Dear Members of the MCA,

Last week, we sent URGENT information out to you by fax, through the phone tree and my mail, regarding S. 1955. This bill pending will preempt all states mandates and state insurance rights. This will have significant impact on all practices and patients benefit plans. The Maine Chiropractic Associataion and its membership has fought hard to protect our patients rights and access to healthcare and freedom of choice. With one fell swoop, all this could be eliminated. This will effect all 50 states. If you have not already been doing so, please have your offices and your patients get the calls and letters out to our two Senators to oppose the legislation, have them call right from your office if necessary...each community will have its own local number for the Senators offices.

Collins: (202)224-2523 Snow: (202)224-5344 John and I have recieved alot of calls from doctors who have had questions or have noted that they have not gotten information. Below you will find two legislative alerts one from the ACA and one from the ICA

Attachment ACA: FEDERAL LEGISLATION (S. 1955) WOULD ABOLISH ALL STATE CHIROPRACTIC PROTECTIONS!!! TO: All Doctors of Chiropractic FROM: The ACA Department of Government Relations It is very important that you carefully read the following Legislative Alert Bulletin and take immediate action as requested ---------------------------------------------------------------------------------------------------------------------

BACKGROUND: For a period of several years, the small employer lobby led by the National Federation of Independent Business (NFIB), the U.S. Chamber of Commerce and others, have lobbied the Republican-controlled Congress to enact federal legislation (known as AHPs or Association Health Plans) that would extend the federal ERISA preemption to allow small businesses and associations to establish group health insurance plans at the state level that would be exempt from all state-enacted consumer and provider protections, such as any-willing provider statues, insurance equality laws, and various mandates requiring access to specific types of treatment, including chiropractic care. Proponents of AHPs argue that small businesses will be able to more easily afford the cost of health insurance for their employees if so-called “costly state mandates” are eliminated.

Over the last six years, various versions of AHP legislation that would abolish state mandates have easily passed the U.S. House of Representatives with strong support from the small-business friendly GOP majority. However, opponents of the legislation, including the ACA, have always succeeded in preventing the advancement of AHP legislation in the U.S. Senate – thanks in large measure to Senate Democrats who have opposed enactment of AHPs.

In the First Session of 109th Congress AHP legislation (HR 525) again passed the House of Representatives by largely a party-line vote. This occurred in the summer of 2005. CURRENT STATUS:

While advancement of legislation precisely identical to HR 525 has thus far been blocked in the Senate – a modified measure (S.1955) was approved by the Senate Health, Education, Labor and Pensions Committee (HELP Committee) Chaired by Senator Mike Enzi (R-WY) on March 15th. The committee vote was on a party-line basis with all Republicans voting for the measure and all Democrats voting against. S.1955 now threatens to advance to the floor of the U.S. Senate for a vote. S.1955 represents a particular danger, because it has been modified in certain ways to make the proposal more attractive to some of the traditional opponents of AHP legislation, and as such, represents a legislative vehicle far more viable and dangerous than the AHP legislation we have successfully blocked in the past. S.1955 is now referred to as “Small Business Health Plans” (SBHPs). If enacted into law, S.1955 would wipe out all state protections relating to the small group and individual health insurance market – accordingly, IT IS IMPERATIVE THAT S.1955 BE DEFEATED. If S. 1955 passes, all previously enacted state laws will be gone. Employers will be free to: § Eliminate chiropractic benefits § Place caps on the number of visits § Require a medical doctor to pre-authorize care § Place higher deductibles on chiropractic care § Discriminate against chiropractic in any manner they choose ACTION NEEDED:

Because of aggressive lobbing by the NFIB and others, if S.1955 reaches the floor of the Senate for a vote, it could pass the Republican-controlled Senate. In order to prevent the measure from advancing to the floor of the Senate, opponents of the measure (Senate Democrats) must agree to filibuster the bill and maintain a solid block of 41 votes against it, in order to prevent its consideration. It is imperative that all recipients of this alert bulletin do the following: Immediately contact your two U.S. Senators and voice your strong opposition to S.1955 or any version of it that would preempt state enacted consumer and provider protections. Senators can be reached by calling 202-224-3121 or via their website at http://www.senate.gov/ Specifically urge your two Senators to support a filibuster of S.1955. It is particularly important to make this argument to Democrat members of the Senate. Both Republicans and Democrats should be urged to vote “against” the measure should it reach the Senate for a vote. It is crucial that you also engage your patients in a grassroots lobbying effort to defeat S.1955 or any similar measure. Grassroots support from chiropractic patients could make the difference between victory and defeat regarding this crucial legislative issue.

