Congressman Maurice Hinchey (NY22) :: Speech :: AOM Alliance Annual Conference

Most of you know me, or know my name, as the author of the Federal Acupuncture Coverage Act, which I've been introducing in Congress since 1995. But you probably don't know that I've been working with acupuncturists and acupuncture advocates for almost 30 years.

Before I was elected to Congress, I served in the New York State legislature for 18 years, which was where I first got involved in acupuncture legislation. And I'm proud to say that my home state has been at the forefront of these issues in many ways. In 1974, New York had legalized acupuncture, just before I was elected to the state Assembly.

After acupuncture was legalized, the Assemblyman who represented at Chinatown at the time put together legislation to license acupuncturists. Having recently left a job managing the state Education Department's professional licensing division, I helped him write the bill. When he left the Assembly in 1980, I rewrote the bill and made it my mission to get it passed. With the help of Dr. Ding, a 19th generation practitioner and the real driving force of New York's acupuncture community, we finally succeeded in implementing licensing in 1990. Licensing acupuncturists has helped the profession boom: while there were only about 100 practitioners in 1980, mostly in and around Chinatown, the number of acupuncturists has exploded to more than 2000 across the state today.

Back in the '70s and '80s, some acupuncturists were leery of state licensure. Many practitioners were unfamiliar with the political process or were intimidated by it, or had a sort of counter-culture mentality, or just plain didn't want anything to do with government. Some saw the professionalization of acupuncture as trying to fit a square peg into a round hole.

I could see their point -- acupuncture doesn't follow the same methodology as Western medicine and certainly there are some conflicts in trying to fit the approach that your profession takes to health care into the rules and regulations of medical doctors. In fact, I'm not much of an "Establishment" kind of guy myself -- evidence of that is all over my voting record in Congress. I know what it's like to be on the short end of a 415 to 10 vote, and still know I did the right thing.

But back in the mid-1970s, there were others, like me, who saw the licensure of acupuncturists as a way to pave the path to mainstream acceptance. Because the fact is that Western medicine isn't going to go away. Traditional oriental medicine will probably never surpass Western medicine as the dominant force in health care in America. So you have to work within the system you've got and work to change it into the system you want it to be.

The long-term outcome of licensure is that it gave credibility to the profession of Oriental medicine. By implementing standard requirements for practicing in New York State, consumers could have confidence in the care they were getting and its safety. When done well, licensure can also level the playing field, so that your education and training is not undermined by those who don't have your qualifications, but want to call themselves acupuncturists anyway.

Licensure -- or certification, or registration, as is the case in some states -- has opened new doors for acupuncturists. Coverage by insurance companies, acceptance in new communities and a higher standard of care have been the happy results.

Ultimately, licensure has proven to be a good thing. Forty-six states now license or otherwise regulate acupuncture professionals. I know you all are working hard to establish standards in the remaining states and territories. Just a few weeks ago, my office heard from a state legislator in Juneau, Alaska who is looking for ways to promote acupuncture in her state.

When I started working on the federal acupuncture legislation in 1995, I heard many of the same concerns that I did in 1970s: that some acupuncturists didn't want to be involved with bureaucratic programs, that they felt that their profession didn't really fit into the federal health care model, and that it was too hard to reach agreement on a national definition of acupuncturists.

I can dispense with those three concerns very quickly: first, if my legislation is enacted, no practitioner will be forced to accept Medicare patients, just as no MD is forced to accept them now. Second, you're right that your profession deserves to be treated differently than Western medicine, but you can't change the system from the sidelines. And third, it is hard to reach agreement on a national definition of what makes a qualified acupuncturist and which specific procedures should be reimbursed -- but that's putting the cart before the horse. Those are the details that are handled in the regulatory process, which comes after you enact a bill into law. We have a lot of hard work ahead of us before we get to that.

Despite those reservations from some practitioners, I believed then, and believe even more strongly now, that acupuncture should have a seat at the table, so to speak, in federal health policy. The care you provide has an important role to play.

Without acceptance from the federal health care programs, you are depriving yourselves of a huge market. Medicare beneficiaries and federal employees make up nearly 20 percent of the population. With today's astronomical health care costs, seniors, the disabled, federal workers and retirees are unlikely to pursue care that is not covered by their insurance carrier, care for which they solely will bear the cost. Those 52 million people are more likely to seek Western medical treatments that are paid for by their insurance than acupuncture treatments that aren't.

Coverage of acupuncture under the federal health care programs also has a significant impact on the private health insurance market -- it's like a "Good Housekeeping Seal of Approval," a signal to private insurers that acupuncture is worthy of coverage.

Without the inclusion of acupuncture in the federal health programs, we are also ignoring an important solution to our nation's very broken health care system.

After all, the biggest problem in health care today is how much it costs. Acupuncture isn't expensive because it doesn't rely on new technologies, pricy equipment or pharmaceuticals. Because it's not invasive, acupuncture patients don't require expensive hospital stays or long recovery periods.

