ADA News

Washington—The Association urged strong opposition to emerging health care reform legislation "that could promote the use of midlevel dental providers to perform surgical dental procedures."

"We're in the eye of the hurricane at the moment because Congress does not return from recess until Jan. 19," ADA President Ron Tankersley told Association members as the U.S. Senate passed a health care reform bill on a 60-39 partisan vote. "After that, we can expect a flurry of activity, so it remains critical for our members to stay in contact with their representatives and senators on these critical issues."

The Senate wrapped its package on Christmas Eve 2009 after the House Nov. 7 passed a separate health care reform bill. The two bills will be merged in a legislative procedure expected to involve negotiations with the White House to resolve differences on oral health and other health policy. The Association has advocated for an oral health agenda as Congress debates health policy but has not endorsed any of the health care reform bills offered in Congress including the final House and Senate bills.

The Association has written a side-by-side comparison of the House and Senate bills, please click here to view.

Midlevel provider provisions are among the differences on oral health policy that must be resolved before Congress sends legislation to the White House for President Obama's expected signature. An "enrolled bill" sent to the White House is the final copy of a bill that both houses have passed in identical form, which means that differences must be reconciled before final passage.

The Senate health care reform bill contains two provisions "that could promote the use of midlevel dental providers to perform surgical dental procedures," Dr. Tankersley said in a Jan. 5, 2010, "immediate action needed" alert. "The ADA strongly believes that such procedures should only be performed by licensed dentists and that both provisions must be changed. The House version does not contain these provisions.

"It appears that House and Senate Democratic leaders will work out the differences in the bills through informal negotiations. Accordingly, we need as many lawmakers as possible to tell them not to include the Senate midlevel (provider) provisions."

The action alert urges ADA members to contact their representatives and senators "to request that they oppose allowing the 'Alternative Dental Health Care Providers Demonstration Project' provision in the Senate bill" to fund midlevel providers who perform surgical procedures. If adopted, this would allow pilot-testing of such midlevel provider models as community dental health coordinator and dental health aide therapist.

Grant applicants would have to certify compliance with applicable state licensing requirements except that DHAT pilot testing requested by Indian tribes or Indian organizations would not have to comply with state licensing laws. The Association opposes this distinction.

"In addition, ask your lawmakers to include the House-passed version of the Indian Health Care Improvement Act in health care reform," the action alert said. "That version does not expand the availability of the Alaska DHAT model to other tribal areas of the country. We oppose federal funding of any midlevel oral health provider who performs surgical procedures that should only be done by a dentist.

"The ADA opposes delegating surgical procedures to people who have not had the comprehensive education of dentists."

Leadership communications with Association members cite the midlevel provider provisions among "issues critical to our nation's oral health" that merit congressional action in the ongoing health care reform negotiations:

• Increase funding for dental Medicaid programs so that low-income Americans can get the dental care they need. Nothing would improve access to dental care for those most in need more than this, yet the House and Senate bills still do nothing to address the drastic underfunding of these programs.
• Eliminate the $2,500 cap on flexible savings accounts in the Senate bill. FSAs are a great way for individuals to pay for much-needed dental care and the government should not limit their use. If a cap must be placed on them, the ADA recommends that it not be lower than the $5,000 a year limit imposed by most employers.
• Eliminate the 40 percent excise tax on health insurance premiums in the Senate bill. This tax could lead to employers dropping both dental coverage and access to FSAs, even though the high costs are primarily associated with medical coverage.
• Allow stand-alone dental plans to be offered on any health insurance exchange created in the bill. The Senate bill would allow dental plans to be offered, while the House bill would leave it to medical plans to provide pediatric dental coverage to individuals who purchase coverage on the exchanges. The ADA supports the Senate provision as it reduces the likelihood that adults will drop their dental coverage.
• Repeal the McCarran-Ferguson antitrust exemption. The House bill contains a strong provision to assure that the Federal Trade Commission can prevent the insurance industry from engaging in antitrust activities and the ADA strongly recommends its inclusion in the final bill.
• Adopt the Senate approach concerning employer mandates, which does not require small employers (less than 50 employees) to purchase coverage for their employees. While both bills offer relief to small employers, the Senate version is more comprehensive and merits inclusion in the final bill.