In 2018, while presenting at a medical conference, I met a team of doctors whose passion and advocacy for patient care would go on to change the nature of my work significantly. Until this meeting, I thought the problem with integrating acupuncture in mainstream medical care was lack of education.
The three pillars of evidence-informed care include: the best evidence available, clinical experience and patient preference. All this time, I thought the lack of dissemination of evidence was the barrier – then one of the MDs explained a scenario to me:
"Imagine a senior on Medicare and Medicaid with fixed income who presents with severe pain. I can prescribe opioids for $2/month, or a course of acupuncture treatment for about $800-$1,000 out-of-pocket – which one will the patient opt for?"
When we factor in patient preference, the evidence shows that patients who have insurance prefer to use their benefits, rather than pay out-of-pocket for care. Those who can afford acupuncture therapy love our services. Those who cannot afford our services have limited options and do not have access to acupuncture therapy.
The Colorado Example
So, I began working with this team of advocates to expand Medicaid coverage here in Colorado to include acupuncture therapy. It began with asking a legislator to sponsor a bill. The bill didn't make it very far, and we were advised that tackling Medicaid coverage was beyond the scope of the committee we would work with in the near future.
The following year, in 2019, the Opioid and Other Substance Use Disorders Study Committee, comprised of Democrats and Republicans, heard our request and crafted H.B. 1085 – this bill mandated all private insurance cover a minimum of six sessions per year for acupuncture therapy, chiropractic, physical therapy, and occupational therapy, plus safer medication.
For anyone thinking, six visits is hardly enough to get anywhere, all I can say is, once you have spent years lobbying and advocating, you realize that going from zero to a minimum of six sessions/year is in fact a significant accomplishment.
While we had come a long way, the year 2020 brought unexpected financial stress. Our bill was scheduled to be signed a couple of weeks after the pandemic hit full force. Between mandated shutdowns, closures and stay-at-home orders, our governor refused to sign any legislation with mandates.
As it goes with legislation, the key is to carry on and try again. On June 28, 2021, our team's patient, persistent work paid off, and the Prevention of Substance Use Disorders bill (H.B. 21-1276) was signed into law. As of Jan 1, 2023, health plans in Colorado will be required to cover a minimum of six acupuncture sessions per year.
The Ingredients That Made This Effort Successful
- A team of legislative sponsors and one strong champion
- Collaboration with medical doctors, physical therapists, chiropractors, and occupational therapists – in our efforts, the Colorado Medical Society and the Colorado Pain Society supported comprehensive care throughout every hurdle
- Continued advocacy and acupuncture presence, including a strong state association with a dedicated lobbyist
Note: Early on in the bill cycle, massage therapy was also included. When that bill language was dropped, I asked why and was informed, "It's because they stopped showing up."
Our Responsibility and Opportunity
Along the road to expanding Medicaid coverage, where more work is to be done, we forged relationships with key allies, gained coverage for acupuncture therapy in the private insurance industry, and got acupuncture into the state's ACA exchange program as an Essential Health Benefit (EHB) in the proposed 2023 Benchmark Plan. Expanding access to acupuncture therapy not only supports our patients, but is also a key step to creating acupuncture jobs and integrating in the U.S. health care system.
As contemporary acupuncturists, it is our job to not only deliver excellent patient care, but also to show up and advocate for our patients' rights. When doing this, we can accomplish great things.
Editor's Note: Look for follow-up articles detailing efforts to achieve Medicaid coverage for acupuncture services in other states.
Dr. Tuesday Wasserman received her Master of Science in Acupuncture and Oriental Medicine from the Seattle Institute of East Asian Medicine in 2010, and her Doctorate of Acupuncture and Chinese Medicine from Pacific College of Health and Science in 2017. Currently, she volunteers as chair of the insurance committee for the Acupuncture Association of Colorado, and chairs the Medicaid committee for the American Society of Acupuncturists. In addition to advocacy, she is passionate about creating jobs for acupuncturists and building bridges within the medical community; to that end, she has participated in education and lectures for continuing medical education, launched and continues to support the acupuncture team at the Birth Center of Boulder, and serves as the current program director for PCHS's transitional DACM department.