PCA Deep Dive: Covered but Not Accessible. The Chiropractic Copay Crisis in Pennsylvania

This episode argues that rising deductibles, copays, visit caps, and administrative barriers are pricing patients out of conservative musculoskeletal care, reshaping treatment choices, and increasing downstream costs. Citing the RAND Health Insurance Experiment, it notes chiropractic use drops about 50% with 25%+ cost sharing and that chiropractic demand is more price-sensitive than general medical care. Studies on high-deductible health plans show patients reduce spending largely by skipping care, disproportionately harming lower-wage workers. In contrast,e a Johns Hopkins study links higher out-of-pocket costs to reduced non-pharmacologic care without reducing opioid use. Evidence shows that removing copays reduces downstream physician services, surgeries, and injections, and that chiropractic coverage correlates with lower total spending. The script highlights Pennsylvania billing data, federal Medicare parity bills (HR 539/S 106), DOJ comments on ERISA misuse, Massachusetts’ prior-authorization ban for non-opioid pain care, and Pennsylvania’s proposed 20% cost-sharing cap and Medicare fee payment floor, concluding with a call to action.

00:00 Why Care Costs More

00:51 The Bill Fear Factor

01:59 Rand Experiment Lessons

04:35 Smart Shopper Myth

06:25 Deductibles And Visit Caps

08:31 Maintenance Care Gap

10:06 When Patients Switch To Pills

11:05 Proof Reform Saves Money

14:02 Pennsylvania Billing Shock

14:59 Medicare Parity Fight

16:48 State Reforms In Motion

17:44 Pennsylvania Copay Blueprint

19:35 What You Can Do Now

20:35 Final Call To Action

References

Baicker, K., & Chandra, A. (2015). JAMA Internal Medicine.

Johns Hopkins University study evaluating the impact of high deductible health plan enrollment on nonpharmacologic treatments. (2023).

Legorreta, A. P., et al. (2004). JAMA Internal Medicine. Also referenced as: Comparative Analysis of Individuals With and Without Chiropractic Coverage.

Lentz, T. A., et al.; ATI Physical Therapy and Duke Clinical Research Institute. (October 2025). Physical Therapy & Rehabilitation Journal.

RAND Health Insurance Experiment. (1974–1982). Findings later analyzed in: Shekelle, P. G., Rogers, W. H., & Newhouse, J. P. (1996). Medical Care.

Smith, M., & Stano, M. (1997). Journal of Manipulative and Physiological Therapeutics.

Swedish randomized controlled trial on maintenance care. (2018).

Texas A&M study evaluating employee behavior in high deductible health plans.

University of California, Berkeley, and Harvard study on high deductible health plans.

USC Schaeffer Center study on the financial burden of high deductible health plans. (2023).

Whedon, J. M., et al. (2024). Journal of Integrative and Complementary Medicine.

JAMA Network Open clinical trial analyzing the addition of chiropractic care to standard military medical care.

Government, Legislative, and Policy Documents

American Chiropractic Association. Chiropractic Medicare Coverage Modernization Act Talking Points. (2025).

Chiropractic Future. Comments submitted to the Department of Justice Anticompetitive Regulations Task Force. (June 2025).

Massachusetts Session Law, Chapter 285. (2024).

Medicare. 2025 Physician Fee Schedule.

PCA Website:https://pennchiro.org/

PCA Email:pca@pennchiro.org