Bill Overview
Title: Chiropractic Act of 2022
Description: This bill expands Medicare coverage of chiropractic services to include evaluation and management services, including examination and imaging services, and other functions provided by chiropractors, rather than only subluxation corrections through manual manipulation of the spine. The bill also allows chiropractors to enter into private contracts with Medicare beneficiaries.
Sponsors: Rep. Posey, Bill [R-FL-8]
Target Audience
Population: People who use or might use chiropractic services
Estimated Size: 10000000
- The bill affects people who use Medicare, which primarily includes senior citizens and individuals with certain disabilities.
- Chiropractic services are typically sought by people experiencing musculoskeletal issues, especially back pain.
- The global target population would encompass any person worldwide who utilizes or would potentially utilize chiropractic services if they were more accessible through public health systems.
- In the US, the specific target is Medicare beneficiaries who are 65 or older or have certain disabilities.
Reasoning
- The policy targets Medicare beneficiaries, mainly affecting elderly individuals who often seek chiropractic services for musculoskeletal issues. We must consider various demographic characteristics that illustrate differences in baseline wellbeing and the impact of chiropractic care, such as age, occupation, and pre-existing health conditions.
- The budgetary constraints require simulating realistic utilization rates among 10 million potential beneficiaries without exceeding cost limits. This means that not every beneficiary will use the expanded services.
- It's important to simulate a mix of people within the target group: those who have never used chiropractic services, those who use them rarely, and frequent users who might use more due to expanded coverage.
- We must also include perspectives from people who are not directly impacted or have low impact, such as Medicare beneficiaries who do not have musculoskeletal issues, to reflect variability in wellbeing changes.
- People with frequent back pain due to their occupational history or current physical demands may experience a significant impact from the policy.
Simulated Interviews
Retired nurse (Florida)
Age: 72 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- I think this policy is beneficial. As a former nurse, I understand the importance of comprehensive care.
- Currently, I pay out-of-pocket for chiropractic care. More coverage would help financially.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 5 |
| Year 5 | 9 | 5 |
| Year 10 | 9 | 5 |
| Year 20 | 9 | 4 |
Retired construction worker (Texas)
Age: 68 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 7/20
Statement of Opinion:
- The coverage extension is great. I use chiropractic care regularly.
- This will ease my financial burden significantly.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 4 |
| Year 5 | 8 | 4 |
| Year 10 | 9 | 3 |
| Year 20 | 9 | 2 |
Retired teacher (Ohio)
Age: 75 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 12/20
Statement of Opinion:
- Additional coverage seems positive, but I haven't used chiropractic services much.
- It's nice to have the option, though.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 6 | 6 |
Retired engineer (California)
Age: 84 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 6/20
Statement of Opinion:
- I'm relatively healthy and don't need chiropractic care often.
- The policy won't change much for me personally.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
Homemaker (New York)
Age: 66 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 8/20
Statement of Opinion:
- This expanded access is a relief; I struggle with limited mobility due to my condition and frequently use chiropractic care for pain management.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 4 |
Retired accountant (Illinois)
Age: 71 | Gender: other
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 10/20
Statement of Opinion:
- While I don't have back issues, I see benefits in having more medical options under Medicare.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Retired farmer (Arizona)
Age: 69 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 9/20
Statement of Opinion:
- Coverage of more services is a godsend. Managing back pain is a constant battle for me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 7 | 3 |
| Year 20 | 6 | 2 |
Retired librarian (Oregon)
Age: 77 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 11/20
Statement of Opinion:
- I'm curious about chiropractic care, and this policy makes it more accessible.
- I might try it as a new way to enhance my wellbeing.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 7 |
| Year 20 | 7 | 6 |
Retired military (Georgia)
Age: 65 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 2.0 years
Commonness: 13/20
Statement of Opinion:
- This policy doesn't impact me much since I get most care through the VA, but it's a good backup.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 6 |
| Year 10 | 6 | 6 |
| Year 20 | 6 | 6 |
Retired factory worker (Pennsylvania)
Age: 70 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 10/20
Statement of Opinion:
- The policy is very supportive, having had to cut back on visits due to cost.
- With expanded coverage, I plan to resume treatments.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 4 |
Cost Estimates
Year 1: $1000000000 (Low: $800000000, High: $1200000000)
Year 2: $1100000000 (Low: $900000000, High: $1300000000)
Year 3: $1210000000 (Low: $990000000, High: $1430000000)
Year 5: $1331000000 (Low: $1089000000, High: $1573000000)
Year 10: $1796650000 (Low: $1461350000, High: $2131950000)
Year 100: $0 (Low: $0, High: $0)
Key Considerations
- The effectiveness of chiropractic services in reducing other medical interventions could lead to healthcare savings that are not directly captured in these estimates.
- Potential changes in Medicare enrollment or eligibility criteria could affect future cost projections.
- Regulatory changes regarding what constitutes reimbursable services under Medicare could alter the long-term financial impact.