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Health care reform

Association analyzes 'the good, the bad and the undecipherable' in current draft legislation

Washington—Congress' August recess offers invitation and opportunity to amplify the Association's health care reform message.

"Here's where things stand right now," ADA President John S. Findley said in a pre-recess eGram to ADA members spelling out details of Congress' five-committee (3 House, 2 Senate) effort to craft health care reforms seen by President Obama as his administration's central domestic policy objective essential to economic viability.

Members of Congress headed home eager for the feedback that will inform their upcoming committee and floor votes. Sen. Claire McCaskill (D-Mo.) was quoted by as saying, "I think it's important I read the whole bill, go home and talk to my constituents about it and then come back prepared to vote." Various committee drafts and bills were in preparation at recess time for House and Senate floor votes expected this fall.

"The dental provisions they contain can best be characterized as the good, the bad and the undecipherable," Dr. Findley said.

"Our most pressing concern is with the proposal for a government-run insurance plan that would compete with private insurers in the marketplace and private plans offered in the so-called 'Exchange' (essentially a mechanism for consumers to comparison shop for health insurance)."

Legislation emerging from a House committee "would be required to offer dental coverage to children, but that requirement needs much clarification for us to decide whether to support it," the ADA president said.

"The whole concept of a public plan remains troubling, and we would oppose any plan that required dentists to participate, directly or indirectly dictated fees for the private market or would lead to a government-run system. And none of the bills enhances Medicaid reimbursement, which translates as no significant access improvements for the poor and other vulnerable populations."

The Association has offered a consistent and comprehensive oral health message throughout the 111th Congress in multimedia communications with ADA members, House of Representatives and Senate members, President Obama and the administration's health policy team. The message is rooted in policy approved by the ADA House of Delegates at the 2008 annual session.

A Jan. 28 Association communication with the Senate Finance Committee offered "dentistry's views" on health information technology legislation, some form of which probably will be included in whatever health care reform legislation Congress sends to the White House.

An April 24 letter to Rep. Peter DeFazio (D-Ore.) seeks repeal of the McCarran-Ferguson Act's federal antitrust exemption for the "business of insurance." Insurance reforms are on the table as well.

In a letter responding to an ADA member inquiry "regarding the American Dental Association's position on health care reform," and in similar letters to the White House and all members of Congress, Dr. Findley said Association advocacy is "focusing on improving the Medicaid safety net, strengthening the public health infrastructure and funding more community-based prevention efforts.

"The ADA does not support a single-payer system because we believe it would stifle access and innovation and reduce the quality of patient care," the ADA president added. "Based on our communications and reports from the appropriate congressional committees, the single-payer alternative is not an option under serious consideration within the context of HCR legislation." That was still the case in the August heat.

An ADA summertime communication with members of the House of Representatives addresses 15 sections of just one proposed measure, the "America's Affordable Health Choices Act of 2009," H.R. 3200, and offers recommendations on each section. "The ADA is adamant that improving access to dental care for those most in need be the focus of any oral health component in a health care reform proposal," the letter said.

Delegate Donna Christensen (D-Virgin Islands), a physician, offered to sponsor the Association's Essential Oral Health Care Act legislation, H.R. 2220, as an amendment to a Commerce Committee bill. Grassroots dentists lobbied members of Congress on the ADA-proposed legislation during the 2009 Washington Leadership Conference.

In policy communications with the House of Representatives, the Association said the amendment would give states the option of receiving enhanced federal matching funds if the state chooses to redesign its dental Medicaid plan in a manner that: pays dentists market rate fees, eliminates administrative barriers, ensures there are enough dentists signed up willing to provide care, and educates parents and other caregivers on the importance of seeking care to ensure that there is a demand for needed dental services.

"This is not a mandate," the Association said. "Rather, it offers states the funding they desperately need to address their dental Medicaid problems—if they choose to fix those problems." The intent is to ensure that individuals covered by a state's dental Medicaid plan have access to oral health care services.

During a House markup of health reform legislation, the Energy and Commerce Committee approved an ADA-backed measure, Rep. Bart Stupak's (D-Mich.) dental emergency responder legislation. The Association is seeking committee support for language that would require that dental services offered as part of a public plan be reimbursed at market rates.

There is no assurance that either measure will become part of whatever health care reform legislation Congress finally approves and sends to the White House, and the public plan option was a major bone of contention on Capitol Hill this summer.

Meanwhile, the Association has spoken out on these and other provisions with dental relevance, and there are many.

The ADA and 10 other Organized Dentistry Coalition organizations told the Senate Finance Committee, "We are opposed to all forms of taxes on health care services, including employer-paid health benefits.

"The effect of limiting the exclusion [from taxation] for employer-provided coverage on health care benefit plans could be profound, potentially leading to a marked reduction in the purchase of dental benefits coverage," the dental professional organizations said. "A reduction in dental coverage will increase the out-of-pocket costs to those who receive dental care, which may serve as a barrier to seeking regular preventive care for some."

Other coalition members voicing unified opposition to the taxation of employee health benefits include the Academy of General Dentistry, American Academy of Oral and Maxillofacial Pathology, American Academy of Pediatric Dentistry, American Academy of Periodontology, American Association of Endodontists, American Association of Oral and Maxillofacial Surgeons, American Association of Orthodontists, American College of Prosthodontists, Hispanic Dental Association and National Dental Association.

These Association communications with policymakers and ADA members offer a comprehensive but incomplete picture of ADA's health policy expressions.

Early 2009 policy communications found an accord with Congress and President Obama who cooperated on state Child Health Insurance Program (CHIP) medical and dental expansions enacted Feb. 4. It was the first health legislation addressed by the new Congress and the new administration in a spirit of cooperation that was far less evident in the health reform debate percolating in the summer heat.

The ADA also had direct input into the legislative process through participation in an ad hoc provider committee organized by the Senate Health, Education, Labor and Pensions Committee.

Nor do these expressions of ADA policy include ongoing ADA staff and grassroots dentists lobbying on an array of issues associated with health reform legislation.

While the Association has taken no position on any of the overall measures going through the House and Senate committees, the ADA proposes to amend, seeks to clarify, opposes, supports and comments on dozens of related provisions offered in the House and Senate.

"We are pursuing amendments to improve the dental provisions," Dr. Findley told ADA members. "Some of you may wonder why we don't just flatly oppose the whole thing. But that simply is not a viable option. If we aren't highly visible in the process, we open the door to other groups who will claim to be the voice of the oral health community and attempt to dictate what kind of dental provisions get included. As the saying goes, you are either at the table or on the menu."

The two Senate committees with jurisdiction over health reform are Health, Education, Labor and Pensions (HELP) and Finance.

In the House, the Education and Labor, Energy and Commerce and Ways and Means committees have jurisdiction over parts of the legislation. House and Senate leaders hope to merge the product of these panels into single, possibly competing, bills from each chamber for resolution in a House-Senate conference committee and congressional passage later this year.