value and cost-effectiveness of their work.
"Health care reform has the potential to increase demand for RDs, but this outcome is not a given," P. A. Tuma, director of regulatory affairs for the Academy of Nutrition and Dietetics, wrote in a policy brief. "RDs can be assured of far greater benefits by advocating for state and federal regulations that specifically identify [dietitians] as capable providers of particular services."
Certified professional midwives (CPMs) secured a "partial victory" in the law, according to Mary Lawlor, MA, CPM, LM, executive director of National Association of Certified Professional Midwives. At the request of Sen. Maria Cantwell, D-Wash., the law requires Medicaid to pay provider and facility fees for licensed midwives at birth centers. That will increase low-income women’s access to midwifery care.
The provision doesn't mention CPMs specifically, making it challenging to ensure states understand, Lawlor says.
"The gap between passing a law and implementation is enormous," Lawlor says. "The provider and facility fee were supposed to go into effect two years ago, but there are still states where implementation is incomplete."
The high cost of conventional birth procedures and shortage of obstetricians, especially in rural areas, will help midwives prove their worth, says Lawlor.
“We’ve been able to make the case that maternity care is in terrible shape," she says. "We spend more money on it than any other country and yet our outcomes are getting worse. Physicians tend to give everyone medical care that's appropriate for only the most high-risk births. We’ve been able to show clearly that midwives can provide better care.”
The top priorities of the Affordable Care Act — covering the uninsured, making treatment more effective and controlling runaway costs — don't include promoting natural medicine.
But those goals could indirectly support an array of professions based more on relationships and behavior changes than on technology.
With a shift in payment models from "fee for service" to "fee for results," health providers will look to practitioners who can make Americans healthier without hospitalization and surgery. Getting involved soon after the bulk of the law takes effect is key, says Michael Cronin, ND, a board member of the American Association of Naturopathic Physicians.
"The better we do early on, the more opportunities will open up," he says.
Integrating with insurance companies could bring additional benefits too, such as reams of new data to study and demonstrate the effectiveness of natural therapies.
"That data will be useful in the future for getting more acceptance and recognition," says Kang, the acupuncturist. "So there's a ripple effect that will go wide and deep."
Related: Health Care Reform Extends Reach of Naturopathic Medicine
Learn more about studying natural medicine at Bastyr University.