The “Opt-Out” Issue

Most  legislators do not respond well for a request to “opt-out” of Medicare.  It seems that this is the reason that the profession has failed to advance any legislative efforts to obtain “opt-out” privileges.

The ICA is trying to re-frame the issue and place it in the context of Freedom of Choice for the patient and as an issue of blatant discrimination against a class of physicians based solely on type of license ( i.e. would be a violation of Sec. 2706 if it applied to Medicare B )

In order to understand the logic … please refer to Sec. 1802 of the Social Security Act.


Since it was the intent of Congress to guarantee the patient the freedom to choose …. it is appropriate to argue that patients are being denied that free choice when that choice happens to be a Doctor of Chiropractic.

Please note that the federal statute addresses this with the following language:

“Sec . 1802 . [ 42 U.S.C. 1395a ] (b) Use of Private Contracts by Medicare Beneficiaries.—
(1) In general.—Subject to the provisions of this subsection, nothing in this title shall prohibit a physician or practitioner from entering into a private contract with a medicare beneficiary for any item or service— “.

The problem is that in Sec. 1802(b)(5)(B), in that by defining “physician” by paragraphs 1 thru 4 and excluding paragraph 5, the DC is being discriminated against solely on the basis that he has a DC license and not an MD/DO license etc.

“Sec . 1802 . [ 42 U.S.C. 1395a ] (b)
(5) Definitions.— In this subsection:
(A) Medicare beneficiary.—The term “medicare beneficiary” means an individual who is entitled to benefits under part A or enrolled under part B.
(B) Physician.— The term “physician” has the meaning given such term by paragraphs (1), (2), (3), and (4) of section 1861(r) .”

It should be noted that a change in the definition of paragraph 5 of Section 1861(r) will not have any affect on the discrimination against the chiropractic patient that exists in Section 1802.

From a statutory perspective, the patient is actually being denied the right to privately contract with a DC solely based upon the type of license.

From a political perspective, it is much easier to seek an end to the discrimination on behalf of the patients by requesting that the Congressional intent of guaranteeing patient choice be reaffirmed rather that, as as historically be done, requesting that the DC be extended to ability to “opt-out” which has always been rejected as “unamerican” by various congressional staffs.

The result of simply deleting the discriminatory phrase ” paragraphs (1), (2), (3), and (4) of “, and simply allowing the current statute to apply to all physicians on an equal basis will actually accomplish what is desired.

From the ICA point of view, it is all about how you frame the question.

This is why the ICA campaign is not about “Medicare reform” in is about “ending discrimination in Medicare”.

Contrary to the BS that is being circulated on Facebook, the ICA proposals have the “Opt-Out” issue identified as a high priority … however, we are framing the issue in a manner that will be more acceptable to Congress.

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