IMPORTANT: Because of security concerns, delivery of surface mail to Congress is often significantly delayed. our communications will likely reach your Senators more quickly if they are via telephone, fax and or-mail. TALKING POINTS: To assist with your lobbying efforts and to help engage your patients in a grassroots effort to defeat S.1955 the following materials are available at http://www.acatoday.org/ Find your Senators Talking points memo Sample letter Opposition letters from other stakeholders ADDITIONAL INFORMATION: Please contact ACA’s Department of Government Relations at 703-812-0224 or at gr@acatoday.org

Attachment ICA: DCs From Across the U.S. Are Mobilizing to Oppose S. 1955

Legislation is moving through the US Senate, S 1955, which would extend the Employee Retirement Income Security Act's (ERISA) preemption to cover the small group insurance market now regulated at the state level. This legislation would have the effect of eliminating the protections now available to chiropractors and chiropractic patients provided by state-enacted insurance equality laws. Chairman of the U.S. Senate Health Education and Labor (HELP) Committee, Senator Mike Enzi (R-Wyoming), is promoting S.1955, which is intended to assist small businesses and other organization secure more affordable group health insurance for their employees. ICA fully supports this intention but we are painfully aware that this legislation would, in fact, have the reverse effect by limiting competition, consumer choice and locking far too many plans into the very narrow, massively high-cost medical model that is presently nearly bankrupting business now. As a practical matter, this legislation would render useless state-enacted protections that include patient access to alternative providers such as doctors of chiropractic, any-willing provider, and insurance equality laws intended to protect health care providers and consumers. If enacted into law, S.1955 would preempt all state directed benefits legislation, not just those that are specific to the chiropractic profession. As well, this legislation would allow for highly discriminatory premiums schedules, based on age, sex and previous health conditions for which basic consumer protections are now provided by many states. To lose these protections would be a dangerous step backwards. We are asking all DCs to immediately contact their United States Senators and ask that they oppose the immediate passage of S. 1955 and call for further development and critical analysis so that this legislation can realize its intent, and not place so many millions at a greater disadvantage in the health insurance market. Because of the slow nature of the US mail, ICA-PAC is asking that DCs fax or e-mail their US Senators. You can find your Senators' contact information by going to the link below, using the FIND YOUR SENATORS function at the top right of the screen, entering your state and copying the contact information that is shown: http://www.senate.gov/ "This is an urgent priority and one that demands action on the part of every doctor of chiropractic in the nation," said ICA Legislative Committee Co-Chairman Dr. Michael S, McLean. "Chiropractic fought so hard over many decades to win the basic patient and marketplace protections embodied in state insurance equality laws, and we cannot afford a single step backwards in this arena." Please feel free to call Mr. Ronald Hendrickson at the ICA headquarters at 1-800-423-4690 if you need assistance or have questions. Act today, however, because time is of the essence. Talking Points S. 1955: Association Health Plan Legislation Out of Alignment for Chiropractors American Chiropractic Association ? March 14, 2006 Congress is considering S.1955, the Health Insurance Marketplace Modernization and Affordability Act, sponsored by Michael Enzi (R-Wyo). If this legislation becomes law, patients enrolled in this smallbusiness friendly plan will have limited, if any, access to chiropractic care. ? The Enzi bill overrides important state laws that regulate insurance plans. This legislation will allow insurers to offer plans without the benefits, services and health care providers that individual state legislatures have identified as critical, including chiropractic care and those services doctors of chiropractic are licensed to provide. ? Access to chiropractic provider protections will be lost. State protections are the result of years of advocacy by your state associations and as a result of thoughtful consideration by state legislatures. These state mandates are there to protect unfair discrimination against the chiropractic profession and allow patients to seek valuable chiropractic care. Not only does the S. 1955 wipe-out these existing laws, but it also prevents state policymakers from making decisions in the future about even minimal protections for the state’s health care consumers. ? The Enzi bill sets aside state laws that protect consumers in the small group market from discriminatory pricing practices. Taking a step opposed by the National Association of Insurance Commissioners, the Enzi bill would allow insurers to charge small businesses as much as 50 percent more for premiums if some of their workers are in less-than-perfect health. It would also allow unlimited premium increases based on the sex or age of workers or on other demographic features. ? The Enzi bill forces consumers to choose between accepting barebones policies and paying higher rates for the more comprehensive coverage they need and want. Many Americans who seek comprehensive coverage, including chiropractic care, will be forced to pay much higher premiums than they currently pay, making health insurance unaffordable for many. ? The Enzi bill will permit and even encourage small business to offer chiropractic services through affinity plans and/or plans that require a M.D. referral for coverage of chiropractic services. ACA is asking doctors of chiropractic across the country to take action by contacting their member of the U.S. Senate and urging them to vote against this legislation. Senators can be reached at 202-224-3121 or via their e-mail at www.senate.gov.

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