RALEIGH – If ever there was a clear, concise account of what has gone wrong with the legislative process in North Carolina, it can be found in an account in this week’s Triad Business Journal of a new state law that promises to steer lots of additional business to chiropractors.
Now, let me establish right off the bat that I have nothing personal against chiropractic. I know plenty of folks who have experienced relief from back and neck pain after visiting their chiropractor. My own visits years ago conferred no lasting relief from my chronic neck pain, unfortunately, but then again the medical doctors I’ve seen could never figure out what to do about it, either, and it’s probably my fault for paying so little attention to my health over the years.
As for broader claims that chiropractic can alleviate or cure all sorts of other diseases or maladies, I am properly skeptical. But I do not believe that the state should attempt to keep North Carolinians away from unscrupulous bone crackers. In a free society, individuals have the right to buy and sell whatever services they wish (as long as they refrain from fraud, which might sometimes be relevant in this case).
My observation of problems with the new state law, then, do not stem from any desire to deprive chiropractors of access to customers.
First of all, the law wasn’t the result of a distinct legislative debate, held in public through committee and floor debate, about a freestanding piece of legislation. Instead, it was slipped into the 2005-07 budget bill despite having no rational connection to the appropriation of state funds.
The second, and more fundamental, problem with the provision is that it interferes with the right to negotiate insurance contracts. It requires health insurers to charge the same co-payment for visits to chiropractors as they do for visits to primary care M.D.s. Previously, chiropractors were usually treated by insurers as specialty providers, thus bearing a co-pay in the $40 to $50 range. Now, it will be more like $10 to $20 per visit.
That seemingly modest change could make a big difference for chiropractors, who often request that patients set up schedules of frequent visits over weeks or months. The Business Journal’s Mark Tosczak used the example of a dozen visits during an initial month of treatment. Under the old rule, the series might bear an out-of-pocket cost of $600. Under the new one, it could be only $240.
Obviously, this was a shameless and shameful piece of special-interest legislation. If a policy of lower co-pays for chiropractic had derived from bargaining in the marketplace, as insurers sought to make their offerings more attractive to employers and their employees, that would be different. But it didn’t.
Indeed, the story is even worse than you might think. The special budget provision made the lower co-pays retroactive to July 1, 2005. As if that wasn’t bad enough, another bill got rushed through the General Assembly during last week’s all-nighter to push the date of retroactivity all the way back to March 1.
So, state legislators used an improper procedure to vitiate the right to contract, reward special-interest lobbying, and change the rules after the fact to force insurers to pay for already delivered services they were not legally or ethically required to fund.
The legislators are reconvening Tuesday in Raleigh. Oh, goody.
Hood is president of the John Locke Foundation.