AMTA: Supporting Massage Therapists for the Affordable Care Act (or Not?)

The Affordable Care Act goes into effect on January 1, 2014. This stands to have a major impact on the ability of massage therapists to be reimbursed by insurance. The 1300+ page document includes language prohibiting discrimination against licensed integrative health care practitioners.

Diana Thompson, well-known educator, author, long-time AMTA member and past president of the Massage Therapy Foundation, recently shared with me a letter she sent to the BOD of AMTA, expressing her concerns that the organization is not supporting the movement of massage therapy into the mainstream as a health care choice. In the letter, Thompson went so far as to call out AMTA for not operating according to their own bylaws, which include the mandates that the organization is, among other things, to

(D.) Promote legislation that supports and upholds, and oppose legislation that harms
and damages, the massage profession;

(E.) Protect and preserve the rights of its members;

(H.) To advocate the rights and interests of persons seeking massage therapy as
health care;

Thompson was moved to write the letter to the BOD after a recent meeting of representatives of CAM professions, held at Bastyr University in Seattle. After the meeting, the purpose of which was to discuss the ACA, Cynthia Price, PhD, LMP, who attended on behalf of the Academic Consortium for Complimentary and Alternative Health Care stated in her report to Executive Director John Weeks:

I was very pleased to attend the Region X/ACA meeting on Monday held at Bastyr this week.  It was a very informative meeting and a nice first step to bring clinicians from different CAM and Medical disciplines into one room together who all want to be better informed and care deeply about this topic.   Deborah Senn did an excellent introductory presentation on the ACA and the current concerns regarding the language that may put CAM providers at risk for inclusion/coverage.  With the exception of the massage representative from the AMTA, all the clinical speakers were excellent and very supportive of the ACA and interested in doing everything possible to support coverage by practitioners within their discipline.  These clinicians expressed similar concerns regarding the ACA and how it may or may not affect CAM services.  There were also clinical examples provided about how the ACA may positively impact certain disciplines, particularly NDs who provide primary care… On a side note, I am very concerned about the position of the AMTA…”

Winona Bontrager, President of the Board of AMTA, responded with a letter to Thompson that stated:

“We have spoken with some other people who attended the recent HHS meeting.  Some of those individuals were there representing other groups and of course our chapter members, and none of them came away from that meeting with the understandings you put forward.  We have no idea how Cynthia Price arrived at the statement she has made to you.”

Thompson also stated in her letter to the BOD that Price had specifically asked that Chris Studebaker, AMTA’s Director of Government and Industry Relations and the person who was representing AMTA at the invitation-only meeting, not be invited to attend future meetings, and that others besides AMTA should be invited to better ensure accurate and professional representation of the interests of massage therapists.

These are serious accusations. AMTA’s response is that Studebaker’s statements at the meeting were conveying the results of AMTA’s last member survey, which revealed that about 50% of the membership has no interest in third-party reimbursement. Bontrager, speaking on behalf of the BOD, stated that Studebaker is being unfairly blamed for things he did not say. Thompson states that she stands by her accusations.

Thompson also stated that she spoke to AMTA leaders about the need for support and action regarding the ACA on at least a couple of other occasions, notably at the last AMTA National Convention in Raleigh, NC and again at the IMTRC held in Boston earlier this year, and that both times was given “wait and see” and “we’re not ready” responses by the leadership.

This entire brouhaha brings to light several issues and bigger questions. First, lest there be any confusion here, even if the ACA results in every massage therapist in the country being eligible for third-party reimbursement, no one is going to be forced to accept insurance. Anyone who wants to keep operating a cash-only practice will be able to do so.

Second, if 50% of AMTA’s membership doesn’t want to participate with insurance clients, that means there is also 50% that does. Since the 50% who don’t want to are not going to be forced to participate, what about representation for the half of the members who do want to?

Third, I must agree with Thompson that this is not the time to “wait and see.” This is the time to be proactive. I will point out the position statements approved by this organization that clearly demonstrate the health benefits of massage therapy! If we can make that more available to the public who have insurance that would pay for it, shouldn’t we be doing that?