Another major source of frustration with our health care system is that consumers feel like they don't have control over the care they get. Most people who have insurance are shuttled into managed care plans, in which their choice of doctors, specialists and health care facilities is limited. Consumers are crying out for more choices in their health care. Acupuncture coverage not only gives people another choice of provider, it offers the choice of a whole different philosophy of health care.

That's why I champion this cause. I do it because I believe in acupuncture's benefits and because I believe in holistic health care. But I also believe that acupuncture can help to fix our flawed, overpriced and inequitable health care system.

A growing number of Americans share my beliefs, which is why I believe that we have a lot of momentum for the Federal Acupuncture Coverage Act right now.

There are more cosponsors for acupuncture legislation: with the help of Bob Marcus, who has spent an awful lot of time pounding the pavement on Capitol Hill, we reached a record-high 68 cosponsors for my legislation in the 108th Congress, which ended in December. I reintroduced the bill in February and have already signed up 33 cosponsors, with the number growing every week.

There is more private insurance coverage for acupuncture: 70 percent of the nation's insurers cover some acupuncture treatments, because they know it's inexpensive, effective and their customers are demanding it.

There is more supportive research coming out of the National Institutes of Health: acupuncture is now recognized as effective by the NIH for pain relief, postoperative and chemotherapy nausea, addiction, stroke rehabilitation, osteoarthritis, and asthma, to name a few conditions.

All of this is great news for acupuncture professionals and their patients. We need to take advantage of this momentum.

That's not to say that moving the Federal Acupuncture Coverage Act forward is an easy endeavor -- we still face a conservative Congress that takes a rather narrow-minded approach to health care and would rather constrict -- not expand -- the benefits offered by the federal plans.

Even if the political dynamics were on our side, big institutions don't move quickly. You'd probably be quite surprised to learn which treatments Medicare doesn't cover, treatments that aren't perceived to be anywhere near as unconventional as acupuncture. For example, hearing aids have been commonly used for about 50 years, but Medicare will only start to provide some coverage for them later this year.

That's a really dramatic example, but here's a more current one: oral chemotherapy treatments have been used for about a decade. It's far cheaper than hospital- or clinic-administered chemotherapy and much easier on cancer patients, but Medicare coverage of oral chemotherapy only began a couple of years ago.

I don't say this to be discouraging, but to point out that it takes years to build a movement. Passing my bill and advancing the acupuncture agenda in other ways can be achieved, but it will take a lot of hard work. I take the fact that I'm here with all of you today, in such a broad gathering of acupuncture practitioners, educators and advocates, as a positive sign -- I can't remember the last time that anyone has invited me to speak to a group about acupuncture. I've worked very hard on this legislation and I will continue to until the day it's enacted into law, but I've often felt like a lone voice in the wilderness.

Visibility for a policy issue is extremely important. A politician who doesn't communicate with his constituents, is never in the news and doesn't show up at public events is unlikely to get reelected because nobody knows who he is. By the same token, legislation doesn't get passed when it doesn't have any visible base of support.

I think the majority of Americans know that the AARP is very powerful, because it represents about 35 million people, or that the NRA or AMA have a lot of pull in Washington. Those organizations have strength in numbers, they are active locally and at the state level, and they are very visible in Washington. Acupuncture doesn't have the sheer numbers of the AARP or the AMA, but that doesn't mean that you can't be effective at moving your agenda forward.

What most Americans don't know is that there are plenty of advocacy groups in Washington -- particularly health specialty groups -- that boast far fewer numbers than the AARP or the NRA -- but are very effective. The best example I can give is of the chiropractic associations. There was a time, not so long ago, when chiropractic care was considered laughably unconventional by the Washington bureaucracy. The thought of federal health programs or private health insurers paying for that so-called "quack medicine" was ridiculed.

The chiropractors wanted to be taken seriously, so they made a serious commitment to advocacy in Washington. The American Chiropractors Association and the International Chiropractors Association established offices in D.C. These organizations didn't agree on everything, but they did present a united front for their profession when necessary. They hired lobbyists. They started meeting with members of Congress, their staff, and committee staff. They hosted fundraisers. They organized their doctors and patients for grassroots campaigns. Little by little, they raised the visibility of their profession, increased its credibility with legislators and eventually wore away resistance to chiropractic care. Now chiropractic care is not only covered by Medicare, they have made inroads in coverage by the Veterans Administration and military hospitals and their views are solicited on broader health care issues like managed care reform. A profession that was once derided as wacky and left wing now has its chief legislative priorities introduced by conservative Republicans and draws support across the entire political spectrum. In short, what the chiropractors figured out is that they needed a political strategy to achieve their goals. They stuck to it and they've been successful.

