MEDICARE AND ACUPUNCTURE HEARING BEFORE THE SELECT COMMITTEE ON AGING HOUSE OF REPRESENTATIVES NINETY-EIGHTH CONGRESS FIRST SESSION NOVEMBER 30, 1983, SAN FRANCISCO, CALIF. Printed for the use of the Select Committee on Aging Comm. Pub. No. 98-425 U.S. GOVERNMENT PRINTING OFFICE 30-832 0 .. WASHINGTON : 1984 SELECT COMMI'ITEE ON AGING Chairman EDWARD R. ROYBAL, California,Ranking Minority Member CLAUDE PEPPER, Florida MATTHEW J. RINALDO, New Jersey, MARIO BIAGGI, New York,1 IKE ANDREWS, North CRrolina JOHN PAUL HAMMERSCHMIDT, Arkansas DON BONKER, W ·~it1gt< RALPH REGULA, Ohio THOMAS J. DOW, 'ErY , New York NORMAN D. SHUMWAY, California JAMES J. FLORlt fi, . ew Jersey OLYMPIA J. SNOWE, Maine HAROLD E. FORD ennessee JAMES M. JEFFORDS, Vermont WILLIAM J. HUG · '3, New Jersey THOMAS J. TAUKE, Iowa MARILYN LLOYD, 'I. nnessee JUDD GREGG, New Hampshire STAN LUNDINE, New York GEORGE C. WORTLEY, New York MARY ROSE OAKAR, Ohio HAL DAUB, Nebraska THOMAS A. LUKEN, Ohio LARRY E. CRAIG, Idaho GERALDINE A. FERRARO, New York ' PER EV ANS, Iowa BEVERLY B. BYRON, Maryland JAMES A. COURTER, New Jersey WILLIAM R. RATCHFORD, Connecticut LYLE WILLIAMS, Ohio DAN MICA, Florida CLAUDINE SCHNEIDER, Rhode Island HENRY A. WAXMAN, California THOMAS J. RIDGE, Pennsylvania MIKE SYNAR, Oklahoma JOHN McCAIN, Arizona BUTLER DERRICK, South Carolina MICHAEL BILIRAKIS, Florida BRUCE F. VENTO, Minnesota GEORGE W. GEKAS, Pennsylvania BARNEY FRANK, Massachusetts MARK D. SILJANDER, Michigan TOM LANTOS, California CHRISTOPHER H. SMITH, New Jersey RON WYDEN, Oregon MICHAEL DEWINE, Ohio DONALD JOSEPH ALBOSTA, Michigan GEO. W. CROCKETT, JR., Michigan WILLIAM HILL BONER, Tennessee IKE SKELTON, Missouri DENNIS M. HERTEL, Michigan ROBERT A. BORSKI, Pennsylvania FREDERICK C. (RICK) BOUCHER, Virginia BEN ERDREICH, Alabama BUDDY MAcKAY, Florida HARRY M. REID, Nevada NORMAN SISISKY, Virginfo TOM VANDERGRIFF, Texa. ROBERT E. WISE, 'JR., West Virginia Staff Director BILL RICHARDSON,. New Mexico Minority Staff Diretl tor JORGE J. 1AMBRINOS, PAUL SCHLEGEL, (II) CONTENTS MEMBERS' OPENING STATEMENTS Page ward R . Roybal ........................................................................................ 1 � � :, . 2 Barbara Boxer................................................................................................................. 3 CHRONOLOGICAL LIST OF WITNESSES Deke Kendall, OMD, Ph.D., research director, American Association of Acu- puncture and Oriental Medicine, Torrance, Calif.................................................. 4 Dr. Peter Eckinan, Palo Alto, Calif.............................................................................. 7 Dr. Stuart Kutchins, OMD, chairman, National Commission for the Certifica- tion of Acupuncture, Inverness, Calif...................................................................... 9 Art .Agnos, assemblyman, 16th District, chairman, joint legislative audit com- mittee, California Legislature . .. .. ... ...... .. .. .. .. .. .. .. .. .. .. .. .. .... .. .. 22 Rosa Mei Lee, certified acupuncturist and doctor of oriental medicine, Moun- tain View, Calif............................................................................................................. 23 Effie Chow, Ph.D., acupuncturist, San Francisco, Calif........................................... 30 Barbara Sklar, planning director, Geriatrics, Mt. Zion Hospital Medical Center, San Francisco, Calif....................................................................................... 38 Charlene Harrington, chair, public policy committee, Western Gerontological Society, San Francisco, Calif...................................................................................... 44 Tish Sommers, president, Older Women's League, Western Office, Oakland, Calif................................................................................................................................ 46 Donna Ambrogi, director, Bay Area Law Center on Long-Term Care, Palo Alto, Calif...................................................................................................................... 51 Lillian Rabinowitz, chair, health committee, Gray Panthers, Berkeley Area, Calif................................................................................................................................ 57 Maureen M. Malvern, staff attorney, Legal Assistance to the Elderly, Inc., San Franciso, Calif....................................................................................................... 59 AUDIENCE PARTICIPATION James Tummey, Haight-Ashbury Acupuncture, San Francisco, Calif.................. 65 Herman Rifkin................................................................................................................. 