Diana Thompson is a long-standing and dedicated member of AMTA. She was instrumental in gaining the right for massage therapists to file insurance in the state of Washington, where 90% of AMTA members do bill insurance. I don’t believe she is on a witch-hunt at AMTA. I believe it came from genuine concern that a major voice that should be speaking out for us is not doing so. Her letter cited the research from AMTA’s own 2009 consumer survey that showed that 97% of massage recipients believe that massage should be considered as health care.

The field of massage therapy has been experiencing growing pains for quite some time. There are concerted and combined efforts going on right now to raise the quality of education, to raise the quality of teaching and education, and to raise the image of massage in the eyes of the public. AMTA has made many efforts in the past on behalf of the membership, and I urge them not to drop the ball this time.

35 Replies to “AMTA: Supporting Massage Therapists for the Affordable Care Act (or Not?)”

  1. Thankfully Dianne caught this and you blogged about it. Janet Kahn did an excellent job explaining the importance of being proactive so that massage therapy is available as part of the affordable care acts approved services. The massage profession must work together to be included in covered services. It is not automatic. The AMTA should be the organization that is taking a aggressive and proactive role.

  2. In 2012, while I was still serving as the AMTA-CA GR Chair, even though we do not yet have mandatory licensure and no Massage Practice Act, I worked with my AMTA-CA Chapter Board to take a pro-active stance on this issue by submitting a letter of Support for SB 690 (Hernandez) which would have preserved a vested right of insurance reimbursement in the future when a Massage Practice Act with clear scope is passed in California. This bill applied to “licensed and certified providers acting within scope”. ABMP’s Director of Government Affairs Jean Robinson also took a proactive approach and submitted a letter of support for SB 690 on behalf of ABMP members.
    Unfortunately this bill was opposed by the California Medical Association and was hung in Assembly Appropriations Committee after passing the CA Senate so died in that Committee in August 2012.

    I completed my appointed term as AMTA-CA GR March 31, 2013 and my comments reflect only my individual opinion and not any official position taken by the AMTA-CA Chapter Board here down. Again this is my cranky opinions expressed.

    Priority One in California–improving operations and communication between stakeholders including public, local code enforcement and massage professionals affected by the voluntary statewide certification program. And Priority Two: Passage of a Practice Act. There are over 45,000 certificate holders AND yet the only official update I have received since February 21, 2012 is a recent CAMTC e-blast marketing the AMC convention in San Diego in September encouraging me to register early to get a discount as a CAMTC certificate holder. What about informing certificate holders of the new statutory requirements effective January 1, 2013?

    Basic regulatory communication 101 but not happening.

  3. There’s the 50% that “want it”. Not much reference to whether that 50% are trained and qualified to be part of a healthcare profession. Just because its wanted doesn’t mean that it should be given.

  4. Hi Laura, I have been talking about this for the past year or more…guess I need to step it up more! My fear is that massage will be included as it says it will be under the new law and the profession won’t be ready. Looks like that is a big possibility. I have been writing as much as I know about it on my blog and just did a piece for massamio – a free download on it.
    I didn’t realize that AMTA actually had the stance that they wouldn’t be doing anything on this. I think it actually is more up to each state really. We are already able to bill health ins. in WA so our WA AMTA is really up on this for us. We hired Diana and a team of researchers to write a paper on it as our OIC asked for it! I am sure it can be used by every other state for starters.

    I have been posting this on my page and anywhere I can find but MT just don’t get it…I don’t get it. MT in each state really need to get proactive, and the best way to do that is through their AMTA I would think because they are more organized for the most part anyways.
    My blog:

    Massamio’s website

    Diana’s paper:

  5. The license that Massage Therapists have studied, worked for, and earned indicates they ARE trained and qualified members of the healthcare profession!

  6. My question is: why isn’t there a qualified AMTA Board member MT there representing and speaking for members? What is the agenda of National staff at this point except coaching the BOD to do as they say with a staff of lawyers? I have seen it! I asked about OCA at our state meeting and “got deer in the headlights” from the state board and staff at that meeting.

    I am a professional member who has been paying dues for almost twenty years. I have continued to watch MT salaries go down, while costs to stay in business go up. We cannot bill insurance by state law, unless we work in the office of a Doctor. So it would definitely improve our bottom line here to be included. States that do like Washington state have higher average MT salaries than the rest of the US.

