January, 2014
Advocacy Update | Government and Public Affairs

Affordable Care Act Deadlines in the Coming Year

January 1 was the pivotal date for the Affordable Care Act, when the most important elements of the law went into effect. The most important of these elements was the beginning of coverage of an estimated 3 million people who signed up for private coverage in the health exchanges, either through state-based enrollment web sites or through the federal government's HealthCare.gov.

As the numbers roll in, here are the major ACA milestones to watch out for over the coming year:

January: All Americans are required to have health coverage. The penalty for failure to comply will be a fine of $95 or 1 percent of taxable income, whichever is greater. The Administration has provided a 3-month grace period (until March 31).

Medicaid expansions in 25 states and the District of Columbia have kicked in, making nearly 4 million more people eligible. Under the law, Medicaid eligibility has increased to 138 percent of the federal poverty line. States may expand their programs at any time. Virginia, for example, with its newly elected Democratic governor, is considering it.

Insurers are now prohibited from discriminating against consumers with pre-existing conditions. Also, insurers are prohibited from imposing annual or lifetime coverage limits on their customers.

October: President Obama, criticized after insurance companies last year started cancelling plans that were not compliant with the law, implemented a policy change that allowed the companies to extend existing plans for one year. That 1-year extension ends Oct. 1, 2014. All non-grandfathered individual and small-group health policies renewed after that date must meet the coverage standards under the ACA.

November 15: This is the date when open enrollment begins for 2015. Many Republicans predict an increase in premiums will add to public discontent over the ACA. Many in the GOP believe that the date, which is 11 days after Election Day, was pushed back a month to protect Democrats, should predictions of increased costs prove true.

Jan. 1, 2015: All businesses with more than 50 full-time employees must offer health insurance or pay a fine per uncovered employee. This requirement was put off a year by the Obama Administration in order to give smaller companies more time to comply without laying off workers or reducing their hours. This provision will apply to virtually no dental practices.


State Dental PAC Officials Meet

Nearly 90 people representing 44 state dental associations and their political action committees (PACs) met in Scottsdale, Ariz., earlier this month to attend ADPAC's State PAC Conference to discuss how best to comply with election laws, ideas for growth, and new grassroots technologies. Speakers included advocacy experts as well as lawmakers. Arizona State Sen. Kimberly Yee (R) spoke to attendees about effective ways to lobby state lawmakers. Rep. Paul Gosar (R-Ariz.) also spoke at the conference, discussing Congress's 2014 legislative agenda.

ADPAC hosts the conference bi-annually. Presentation materials as well as a video of the meeting are available to members and constituent society staff upon requests emailed to govtpol@ada.org.

Association Urges Congress to Continue Permitting Small Businesses to Use Cash Basis Accounting

The ADA is asking congressional leaders to oppose efforts to eliminate the provision in the tax code that allows businesses with $5 million or less in gross receipts to use a cash basis of accounting. The Association is working with a large coalition of organizations representing small businesses on the issue.

Cash accounting is simpler and requires less bookkeeping than the accrual method, which is why many small businesses, including dental practices, prefer to use it. In a cash accounting method, income and expenses are recorded only when funds are received or disbursed.

In accrual accounting, income is recorded when a sale is made, not when payment is received. Expenses are recorded when services or goods are received, not when they are paid.


ADA Calls for Tax-Free Student Loan Repayments from Indian Health Service

The ADA, along with the 26 other members of the Friends of Indian Health, is urging Congress to pass H.R. 3391, the Indian Health Service Health Professions Tax Fairness Act. The bill, introduced by Rep. David Valadao (R-Calif.) would amend the tax code to provide health care professionals who receive student loan repayments from the Indian Health Service (IHS) the same tax free status enjoyed by those who receive National Health Service Corps (NHSC) loan repayments. Under the IHS and NHSC programs, health care professionals provide needed care and services to underserved populations.

Action for Dental Health: Bringing Dental Care to Senior Citizens

The Affordable Care Act substantially expands oral health care coverage for children. The ADA estimates that it will reduce by 55 percent the number of children without dental coverage.

