In a year when much of Minnesota's health care industry was in retreat at the State Capitol, chiropractors emerged as one of the few winners.
For that they can thank a veteran chiropractor who is now one of the most influential state House members on health care issues: Rep. Jim Abeler, R-Anoka.
Through Abeler's efforts, a budget that cut health care services in a number of areas also doubled the number of annual chiropractic visits covered by some state payments. It extended the state's Medical Assistance coverage to acupuncture treatments performed by chiropractors and others. It also ensured the creation of a state demonstration project on alternative therapy that is likely to be conducted by Northwestern Health Sciences University in Bloomington, where Abeler attended chiropractic school.
Abeler, who leads the House Health and Human Services Finance Committee, says that whatever boon the measures provide are small-potato features in a health and human services bill that spanned 304 pages and totaled $11.3 billion.
Dr. Robert Meiches, chief executive of the Minnesota Medical Association, said Abeler's changes were "pretty much last-minute surprises" when they passed during July's brief special legislative session. The discord reflects a larger debate on how best to stretch increasingly scarce health care dollars and what treatments are most effective for the money spent. In that arena, the seesaw between traditional medicine and alternative care is moving toward center stage now that Abeler, a seven-term legislator, has risen to prominence in the Republican House majority.
Dr. Craig Couillard, who chairs the legislative panel for the Minnesota Chiropractic Association, said the group did not get everything it wanted in this session and in fact failed to achieve its top priority -- a proposal Abeler co-sponsored that, among other things, would allow chiropractors to legally call themselves "chiropractic physicians."
Abeler has long railed against the diminished status given to alternative practitioners. "They think all this stuff is a cult," he said, referring to the medical establishment.
Speaking to health care professionals in March, Abeler said, "Many of the occupants of this room would like nothing to change."
Abeler said his actions crossed no ethical lines, adding that "I always think about that sort of thing." He said that the chiropractic school doing the demonstration project -- not the state -- will pay the costs, and that the other changes benefiting chiropractors would not cost taxpayers.
Rep. Thomas Huntley, DFL-Duluth, the ranking DFLer on Abeler's House Health and Human Services Finance Committee, said he does not think Abeler had an ethical conflict because the provisions benefit all chiropractors, not just Abeler.
But Huntley said he disagrees with Abeler on the role of chiropractors. "He would like them to be considered primary-care-type docs. I don't happen to agree with that," Huntley said. "I do strongly support chiropractors for lower-back pain. I think they do a great job ... [but] I don't think chiropractors should be advising people on what kind of food to eat."
Huntley said he also opposed a state-sponsored demonstration project for alternative therapy. "Unless there [are] scientific studies that show that that stuff works, then why are you wasting our time?" he said.
Abeler, a chiropractor for 32 years and the son of a chiropractor, is a one-man proselytizer. His practice describes his "gentle approach to spinal care" as using "kinesiology, spinal and muscular balancing, nutritional advice and a strong emphasis on personal responsibility," and his clinic website offers chiropractic to help with everything from allergies to pre-menstrual symptoms.
It also attempts to debunk chiropractic "myths," like "chiropractors are not real doctors." According to the website, "Just like medical doctors, chiropractors are professionals that are subject to the same type of testing procedures, licensing and monitoring by state and national peer-reviewed boards." The biggest difference between chiropractors and medical doctors, the site says, "lies not in their level of education, but in their preferred method of caring for people." Northwestern, Abeler's alma mater in Bloomington, requires chiropractic applicants to have three years of college and a C average.
Meiches said the central issue is not whether chiropractors are equivalent to medical physicians. "This, for us, is not about chiropractors -- good or bad?" he said, but about what works best.
In doubling the number of annual visits to chiropractors for fee-for-service Medical Assistance patients, Abeler scored a political victory.
Two years ago state officials, led by then-Gov. Tim Pawlenty, recommended eliminating all coverage for chiropractor visits in the state's Medical Assistance, General Assistance and MinnesotaCare programs. At the time, patients could get covered for up to 24 chiropractic visits a year, or one every two weeks. A cost projection estimated that at that rate, the state would spend $2.219 million on chiropractic services in the 2012-13 budget.
State officials said the elimination was designed, in part, to "encourage the use of evidence-based care." As a compromise that year, legislators dropped the maximum visits to 12.
This year, the state's Department of Human Services took no position on Abeler's chiropractic proposals, including doubling the number of allowable visits, back to 24. Karen Smigielski, a department spokeswoman, said that only "a very small number of chiropractic visits exceeded 12 per year prior to the 2010 law, so it is assumed that going back to ... 24 would not have any fiscal impact," she said.
Rep. Erin Murphy, DFL-St. Paul, a member of Abeler's Health and Human Services Committee, said she never understood Abeler's push. "In a year where we're doing so much cutting," said Murphy, "what is the rationale for doing that?"
But Debra Hurston, executive director of the Minnesota Chiropractic Association, said Abeler's motives are clear. "He's very passionate, a very well-meaning [man]," she said. "He's going to look at the legislation from a wellness approach."
Mike Kaszuba • 651-222-1673