    I don’t understand why National Staff members have so much power over our association. Some have suggested reviving the standing Committee of Government Relations Chairs. That group of MT volunteers shared best practices in dealing with lawmakers and industry to decide our collective fate until 2006. Why is this job with all its influence, is now held by one person, who is not a LMT, at National Staff Office? This was the request and suggestion of Bill Brown, formerly GR Director who is now Executive Director, replacing Shelly Johnson. He’s a former IL state lobbyist. Fast forward to now, Chris Studebaker was appointed to GC Director despite his lack of massage industry experience (he represented a drywallers union before AMTA). We are being misrepresented by staff in meetings and the media all the time, whose average salary for a 40 hr week is over 3 times what a MT earns yearly, while the average massage therapist is paid less each year. These people don’t work in our field, never have, and rely on consistently outdated, skewed information on agendas they choose, that are enforced by National BOD of the AMTA.

    It should be the other way around. BOD should be representing best interests of membership to increase MT’s earning power and influence, telling National Staff what to do, whose only interest seems keeping their jobs, hold over chapters and their bank accounts. People who asked these questions in my state were definitely intimidated by AMTA BOD and officials in back channels. Good for Diane! Maybe she is too big to intimidate. The AMTA should be advocating for us, but as long as they follow the dictates of Staff over members they will not.

  7. Linda, just because someone is “licensed” doesn’t mean that they’re qualified to be considered healthcare providers. When you consider how fractured the education system is from from State to State and the poor requirement standards to that it takes even to teach massage therapy (hardly nothing in the State I’m in) this is a serious ethical question – not just one in which it could be that we’re deluding ourselves into thinking we’re something we’re not. We might be jumping the gun here. Are our
    basic standards good enough? I don’t think they are. It’s not a common view though.
    When I read some of the rings online, written by “licensed” and “certified” massage therapists, it makes me think that we’re nowhere near the mark for being considered healthcare providers education-wise.
    But money usually overrides ethics. It’s the way of the world.

  8. Rose has valid points. However, as Diana Thompson provided more than 900 research references on the efficacy of massage therapy as part of the process of getting MTs the ability to file insurance in WA state, and as Rose’s own winning case report demonstrates, and as the research required for the AMTA HOD to pass the position statements, it is already a valuable part of health care, or wellness care, whichever you’d like to call it.

    If an MT helps someone with ankylosing spondylitis, as in Rose’s report, or some other medical condition, then that person is being helped whether any insurance is filed for not. If the person is going to seek massage therapy, and ultimately be helped, then there is no ethical bearing to me on whether it was an insurance case or not.

    Christopher Moyer’s work on anxiety and depression is evidence of massage helping those conditions, and relaxation massage is not rocket science. If people suffering from those conditions (and many others) had the option of their insurance paying instead of spending out of pocket, I personally think that should be available.

  9. “When I read some of the rings online, written by “licensed” and “certified” massage therapists, it makes me think that we’re nowhere near the mark for being considered healthcare providers education-wise.
    But money usually overrides ethics. It’s the way of the world.”

    Rosemary’s exactly right here–massage licensing/regulation has done nothing to ensure any minimum standards at all in the way of the quality of information in the field.

    When our clients have to protect themselves against the snake oil, wishful/magical thinking, scope of practice violation, and other active misinformation many (not all) of us provide, then no one can really say that we, as a group, are qualified healthcare providers.

    Case in point: one of the public faces of massage, the admin of an MT group on Facebook, hawks “Bars” pseudoscience as CE to MTs, and publicly second-guessed the diagnosis of Tim Curry’s recent stroke, claiming a very primitive explanation of what causes stroke, and that if he had only drunk an expensive proprietary filtered water, then he would not have suffered the stroke.

    Sadly, that pathology misinformation, out-of-scope diagnosis, and pseudoscience is not an isolated event in massage–iy’s very representative of the industry. And that’s not healthcare professional behavior, not at all.

    If we really want this, we have a ton of work to do to show other members of the healthcare team that we’re committed to the same client-centered professional knowledge base they share.

  10. “However, as Diana Thompson provided more than 900 research references on the efficacy of massage therapy as part of the process of getting MTs the ability to file insurance in WA state, and as Rose’s own winning case report demonstrates, and as the research required for the AMTA HOD to pass the position statements, it is already a valuable part of health care, or wellness care, whichever you’d like to call it.”

