Health Care Reform and its Impact on Dentistry

1. Health Care Reform and its Impact on Dentistry

2. November, 2008 – The Political Landscape • Highest voter turnout since 1960 • Largest Electoral College Margin since 1996 • Largest Popular Vote Margin Since 1988 • 60-40 Partisan Split in the Senate • 77 Vote Majority in the House • Indiana, Virginia and Nebraska* Vote Democrat

3. ADA Decides to Engage “…a responsibility to assert leadership when an issue of this magnitude is on the national agenda…” • ADA Is Not the Only Oral Health Advocate In Washington • If the ADA Was Not Representing Dentistry, Someone Else Would • If You’re Not At the Table You’re On the Menu

4. What Will Guide ADA Policy? HOD Resolutions Board of Trustees Guidance from ADA Washington & Chicago Staff Whether the Legislation Would Have a Major, Positive Impact on Oral Health “Fundamentally, our advocacy is guided by ADA policy based on a belief that the dental delivery system works extremely well for most Americans and should be left untouched by any reform effort.”

5. ADA’s Priorities in HCR Debate • Mending the Tattered Medicaid Safety Net • Rebuilding the Dental Public Health Infrastructure • Adequately funding community-based prevention measures, such as water fluoridation, school-based sealant programs, and oral health promotion and education programs.

6. What Happened in Congress? • Three Committees in the House, Two Committees in the Senate Work to Create Two Separate Bills • November 7, 2009 House Passes Its Version 220-215 • December 24, 2009 Senate Passes Its Version 60-39 • January 19, 2010 Scott Brown Elected • March 24, 2010 House Passes Senate Bill 219-212

7. What Does the ADA Support in the Bill? • 5 YR National Education Campaign focused on Oral Health Care Prevention and Education • Increased Funding for Public Health Infrastructure, including Centers for Disease Control and Prevention Programs • Additional Funding for School-Based Health Center Facilities and Federally Qualified Health Centers • Increased Title VII Grant Program Opportunities for General, Pediatric or Public Health Dentists • National Health Service Corps Loan Repayment Programs • Liability Protection for Individuals Working At Free Clinics

8. Title VII “Dental Cluster” • Title VII is amended to provide a dental specific provision - grants to plan, develop, and operate dental training programs • Financial assistance for dental students and dentists in these programs • Grants that will fund financial assistance and loan repayment for dental faculty • Funding for FQHC’s

9. What Are the ADA’s Primary Concerns? • FAILS TO FUND MEDICAID • Extension of Medicaid Eligibility to Individuals in Families With Incomes Up to 133% of FPL Yet No Basic Adult Dental Benefit for Existing or New Medicaid Enrollees • Fails to Address Administrative Barriers In Medicaid System • Provisions to Allow Workforce Pilot Programs That May Lead to Non-Dentists Performing Surgical Dental procedures • Restrictions on FSAs, Lack of Patient Protections in Group Plans, Lack of Medical Liability Reform

10. Title VII Alternative Dental Health Providers • 15 Grant Opportunities for Entities to Establish Demonstration Programs to Train “Alternative Dental Health Providers” • The Program Must be Accredited by the Commission on Dental Accreditation or be Housed Within a Dental Education Program in an Accredited Institution

11. Impact on Dentists As Providers: • Secretary of Department of Health and Human Services Tasked With Writing Rules and Regulations • Reporting Requirements Regarding Plan Coverage and Provider Reimbursement Structures Designed to Improve Outcomes • Provider Level Outcomes • Unclear What Impact This Will Have on Dentistry

12. Impact on Dentists As Employers: • 50 or Fewer Employees, No Requirement to Provide Insurance • 2014 States May Develop Exchanges • May Provide An Opportunity for Small Businesses to Purchase Coverage • Employers Who Do Provide Coverage for Dependent Children Must Now Provide Coverage For “Children” to Age 26 • Prohibition on Refusal to Cover Pre-Existing Conditions • Employers With <25 Employees and Average Annual Wages of less Than $50K Eligible for Tax Credits

13. Impact on Dentists as Consumers: • If Your Plan’s Premium Exceeds $10,200/Individual $27,500/Family You May Be Subject to Additional Taxes • ADA Successful in Removing Dental/Vision Plans From The Total Amount • FSAs Limited to $2,500/yr in 2013

14. Next Steps: • Regulatory/Rule Making Process Underway – ADA Engaged At Every Level • 11 Committees and Commissions Created to Address Workforce, Quality and Prevention • Political Events May Change Much of What Was Passed • Repeal • Replace • Defund • Some Efforts Already Undertaken • 1099s • Possible Tax on Dental Devices • QUESTIONS?

15. Get Involved: • Join the ADA’s Grassroots Team • Make a contribution to ADPAC Today (www.ada.org) • Serve on ADA Boards, State Boards, as an Extern Do it for Your Practice! Do it for Your Education! Michael Brzica brzicam@ada.org 202.898.2404