What the chiropractic associations also figured out is that if they wanted the support of Members of Congress for their cause, they had to find out what motivated them. Frankly, that breaks down into three categories: philosophy, fundraising and reelection.

Now, I wish that we lived in a world where political philosophy alone motivated Congress, as it motivates me, but that's not the reality. Once we recapture all of last year's cosponsors for the Federal Acupuncture Coverage Act, in my political estimation, we will have reached most of the Representatives who already support acupuncture or have a natural affinity for the issue. With only 60 or 65 supporters, this bill will never see the light of day.

I don't want to settle for that, and I hope that you don't either. But in order for this legislation to advance, I need to have all of you as partners. As a profession, you must decide whether you want to commit to advancing your cause beyond the small percentage of legislators who know about and are comfortable with acupuncture. I work hard every day on this legislation, but I need your help educating and convincing at least a majority of the other 370 Representatives and 100 Senators.

If you are willing to work with me, I believe that we can get this done. In fact, I think we can achieve much more than passing the Federal Acupuncture Coverage Act. If acupuncturists, educators and patients commit to this effort, I truly believe that we can succeed on a broad range of issues that affect your profession.

First, you must win the public relations battle. I would guess that the vast majority of Americans don't know much about acupuncture and they don't understand what you do. I'm pretty sure that the majority of representatives in Congress don't even know that the National Institutes of Health is conducting research into acupuncture, proving its benefits all the time.

Many of you come from parts of the country where acupuncture is well known and there are many practitioners. Many of you practice in communities where acupuncture isn't considered unconventional at all. But that's not true across the United States. That's why we have a lot of cosponsors of my bill from the West Coast and not too many from the Midwest or the South.

If you are going to change people's minds about acupuncture, you have to be more visible. You don't need to buy advertisements in the newspaper, you just need to find opportunities to educate people about what you do: get stories in your local newspapers, join local civic organizations and tell other members about your profession, join up with other alternative medicine providers.

Second, you must win the political battle. You must demonstrate the strength of your constituency. Studies show that more than 8 million Americans have received acupuncture treatments. The NRA claims to have 4 million members. So why isn't the acupuncture profession twice as powerful as the gun lobby? Because you haven't taken advantage of the strength in your numbers.

Members of Congress want to get re-elected, so they want to appeal to large blocks of voters. You need to show that you represent a significant block of voters: practitioners, patients and their family members. Make sure that you are registered to vote; make sure your patients are registered to vote; if they aren't, tell them why it's important to do so and help them get registered. Build mailing and email lists of supporters who are willing to help. We need for people who care about acupuncture to be involved in the political process.

You and your patients can write letters to your representatives. You can raise money for candidates who support your cause. You can build ad-hoc coalitions with other acupuncture groups to pool your strength. You can show your seriousness by developing a comprehensive advocacy agenda that extends beyond HR 818 and includes all of the issues that impact acupuncture. You can endorse candidates who support that agenda and then make sure your colleagues and patients know who's on your side in Congress.

This grassroots activism works and it can be remarkably effective. Let me give you an example: when the Department of Health and Human Services issues a ruling that the AMA doesn't like or a piece of legislation is introduced that they do, I get stacks of emails within 24 hours and stacks of letters within days from my constituents. I may not always agree with their position, but I know that they are out there and their members, my constituents, are looking to hear my views on these issues. You have the power to make your presence known just like they do.

When you've made progress on the PR battle, and you've made progress on the political battle, then you can win the legislative battle. It takes 218 votes to pass a bill in the House, but when you are trying to change Medicare or other health policies, it rarely comes down to a vote on the floor. Most health policy changes happen in big, omnibus bills, so most provisions -- like I hope that the Federal Acupuncture Coverage Act will be -- are added to a bigger legislative package during the committee process. However, in order to get to that stage, we need to be able to show that there is majority support for our bill, which means getting more cosponsors.

You all are as important to winning the legislative battle as you are to winning the PR and political battles. It's surprisingly easily to persuade Members of Congress to support a bill: ask them to. Ask for a meeting in their local offices or in Washington. Write letters. Have your patients write letters. Appeal to your Representative's interests: if he or she is very concerned about fiscal responsibility, explain how acupuncture can save scarce health care dollars. If your Representative is interested in scientific research, point out the research supporting acupuncture. When you make a reasoned case, I think you'll be surprised to find out how receptive your Representatives will be.

Passing the Federal Acupuncture Act isn't an insurmountable challenge. In fact, I feel more confident than ever that we can get the job done. But it will take hard work, dedication and patience. It may require working with people or organizations you don't agree with, but who share your goals on this issue. It may require settling for incremental progress, because that's how you nudge big institutions toward change. It may require putting your money where your mouth is.

But most of all, it requires getting involved. If you don't do the work to define your profession and the goals of the acupuncture community, someone else is going to do it for you, perhaps in a way you don't like. Government isn't a spectator sport; you can't sit on the sidelines. You have to get involved.