    For one thing, it’s not clear whether they really read and evaluated all of those 900 references, and determined that they are valid and reliable, or whether they just did a PubMed search and took them at face value to put them in a list.

    When we are defending the case for MT, the former scenario will put us in a much stronger position than the latter.

    And although we are part of the system in WA, there are also forces that oppose us being there. When we were first added, Deborah Senn had to fight tooth-and-nail to make it go through.

    When we demonstrate publicly that we, as a group, don’t even share a minimum of healthcare professional knowledge and ethical behavior, we hand insurance companies and others who’d still like to see Senn’s decision revisited a *huge* weapon to use in that struggle against us.

  11. First, thank you Laura, for writing about these issues. No matter what direction this whole process goes we must all have the opportunity to be better informed so that we can make the best decisions for our practice as well as our clients. Another concern (and I will be contacting National on this) is that I see on the convention schedule for credit, a class entitled “Closing Keynote: The Affordable Care Act and the Massage Profession”. My concern is that this is information that needs to go out to everyone and not be limited by those at convention or those who are taking ‘for credit’ classes. As a side note, I live in a state that most do not want to be embroiled in this issue, with a government administration that does not support its people who will have difficulty paying for insurance, but I still want to know my options.

  12. I don’t see how we are going to get away from it, Ravensara. If it was legal for us all to file insurance right this minute, there would still be people claiming they have 32 electrical bars running around their head. If the MTBOK, the ELAP, the Model Practice Act, the Teacher’s Core Competencies and all the rest was in place and ready to propel us forward right now, there would still be people who are going to do that. I don’t know what we’re supposed to do about it. I don’t think it will ever go away.

    As far as the money goes, I employ a chiropractor in my office; I have one factory here in town that pays for their employees to get massage without having to go through the chiropractor, and I’ve billed insurance for years. I don’t expect it is going to affect me much personally one way or the other, but it does stand to impact a lot of therapists.

  13. I am glad my patients/clients don’t believe everything they read online. There are so many MD and ND and DC quacks (the list goes on) claiming to heal this, that, and the other. It would be paralyzing to any healthcare profession if they felt they had to wait until every member of their profession was of stellar quality before moving their profession forward. Yes, it is embarrassing, but I have my patients to consider. Today I saw a woman who, three months ago, had a face lift was so severe, skin pulled so tight with so much swelling that she couldn’t breathe without gasping. After our first session (day 5), she could breathe calmly, but still had to sleep on a lawn chair outside, sitting upright. Today she is happy, sleeping in her own bed, and now comes for more general health benefits. A first-time patient came today for post-mastectomy lymphedema. She said she got more from this one session than 6 months of physical therapy. What I do IS healthcare. I refuse wait until all of the crazy claims other massage therapists are making are off the internet before making sure my care is available to patients who choose it. I firmly believe that if we spend less time worrying about what the crazy minority are doing, and spend more time providing valuable service to patients/clients, we will move this profession forward.

    My biggest issue is the complacency of the AMTA. What happened to the organization that was forward thinking, that created an educational accreditation arm before most massage schools could even qualify, that created a research foundation before there was credible research, that created a National certifying body before there was reciprocity or equal educational requirements or similar scopes of practice from state to state. We move this profession forward by strategically preparing for what is coming, not by waiting until everything is already in place. For example, Naturopaths only have licensure in a handful of states but they continue to prepare for the ACA on a national level. Chiropractors have battled accusations of quackery for decades, but their national lobbyists make sure chiropractic is named in every statue that otherwise only mentions alternative healthcare. We need to mobilize nationally and share the accomplishments of Washington and Oregon to other states.

    As for the 995 citations, no, we did not do a systematic review. We had six days. And no funding. However, the document we came up with would make a great foundation for a systematic review. That proposal is before the Massage Therapy Foundation. It will cost upwards of $100,000 to do it, so please donate. But if we waited until we had a systematic review on every condition massage therapy typically treats, we would have missed the call for research citations from the Office of the Insurance Commissioner. And Washington might not have selected a plan for the ACA that includes massage therapy.

