health care reform and its impact on dentistry

Health Care Reform and its Impact on

Dentistry

© 2010 American Dental Association, All Rights Reserved

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


ADA Decides to Engage

“…a responsibilityto assert leadership when an issue of this magnitude is on thenational 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


What Will Guide ADA Policy?

“Fundamentally, our advocacy is guided by ADA policy based on abelief that the dental delivery system works extremely well for mostAmericans and should be left untouched by any reform effort.”

HOD Resolutions

Board of Trustees

Guidance from ADA Washington & Chicago Staff

Whether the Legislation Would Have a Major, Positive Impact on Oral Health


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.


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


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


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


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


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


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


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


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


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?


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

[email protected] 202.898.2404

health care reform and its impact on dentistry

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