But the ACA did little to expand dental coverage to underserved adults, which includes a large population of elderly people. Today there are approximately 1.3 million nursing home residents in America and they face the greatest barriers to accessing dental care of any population group. As people live longer and retain more natural teeth, the complexity of their treatment increases. As a particularly vulnerable population, senior citizens in institutional settings often need an extraordinary amount of dental health monitoring and treatment. A growing percentage of these adults are unable to fully care for themselves.

Delivering care to nursing home residents is one of the initiatives in the Action for Dental Health: Dentists Making a Difference (ADH) campaign. There are a number of ways to connect institutionalized seniors with dentists. Because often the problem is one of logistics, the ADA and its constituent societies are expanding existing programs that work in bringing needed oral health care to senior citizens living in institutional settings.

Last month the ADA hosted a long-term care conference in Washington, D.C., at which representatives from eight states met to discuss the formation or expansion of programs to provide oral health care for the elderly in their respective states. The conference provided attendees with an opportunity to network with other state dental association officials and to use the ADA as a clearinghouse for ideas that work. The ADA has incorporated information on existing programs in the states into materials for use by dental associations that wish to launch their own long-term care initiatives.

"There aren't a lot of funds available for dental care and this is true throughout the country,” said conference participant Dr. Frank Iuorno, a practicing orthodontist in Virginia and a member of the Virginia Dental Association's Long Term Care Task Force. "Our task force is working on a lot of things, like adapting the Give Kids A Smile model in Richmond and calling it Give Elders A Smile. The challenge for us isn't buy-in from the dentists—a lot of them already deliver care to seniors. The challenge is to get preventive care to this population.”

According to Dr. Iuorno, VDA is attempting to show private and government officials in the state that creating, licensing and establishing a workforce position that will essentially serve as a case manager for institutionalized seniors. "We want to start a program to go into nursing homes in the state, have a full-time presence in homes to monitor dental needs,” he said. "This person would identify patients who need more treatment, get them screened and get them care. The treatment would be provided free of charge, but the point would be to show how identifying these patients and emphasizing prevention is cheaper than emergent care. We need to heighten awareness. We have to educate patients and caregivers that this is important for overall health.

"Ultimately the success of any nursing home program is going to rely on funds coming from outside government,” Dr. Iuorno said. "Frankly, this is just not a priority for governments.”

The Action for Dental goal for long-term care: at least 10 state dental associations committed to implementing long-term programs by 2015, with 1,000 dentists trained to provide that care by 2020. That training includes educating dentists and caregivers about incurred medical expense (IME) billing, which helps long-term care residents get dental treatment and allows dental practices to get reimbursed for services.


Other Dental Health Access News

The ADA outlined its solutions to the national dental health crisis to members of the Senate Health, Education, Labor and Pensions Subcommittee on Primary Health and Aging. The Association sent the 10-page letter to subcommittee members in lieu of submitting official testimony for the Sept. 12 hearing organized by subcommittee chairman Sen. Bernie Sanders (I-Vt.).

Also recently, the ADA outlined in a letter to Sen. Sanders the various provisions of his Comprehensive Dental Reform Act (S. 1522) the ADA supports as well as parts it opposes, particularly language that calls for demonstration projects that would train or employ dental therapists in various locations.


Health Care Reform: Media Seek ADA Input for Stories on ACA and Dental Coverage

There has been a lot of interest among tier one media outlets in the Affordable Care Act and dental coverage, particularly how the pediatric dental benefit is being implemented. The Wall Street Journal, New York Times and USA Today all have sought help from the ADA, which has provided extensive background briefings, as well as on-the-record interviews with volunteer leaders.

The ADA recently developed a checklist to help consumers and the navigators appointed to help them choose dental plans.

American Dental Political Action Committee News

ADPAC got a big boost from Annual Session attendees, who contributed a record $503,000 during Annual Session in New Orleans, a substantial increase over the 2012 Annual Session total of $325,005. The PAC continues to play a pivotal role in the ADA's overall advocacy, providing funding for grassroots organizing, in addition to contributing to candidates that support sensible oral health care policies and have good relationships with the dentists in their home districts.