    I truly believe that what we do as massage therapists is enough. We do not diagnose; we are not doctors. We do not cure; we offer relief. We provide safe, educated, comforting touch that makes a difference in the mental, emotional, and physical wellbeing of most people. I call that health-care. My patients choose massage. Do not take that choice away from them.

  14. I don’t know about you all, but I just finished a two year degree in massage therapy and a degree in fitness. I may not be credentialed to be a doctor, but I have taken a lot of schooling and it’s pretty equal to “nurse assistants, and many other health care professionals. Maybe they should up the hours to be a practitioner. So all you who are saying you don’t have enough education to be a health care provider, go back to school.

  15. “I don’t know what we’re supposed to do about it. I don’t think it will ever go away.”

    To address the problems would mean investing money, time, and other resources into a workable plan to get MTs more ready, and then committing to carrying out that plan in the time remaining.

    It should have been done the minute PPACA was up for a vote, but it wasn’t, so we are in the situation where the time is now.

    Like the proverb, “The best time to plant a tree is 20 years ago. The second-best time is now.”. There are still steps we could take to get more ready in the time remaining before the provisions of 1 Jan go into effect, and the months afterward where people will be sorting out what that means.

    It sounds, though, like the prevailing attitude among the leadership, as you described, is “wait and see”, instead.

    So we’ll see what history decides with us, I guess.

  16. Thank you, Laura. There are some very insightful comments here.

    The following article just came out and it is relevant. The opening paragraph states:

    “Although Americans are living longer, with overall U.S. life expectancy increasing to 78.2 in 2010 from 75.2 in 1990, increases in psychiatric disorders, substance abuse and conditions that cause back, muscle and joint pain mean many do not feel well enough to enjoy those added years of life.”
    If this doesn’t clarify the importance of massage therapy as an Essential Health Benefit (EHB), I don’t know what does. Massage therapy needs to be included– state by state– as an EHB in order to be covered by the Affordable Care Act. As a responsible massage therapy educator, I share this with my students. As a Past National President of the American Massage Therapy Association and a Past Chair of the Arizona State Board of Massage Therapy, I call upon the AMTA and all of the State Boards to Take Action Now to bring this about.

  17. “If this doesn’t clarify the importance of massage therapy as an Essential Health Benefit (EHB), I don’t know what does. Massage therapy needs to be included– state by state– as an EHB in order to be covered by the Affordable Care Act.”

    This is what we’re up against:

    “Unfortunately, with the backing of the Bravewell Collaborative, the Samueli Institute, and the National Center for Complementary and Alternative Medicine, advocates of CAM/IM are in a strong position to insert themselves into the upcoming political debate over health care reform. If science-based medicine is to repulse this infiltration, two things will have to happen. First, the Obama Administration’s science and medical advisors will have to be sufficiently savvy not to fall for the blandishments of sectarians and to promote science-based, not pseudoscience-based, medicine. On that score, I am cautiously optimistic. The second thing that will have to happen is that science-based physicians will have to mount an effort to influence legislators at least equal to what CAM advocates are already doing.”

    Unlike some kinds of CAM, we can actually win this argument on the evidence, if we do it in the right way.

    Just not the way our leadership is currently behaving, though.

    There are some very specific steps we could take to cut this criticism off at the knees, and we’re not doing it.

    “Wait and see” on the part of our professional organizations is going to lose this battle for all of us.

  18. Laura and Diana you are singing my song and I couldn’t agree more with both of you! I have been wondering where the energy and movement is towards the inclusion of massage therapy in the Affordable Care Act. Diana, it sounds to me as if AMTA has capitalized on your work within the profession without providing you the support that you need to move things forward. Thanks to both of you for bringing to light what I have felt in my gut for sometime. We need a unified platform within massage therapy, proof of outcomes, and networking with the naturopathic and chiropractic communities on a national level if we are to be included in the ACA.

    And I agree with Ravensara that “the best time to plant a tree was 20 years ago, the second best time is now”. AMTA did amazing things in it’s early days and it sounds like it got derailed at some point. It is time to get the train back on track and move forward. the “wait and see” attitude is beyond ridiculous and very irresponsible at this point. It is an embarrassment to our profession. If you are making a salary representing us then you had better get mobilized and represent us.

  19. So I was just looking at the AMTA convention education program for Sept in Tx and the closing presentation is on the ACA so I am not sure how someone can say that they are not involved in this. Has anyone asked AMTA gov’t relations guy?

