Who Pays for Alternative Medical Care?

LEGAL FEUD

BY the millions, Americans are turning to alternative means of medical treatment - and most are paying for such care out of their own pockets.

But in January, Washington State became the first in the nation to require health-care insurers to pay for "nontraditional" care. This includes such treatments as acupuncture, chiropractic, massage therapy, and other unconventional approaches.

The controversial mandate is provoking a legal backlash by some insurance companies. But Washington State's move may also portend a significant financial shift not only for the health insurance industry but also for many individuals.

It comes at a time when Congress is also considering several federal health-care reform bills that would permit citizens to be "treated by a health-care practitioner with any method of medical treatment such individual requests," as one bill puts it.

"There are people in our country who are desperate ... for cures that conventional medicine simply does not seem to be able to provide," says Sen. Tom Daschle (D) of South Dakota, who is co-sponsoring the Access to Medical Treatment Act with Senate majority leader Bob Dole (R) of Kansas.

The Washington State law requires that medical insurers, health-care service contractors, and health maintenance organizations (HMOs) cover a range of treatments by providers who are licensed and registered by the state.

(Since Christian Science practitioners are not licensed by the state, the law won't affect their patients' payments. However, some health insurance plans already make provision for such treatment.)

"Many of the alternative providers' services are much less expensive than traditional care," says Washington State Insurance Commissioner Deborah Senn. "For example, licensed midwives' cost of deliveries at birthing centers or at home ranks far below the cost of hospital care."

Many of the "alternative" providers, says Ms. Senn, "emphasize healthy lifestyles and conservative forms of treatment that do not include surgery or drugs with potentially serious side effects," she says. "In the long term, these factors promise lower health-care costs as well as healthier subscribers."

But some insurers are balking, saying that Senn's ruling that "all categories of providers" be included in every "fee-for-service" or "managed-care health plan" encourages quackery and will force insurance companies to pay for "unnecessary" treatments.

Ten of the state's largest health plans recently launched a legal challenge to commissioner Senn's interpretation of the new statute, which they allege "vastly exceeds the scope and the intent of the law, and would make it virtually impossible to effectively manage care and keep alternative medicine affordable and accessible for consumers."

Because of the growth in the use of alternative medicine in the West - and the Northwest in particular - the case is being closely followed here and elsewhere around the nation.

The King County Council (which governs the greater Seattle area) recently approved plans for what would be the country's first government-subsidized naturopathic health clinic. Seattle is home to Bastyr University, one of two nationally-accredited natural medicine universities. The other is in Portland, Ore. (Naturopathic medicine emphasizes disease prevention and treatment using diet, exercise, plant materials and other natural substances.)

Experts say there is growing interest across the country in alternative health care. As reported in the New England Journal of Medicine, Boston-area hospitals and medical schools conducted a national survey showing that 34 percent of Americans had made use of "at least one unconventional therapy" during the previous year.

"We found that unconventional medicine has an enormous presence in the US health care system," the researchers declared. Americans spend more than $13 billion a year on such health care, and until now most health insurance plans did not cover such care.

But Washington State's law - if it is upheld, and if other states follow suit - could dramatically change that. This is one reason why group health-care organizations such as Kaiser Permanente and Blue Cross of Washington and Alaska have taken commissioner Senn to court.

Another concern is that alternative treatments and therapies may not have been scientifically proven effective, or that patients may be duped into believing that they are. But advocates say protections can be built into federal or state law.

"I want to protect sick and vulnerable individuals from negligent charlatans who would prey on their misfortunes and fears for personal gain," says Rep. Peter DeFazio (D) of Oregon, lead sponsor of the House version of the Access to Medical Treatment Act. "In order to protect consumers, this bill limits those qualified to administer treatments to state-authorized medical providers who are working within their scope of practice."

Or as Washington State's Senn puts it: "Obviously, licensed midwives do not do heart surgery. Nor would a nutritionist deliver babies."

As the health-care debate continues, interest in alternative means of care continues to grow among those professionally interested in peoples' well-being. One well-reported recent event at Harvard Medical School was a conference titled "Spirituality and Healing in Medicine," which was attended by some 800 scholars, chaplains, doctors, and other medical professionals.

Washington is the only state so far requiring medical insurers to cover alternative means of health care. But eight states now license naturopathic physicians, and Utah is about to become the ninth. "There's been an incredible explosion of interest," says Peter Chowka of the American Association of Naturopathic Physicians."

"Health care reform requires more than just access to conventional treatments," says Mr. DeFazio. "Real reform examines the fundamental premise and framework of our current medical system. As we confront escalating medical costs and struggle to contain Medicare and Medicaid spending, alternative medicine provides some affordable, less invasive, and effective answers."