A measure passed by the Missouri legislature this year would let chiropractic physicians treat Medicaid recipients for back pain.  The bill was not been signed by Republican Eric Greitens before he resigned from office last Friday, but could be considered by newly sworn-in GOP head of state Mike Parson.

Currently, people served by the low-income federal health program are required to seek care for such ailments through traditional medical doctors.

Republican Representative John Weimann of O’Fallon

The Senate passed the measure by a 32-0 in early May.  It’s been sponsored by Republican Representative John Wiemann of O’Fallon for the past two years.

Both years it’s received strong bipartisan support in the lower chamber but failed to move last year in the Senate.  The upper chamber was bogged down for much of 2017 due to internal wrangling and public conflicts with Governor Eric Greitens.

Wiemann says his legislation will help ease the opioid crisis and save the state millions of dollars by offering a less expensive alternative to Medicaid recipients with back pain.

“This is one thing that we can do within the Medicaid population to allow them another option besides going to the ER, going to the regular medical doctor to get relief from severe back pain, aside from getting narcotics or opiates prescribed to them,” said Wiemann.

In 2017, the American College of Physicians (ACP) released new guidelines for managing lower back pain.  The guidelines advised non-drug options first — including spinal manipulation performed by chiropractors.

This year the Joint Commission, a U.S. based nonprofit that accredits health care organizations and programs, is requiring hospitals to offer non-pharmacological treatment options that include the services offered by chiropractic physicians.

Wiemann thinks it only makes sense to let chiropractors be a source of back pain relief that doesn’t involve the use of drugs and narcotics.

“It’s become more of a situation where we need to start taking action because they (chiropractors) can truly, in fact, help a patient population of Medicaid enrollees to find alternative services that aren’t related to the traditional means of relieving back pain through drugs and narcotics,” Wiemann said.

Representative Wiemann’s office released a statement in December, saying studies suggest integrated care from chiropractic physicians could decrease the number of opioid prescriptions by up to 77 percent in patients suffering from chronic pain, and save the state between $12.9 million and $21 million a year.

Research from the University of North Carolina School of Medicine has shown that more than 80 percent of Americans will experience an episode of low back pain at some time in their lives, with the total costs of the condition estimated at greater than $100 billion annually.  Most of the loss is blamed on decreased wages and productivity.

Wiemann says chiropractic care for back pain has become widely accepted by both government and private insurers.  “Medicare reimburses for chiropractic services,” said Wiemann.  “All the insurance companies also reimburse your chiropractic services, so it’s a commonly excepted medical service offered around the country.”

A financial statement prepared by the nonpartisan Legislative Research Oversight Division says the net effect on the state’s general revenues would be no more than $2,669,270 in the upcoming fiscal year and would have a positive impact of close $6 million in each of the next two years.

The statement also says the bill could “could have a direct, positive fiscal impact on small business chiropractors if they decide to become Medicaid providers.”

Lawmakers in both chambers were happy with their progress in getting proposals through the legislature this year.  But leadership in both chambers was wary of sending anything to Governor Eric Greitens for signature, given the legal challenges he was facing in office.  (He still faces hurdles with ethics and the law on several fronts.)

There was speculation in the Capitol that Greitens could threaten to withhold his signature if bill sponsors or other lawmakers didn’t side with him in the special session on his possible impeachment.  That session has stalled with Greitens resignation.

As it turns out, he signed 77 of the 143 bill approved by lawmakers before leaving office.  Current Governor Parson has until July 14th the sign or veto the remaining 66 measures.  If he fails to act on any of them, they’ll become law on their own.

Representative Wiemann is not a medical doctor or a chiropractor but is heavily involved in the industry through his business as the owner of an insurance brokerage firm.

He has a master’s degree in healthcare administration and says he’s worked for hospitals, physicians, and insurance companies in the past.  His parents operate a home for developmentally disabled individuals that they’ve owned for 40 years.