Chiropractors get a lift in the Senate health care bill, thanks to a senator from the state practitioners consider the birthplace of their profession _ Iowa.
Search the fine print of the bill unveiled this week by Senate Majority Leader Harry Reid, D-Nev., and you'll find scores of provisions making winners out of some interest groups and losers of others, from makers of costly biological drugs to insurance company executives.
It's not surprising considering the $1 trillion, 10-year price tag of the 2,074-page legislation.
Chiropractors, sometimes criticized as unscientific by medical doctors, could join health teams designed to help primary care physicians coordinate the treatment of patients. Though the precise financial impact is unclear, the language would help steer more patients to a profession whose participation in many federal programs is limited, including Medicare, Medicaid and the medical systems for veterans, the military and civil servants.
"It's important because it just further legitimizes the services that are delivered by a chiropractor, and recognizes they are well received by the patient public," said John Falardeau, lobbyist for the American Chiropractic Association.
The language was approved earlier this year by the Senate health committee. Falardeau said that panel's chairman, Sen. Tom Harkin, D-Iowa, was largely responsible for getting it included by Reid, who wrote the final Senate bill behind closed doors. The lobbyist said numerous chiropractors and their patients contacted Harkin and other senators to push for the language.
"I like to call Iowa the Cooperstown of chiropractic," said Falardeau, alluding to the site of Baseball's Hall of Fame. He noted that Iowa is where the discipline began and is home to the Palmer College of Chiropractic, where many practitioners are trained.
Less fortunate were well-paid officials of health insurance companies. Reid included language Sen. Blanche Lincoln, D-Ark., got into the Senate Finance Committee version of the bill. The wording eliminates companies' tax deductions for the portion of insurance executives' pay that exceeds $500,000.
Lincoln faces a difficult re-election campaign next year, and is among a handful of moderate Democratic senators who have not said whether they will support Reid's bill. Health insurance companies have been repeatedly vilified by President Barack Obama and congressional Democrats, and axing an industry tax break could have populist appeal.
Robert Zirkelbach, spokesman for America's Health Insurance Plans, the industry's trade group, said his group has done no lobbying on the provision.
In the latest round of a bitter struggle over the country's $46 billion market for biological drugs, the Senate bill extends the protection some brand-name manufacturers would get from generic competitors.
The drugs, made from living cells, are a growing part of the pharmaceutical market. Benefiting from a well-financed lobbying campaign and influential supporters, the manufacturers won language in the Senate health committee bill _ and in the House-passed health overhaul legislation _ giving them 12 years of protection from generic competitors.
Reid's bill would add another six months of protection for drugmakers who also test those products for use by children. Generic companies want to be able to compete immediately.
Kathleen Jaeger, president of the Generic Pharmaceutical Association, said Reid's decision represents "a total hijack" by drug manufacturers that she said will keep consumers' costs higher for a longer time. Ken Johnson, a senior vice president for the Pharmaceutical Research and Manufacturers of America, said drugmakers pursued the issue with senators and that the extra six months of protection gives companies an incentive to make products for children.
The bill also has language prohibiting the government from discriminating against health care providers that refuse to provide services for assisted suicides.
Similar provisions were included in earlier versions by Sens. Tom Coburn, R-Okla., and Orrin Hatch, R-Utah. The legal status of the practice is murky in much of the country, with Oregon and Washington the only states with voter-approved assisted suicide laws and a court case pending in Montana.
Reid's bill also allows Medicaid coverage for babies delivered in the roughly 300 birth centers that operate outside hospitals around the country, mostly for low-income women or those in remote areas.