CORRECTION

A headline on Page 1B of Sunday's City&State section about a state budget provision involving chiropractors incorrectly characterized how the provision was included in the budget. The headline and story should have made clear that the provision first appeared in the state House budget proposal, released in June.

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House Speaker Jim Black says he dislikes using the state budget to make public policy, so much so that he agreed several years ago to limit it to what a budget should be -- a spending plan for public schools, roads, prisons and other state services.

But in the budget proposal that cleared the legislature last week and was signed Saturday by Gov. Mike Easley, Black slipped in a sentence that could steer plenty of business to a group that has given him generous campaign support over the years -- chiropractors. The change requires chiropractors to be treated the same by health insurance providers as primary care doctors.

In other words, if your co-payment for your family doctor is $20, it will be that way for chiropractors, too. Health insurers often require their customers to pay $10 or $20 more to see chiropractors, physical therapists, dermatologists and other specialists.

"Why in the world should a patient not see a chiropractor for the same fee as a doctor?" said Black, a Mecklenburg County Democrat and an optometrist.

Black said the roughly $145,000 in political contributions he has received from chiropractors and their political action committee over the past 16 years had nothing to do with the change.

Chiropractors treat health problems by spinal adjustments and other measures to relieve pressure on the nervous system. Patients visit them most often for treatment of neck and back pain. Licensed chiropractors are permitted to use the title of doctor.

Some physicians and scientists have long questioned the medical foundations on which chiropractic medicine is based, but insurers have shown growing willingness to pay for chiropractic treatment because they see it as therapeutic care.

The health insurance provision is one of many in the 364-page budget proposal that many critics say undermines open government. The provisions receive no debate before they pop up in a thick document that lawmakers have little time to review. Most states don't allow it, said Ran Coble, executive director of the N.C. Center for Public Policy Research.

"It's not good public policy," Coble said. "I think it lengthens the session and has the effect of passing things into law that wouldn't make it on their own."

Coble praised Black for trying to curb the provisions in 1999. But they have grown in successive budgets. Coble said it won't stop until Black and Senate leader Marc Basnight, both of whom have said they want to open up the budget process, get together and agree to eliminate them.

Insurers surprised

Black's provision regarding the chiropractors threw a curve to health insurers, who were not given an opportunity to debate the provision. They now have to readjust their health plans; some may need to issue refunds to their clients, because the provision is backdated to July 1, the start of the fiscal year.

"We will comply with the change," said Lynne Garrison, a vice president for Blue Cross/Blue Shield of North Carolina, the largest health insurer in the state. "Certainly our preference is that a government mandate of this nature should be proposed and debated in the open so all the implications could be considered."

Black said he inserted the provision so that chiropractors would be treated the same as physicians. The N.C. Chiropractic Association and its lobbyist could not be reached for comment.

Garrison said Blue Cross requires a higher co-payment for chiropractors and other specialists so that people will first see their family doctor, who can determine whether they need the additional services. Chiropractors, she said, may not catch the true cause of the problem.

"The primary care doctor knows the most about you as a total person," Garrison said. "So we always want to encourage people to see their doctor first."

The budget includes other provisions that, like the one regarding chiropractors, set policy rather than direct state spending. Among them:

* Academic scholarship foundations and athletic booster clubs at UNC campuses will be charged the much cheaper in-state tuition rates for athletic and academic scholarships for out-of-state students. This will allow them to stretch their dollars and offer more scholarships, but it could allow campuses to circumvent caps on the number of out-of-state students admitted. Those caps are intended to make sure North Carolinians have access to UNC schools.

* Most parents will have to pay for an eye exam by an optometrist or ophthalmologist for their children before the children can be enrolled in public schools. The state will pick up the cost for families who cannot afford the exam.

(Researchers Susan Ebbs and Lamara Williams-Hackett contributed to this report.)