66 Lee Grieux, social worker, Francis of Assisi Senior Housing, San Francisco, Calif................................................................................................................................ 66 Mr. McDevitt..................................................................................................................... 66 George Suey, member, State Commission on Aging, California ............................. 66 Morris Pensky, San Francisco, Calif............................................................................ 68 APPENDIX Additional material submitted for the record: Prepared statement of Kim Man Lai, president, California Certified Acu- puncturists Association, Oakland, Calif........................................................... 71 Prepared statement of Harry F. Tam, D.C., C.A., president of UAC, San Francisco, Calif...................................... ,.............................................................. 74 (Ill) MEDICARE AND ACUPUNCTURE WEDNESDAY, NOVEMBER 30, 1983 U.S. HOUSE OF REPRESENTATIVES, SELECT CoMMITTEE ON AGING, San Franc-isco, Calif. The committee met, pursuant to notice, at 9 a.m., in the ceremo­ nial courtroom, 19th floor, Phillip Burton Federal Building and Courthouse, San Francisco, Calif., Hon. Edward R. Roybal (chair­ man of the committee) presiding. Members present: Representatives Roybal of California and Burton of California. Staff present: Jorge Lambrinos, staff director, Select Committee on Aging; Edwin Davis, Judy Lemons, and Christine Pelosi of Rep­ resentative Burton's staff. OPENING STATEMENT OF CHAIRMAN EDWARD R. ROYBAL Mr. ROYBAL. The House Committee on Aging will now come to order. Ladies and gentlemen, it is a pleasure to be here in San Francis­ co, and have the opportunity to work with Congresswoman Burton on the issues of improving the medicare program, and covering acupuncture services under medicare and medicaid. In January, the Congress will once again be faced with the prob­ lems surrounding the medicare and medicaid programs. Both pro­ grams have been hit hard by the rising cost of health care, and have had difficulty keeping up with the needs of the elderly and the poor. These pressures have made it more difficult for Congress to consider changes in services, covered by medicare and medicaid. However, I remain convinced that the Congress should keep an open mind as it considers the wide range of proposals for changing medicare and medicaid financing and covered services. One such change in covered service is the legislative proposal on acupuncture made by Congresswoman Burton. This service has re­ mained outside the medicare and medicaid programs. Acupuncture is a practice which has been used for centuries in other countries and which has gained popularity just recently in the United States. After listening to the argument by Congresswoman Burton for the coverage of acupuncture under medicare and medicaid, I agreed that the House Select Committee on Aging should include an ex­ amination of acupuncture as part of this hearing on medicare. The first panel of witnesses will focus on the issue of the coverage of acupuncture under both medicare and medicaid. During the second part of the hearing, I have asked witnesses to speak on more general issues surrounding the elderly and the (1) 2 medicare program in general. If medicare is to be kept alive, and its covered services and eligibility expanded, we need to gain better control over rising health costs. This will require a joint effort be­ tween the Congress and the health care insurers and providers. At the same time that we are trying to contain health care costs, I want the aging committee to examine approaches for improving both benefits and eligibility for the poor and for the elderly. I trust that this hearing will touch on several issues of concern to the elderly and to the long term financing health of the medi­ care program itself. As you know, the medicare program is present­ ly operating under great difficulty. There are some who predict that we will run out of these funds as early as 1990, and possibly even before. However, we are going to look into the subject matter very carefully. I can assure you that Mrs. Burton will join me and the Committee on Aging in seeing to it that medicare is well fi­ nanced and it will continue beyond this century. I realize that it is a tremendous problem, but one that is not insolvable. I want to express my appreciation to Congresswoman Burton and her staff for assisting the Aging Committee in holding hearings here in San Francisco. This is the first hearing on acupuncture. We will go back to Washington, D.C., and hold a hearing there on the same subject matter. We will also include acupuncture in other hearings that will be held throughout the country. The committee