Supreme Court Upholds Health Reform Law

ACA Will Continue to Fight for Patient Access to Chiropractic as Law is Fully Implemented

Arlington, Va. — On June 28, 2012, the U.S. Supreme Court, in a controversial 5 to 4 decision, declared the Patient Protection and Affordable Care Act (PPACA) to be constitutional, including the much disputed “individual mandate” provision which requires individuals to purchase health insurance coverage. According to the American Chiropractic Association (ACA), the long-awaited court decision removes legal obstacles to the full implementation of the law on a timeline very close to what was planned when PPACA was signed into law in March 2010.

A critically important result of the court’s decision is the preservation of Section 2706, which establishes a “provider non-discrimination provision” applicable to all Employee Retirement Income Security Act (ERISA) health care plans, including self-insured, multi-state plans that are not subject to provider-friendly state laws. ACA worked hard to ensure the inclusion of this provision in the legislation.

“Regardless of how you feel about this legislation in general, Section 2706 has to be recognized as an historic first for the chiropractic profession. We now have a federal law applicable to ERISA plans that makes it illegal for insurance companies to discriminate against doctors of chiropractic and other providers based on the provider’s license or scope of practice,” said ACA President, Keith Overland, DC. “While the fight to fully level the playing field for doctors of chiropractic in our health care system goes on, the non-discrimination provision, when it is fully implemented, will extend the availability of chiropractic services to several million employees at large, national firms that operate in multiple states.”

Under the timetable embedded in the law, the majority of its key provisions, including the provider non-discrimination provision and the individual mandate, are scheduled to take effect no later than 2014.

The Court’s ruling also means that all 50 states will be required to establish “state insurance exchanges” where eligible consumers will have an opportunity to shop and compare prices and benefits for a range of insurance policies that meet certain specified guidelines established by the federal government. A group of 26 states had joined together to challenge the law on constitutional grounds, and it was their challenge to the law that was effectively rejected by the courts.

Only about a dozen states have moved to establish the required exchanges. States that delayed will have a hard time meeting the law’s specified deadlines, likely forcing the Department of Health and Human Services (HHS) to issue “waivers” to state governments, granting them additional time to comply fully with the law.

For more than two years, ACA has worked with state chiropractic associations to prepare for the establishment of the state exchanges and, along with other groups, was successful in lobbying HHS to adopt regulations related to the exchanges that leave a significant level of authority in the hands of state governments. Safeguarding significant “state flexibility” is seen as one way to ensure that consumers have access to the services provided by doctors of chiropractic and that state laws favoring consumer choice of provider remain applicable, for the most part, in the state exchange environment.

Additionally, in regard to the Medicaid expansion, a majority of the court held that the expansion is constitutional but that it would be unconstitutional for the federal government to withhold existing Medicaid funding from states that do not comply with the expansion’s provisions. The Constitution requires that states have a choice about whether to participate in the expansion of eligibility; if they decide not to, they can continue to receive funds for the rest of the program.

Despite the court’s ruling, recent polls reflect substantial public concern regarding the law and in some cases, a deepening opposition to it. At this point, the only viable way to modify or repeal the law rests in the hands of Congress through a series of regulatory battles and a new round of “repeal and replace” efforts. ACA will remain fully engaged in this issue, working to ensure that all regulations implementing the law are constructed, carried out and enforced in a manner favorable to the chiropractic profession and its patients.


The American Chiropractic Association (ACA), based in Arlington, Va., is the largest professional association in the United States representing doctors of chiropractic. ACA promotes the highest standards of patient care and ethics, and supports research that contributes to the health and well-being of millions of chiropractic patients. Visit