  20. Their GR rep, Chris Studebaker, was by invitation at the meeting this blog concerns, so of course they are “involved,” if you want to call having “no comment” and “wait and see” responses at the meeting being “involved.” They would really be dropping the ball if they DIDN’T have information on the ACA at this convention, since it is the last one before the ACA takes effect. I’m not going to be impressed until I hear it. I was very impressed with the one Dr. Janet Kahn gave at the IMTRC. I don’t even see it listed in the the program of WHO is going to present that. It would be great if it is Dr. Kahn.

  21. A closing presentation, or keynote, is really just a speech, so they can say anything up there.

    The real question that people are concerned with is not just one keynote speech at one convention, but what they are actually doing behind the scenes

    There is a tremendous amount of work to do, and it should be full-time jobs for several people to do that preparation work.

    I’m not seeing evidence that the professional organizations are either willing or able to get that work done.

    Nice optimistic language about how it’s all going to fall into place in one keynote speech, at one conference, won’t compensate for not doing all the work that needs to be done.

  22. I don’t think a speech is going to make it all fall into place. I am just interested to hear whether it is someone who is as well-informed about it as Janet Kahn, or whether it’s going to be a speech about how 50% of MTs don’t care about it. I will be there so I’ll find out first-hand.

  23. Thanks Diana for ALL YOUR EFFORT

    Laura / Diana: How can I get involved with this in my state of NC? I am an AMTA member and want to be one of the “PROACTIVE” people that Diana said was part of the AMTA years ago but what happened and now the AMTA seems more complacent.

    Maybe its just who is steering the AMTA now. They are not energized and focuses to see the insurance coverage happen?


  24. I’ve been hitting my head against a brick wall with some of the discussions “arguments” going on in forums with massage therapists bickering over where our industry is heading. I had an article about having a two tiered massage licensing system that was hotly debated. After reading your blog I became clear. We are really divided. 50% want to move forward and become accepted by the medical community and get reimbursed by health insurance companies. While the other side just wants to sit on side lines and do nothing to promote our industry. So many have become massage therapists because they like being “alternative” and now they feel threatened by going “main stream”. I personally got into this business to help people. I know what I do has real therapeutic benefit and fits well in the medical model. I want to be included with the healthcare reform act. I honestly feel we’ve come to the point where we need to start a new national organization that’s focus is for the 50% who want to see research, legislation passed, improvements in education and ceu requirements, national certification, etc. Let the other group stagnate, and let’s move forward. Quit trying to convince the other 50% of the importance of all these historic changes taking place. Those are the same group that probably would prefer NO.licensing anyways. There is just too large a divide between our two groups. We will just bicker and stagnate while the AMA and other organizations look down on us, and probably for good reason…

  25. Is the AMTA the only lobby group the massage industry has speaking for us? Who else can we contact to advocate for the therapists who want to become providers under the ACA?

  26. Appreciation for the nice writeup. The item in reality was obviously a leisure bill the idea. Glimpse sophisticated to a lot more brought gratifying on your part! Having said that, how can we communicate?

  27. AMTA should decide what their charter is going to be. If they have no interest in Medical Massage Therapists, then they should say so publicly. I use to be an AMTA member here in South Carolina until I discovered they had no interest in anything outside of relaxation and pampering massage. I asked if they could push for us getting our own Codes so that we could bill insurance. They had no desire to do this. SO, I agree with Ms. Thompson- the AMTA should send better delegates and work for us who are in the medical field.
    Working for an Osteopath M.D. for 8 years, I have helped people get their lives back when all else had failed. We were their last resort, and they got better! My question was, shouldn’t they have seen us first and not have had to go through all the agony of procedures, surgeries, and medications that did not work? We should be on the front end of treatment, not the back end when they have wasted hundreds of thousands of dollars. AMTA should highlight how we can save taxpayer and insurance companies so much money. In a time when Health Care Reform is getting such a bad rap and medical costs continue to soar- we could actually be a solution. This should be highlighted to the highest mountain top.

  28. What about if you work as an independent contractor within a chiropractic office. I’m wondering if they can legally require me to do insurance massages. Wouldn’t that be a violation of independent contractor status?

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