Those searching for the financial impact of including the integrative care of naturopathic doctors in insurance plans will find some answers in a recent government report from the state of Maine. The report also raises a next stage question.
The state’s Department of Professional and Financial Regulation (DPFR) surveyed Maine’s insurers who had previously covered naturopathic services. They reviewed testimony of naturopathic doctors and patients and examined experience data nationwide on the costs of naturopathic coverage. The agency concluded: “We believe any increase in costs due to [adding coverage] would be minimal and if the services are a substitute for MD services, there may be a decrease in cost for some patients.”
The report was developed for the Maine legislature. Those elected officials recently made headlines when they voted nearly unanimously to overturn a veto from the state’s eccentric Governor Paul LePage of an insurance mandate for naturopathic services. The officials’ favorble perspective on the new law was based in part on the DPFR’s 18-page Review and Evaluation of LD 1030: An Act to Require Nondiscrimination Policies in Providing Health Insurance. This evidence backed the overturn of LePage’s veto on votes of 32-2 and 135-11 in the Senate and House, respectively. In January 2019, coverage of naturopathic doctors will be required in all Maine private insurance plans.
The legislative override came after legislators received a rash of calls from their constituents. The grassroots effort was organized through the Maine Association of Naturopathic Doctors led by Anne Jacobs, ND, and Elizabeth Yori, ND (pictured) and others. They used social-media and old-fashioned political methods to get the job done. Said Jacobs: “Over 4 days, we tried to call everyone.”
But the foundation for the overturn was the agency’s report. Previous experience of insurers in the state removed a first level of legislative concern: “Aetna and Anthem estimated the expansion of coverage under the amended bill to be cost neutral. Community Health Options and Harvard Pilgrim Health Care were not able to provide cost implications although Harvard Pilgrim Health Care stated that any cost increase would be insignificant. United Healthcare Insurance Company estimated a 0.1% increase to costs.”
Officials from Harvard Pilgrim Health Care upped the profession’s positive profile for any legislator concerned about the bottom line. This insurer “indicated there could be potential savings in health care costs specific to certain conditions, particularly with regard to control of hypertension, obesity, and select chronic pain.”
The theme of the special value of naturopathic doctors for chronic conditions re-occurs. Patients reported that “conventional treatment methods for chronic conditions were not successful so they pursued treatment from naturopathic doctors and had more positive results leading to a higher quality of life.” And again: “Providers such as naturopathic doctors provide a more integrative approach to medicine that may improve the quality of life for patients.”
Yet such findings did not appear to open legislative curiosity to exploring where the value might be in the naturopathic profession’s integrative, lifestyle-oriented model. The law states that any services of naturopathic doctors that are not standard for MDs, DOs, and nurse practitioners would not be covered. Thus, even though patients may believe that what the naturopathic doctors do may help them when conventional medicine has not, additional costs – for instance of supplements or special naturopathic lab or procedures – would be borne by patients “because alternative treatments would still not be covered.”
Jacobs argues that passing such a law has two sets of beneficiaries. Patients, especially those less-resourced, will gain more access to the naturopathic option: “I have many, many patients who are low income, and others who are poverty level. If we can keep them from more expensive procedures and treatment, all the better.” Jacobs expects the state will also attract more new naturopathic graduates, thus also expanding access to these lifestyle-oriented practitioners.
A third stakeholder beneficiary could be regulators and legislators in other states. The Maine report should be handy for others, In fact, Jensen shared that she knows it is already being put to work in other states.
Jacobs shared that their campaign originally began in the context of the 2010 Affordable Care Act and the Non-Discrimination in Health Care Section 2706. As general practitioners, what naturopathic doctors do is routinely covered when provided by medical doctors, osteopaths and nurse practitioners. Thus Section 2706 seemed to grease the skids for naturopathic coverage. Yet insurers in most states resisted through tortuous interpretations of the straight-forward statute. With this new law, Maine joins Hawaii as one of the few states to have the Congressional intent behind Section 2706.
Yet this coverage, as useful as it may be for each of these stakeholders, is for coverage of a naturopathic practice that is quietly passing as a conventional one. Hidden is the uniqueness that the DPFR references when it speaks of patients with chronic conditions “who feel that an ND can help them when conventional medicine has not.” Might it not be useful to examine the global costs and savings from the naturopathic doctors’ lifestyle-oriented, integrative model?
This is the big question that the Maine report side-steps. Hopefully this initial coverage will one day open a transparent examination of the effect on the payment and delivery system of what patients find in the full expression of this integrative approach.