While the ADA does not support the overall health care reform measure (H.R. 3962) that passed the House of Representatives on Saturday, the Association is pleased to see a number of provisions that would benefit dentistry and dental patients. These include a repeal of the McCarran-Ferguson federal antitrust exemption, and more funding for public health infrastructure and wellness and prevention programs. Other dental-related provisions include:

• A government study on the need and cost of providing adult dental care as a required benefit;
• An exemption for small businesses with payrolls less than $500,000 from the requirement to provide their employees insurance coverage. (The ADA rejects this provision, preferring instead the Senate version that exempts small businesses with 25 or fewer employees);
• A requirement that insurance plans participating in the government's "exchange" offer children's dental coverage.

The ADA and its members continue to stress that reform will offer little of substance to low-income Americans in need of oral care unless it includes enhanced federal support for the dental Medicaid program and a requirement that plans cover adults in the program. In addition, lawmakers should continue to consider improving the legislation through the House/Senate conference process, and do the following:

• Include stand-alone dental plans in the proposed health insurance exchange and subject them to the ERISA-regulated consumer protections in the bill, as well as prohibit them from limiting payment on services not covered by the plan.
• Remove the $2,500 cap placed on health flexible spending arrangements (FSAs) and eliminate the medical device tax as a method for paying for health care reform.
• Strengthen the medical liability reform provision in the bill. 
• Exempt employers with 25 or fewer employees from having to contribute to their staff's health care coverage. This is the Senate HELP Committee's version of the exemption language, preferable to the $500,000 payroll floor in the House bill. (See above.)

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Speaker of the House Nancy Pelosi (D-Calif.) released a new draft of health care reform legislation yesterday and the Washington Office is reviewing all 1,990 pages.  Democratic leaders say they intend to bring the legislation to the House floor sometime late next week.

Like earlier versions of health care reform legislation, the new bill would create a health insurance exchange—a virtual marketplace in which health benefit plans would compete for the business of consumers and small businesses. The exchange plans would be required to offer certain benefits, including pediatric dental benefits. Initially, access to the plans would be limited to individuals without coverage and small employers of 25 employees or fewer. The new bill also includes a public option that would compete with private health plans on the exchange.

Other provisions of interest to dentistry:

• Small businesses with payrolls below $500,000 would be exempt from a requirement to purchase health coverage for their employees;
• The bill would repeal much of the McCarran-Ferguson antitrust exemption enjoyed by health insurers.
• The measure contains the Indian Health Care Improvement Act, including the provision that limits the Dental Health Aide Therapist (DHAT) program to Alaska.

Unfortunately, improving access to dental care for Medicaid populations continues to be largely ignored.

We are continuing to analyze the many details associated with the provisions in the bill and plan to have a grassroots message for members to deliver to their lawmakers by Monday.

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While there is no deadline for a final Senate vote on health care reform legislation, Democratic leaders in the House hope to vote on a bill during the first week of November.

Of course, the separate House and Senate votes will be followed by a lengthy and contentious effort to work out the many differences between the bills to reach consensus on a single version that can pass both chambers. That could take until the end of the year.

The ADA continues to advocate for a common-sense approach that maintains the private delivery system, does not penalize those who choose a higher level of health care, improves the public health infrastructure, and ensures that the insurance industry provides consumers with the coverage and care that they pay for. Right now, no version of health care reform merits ADA support.

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There is a significant amount of support, which continues to grow, among House and Senate Democrats for repeal of the McCarran-Ferguson federal antitrust exemption as part of health care reform. The ADA has been the most vocal health care group in Washington calling for this action, and there is momentum in Congress to strip the exemption away from health insurers.

For example, the Senate Judiciary Committee held a hearing last week regarding anticompetitive behavior in the health care insurance industry, and a representative from the Consumer Federation of America—a key member of the ADA's Insurance Reform Coalition—was one of only two witnesses. The ADA submitted a statement for the hearing record to explain to policymakers how the McCarran-Ferguson federal antitrust exemption is adversely affecting dental consumers.

On Oct. 21 the House Judiciary Committee passed H.R. 3596 by a 20-9 vote.  The bill would essentially repeal the 60-year-old antitrust exemption by allowing the federal government to investigate potentially anticompetitive conduct on the part of health insurers.   

ADA members have sent thousands of emails to members of Congress, urging them to support repeal of the insurance industry's antitrust exemption, and ADA President Ron Tankersley and Executive Director Kathleen O'Loughlin sent a letter to all members of Congress, asking them to support the legislation.

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House and Senate sponsors of the Indian Health Care Improvement Act (IHCIA) legislation (HR 2708/ S.1790) have told ADA lobbyists that they intend to add parts of IHCIA to health care reform legislation moving through Congress.  As introduced, the House version includes a provision agreed to years ago by the Alaska tribes and the ADA that would prohibit the Indian Health Service from bringing the dental health aide therapist model program to other states.  The Senate bill is less comprehensive than the House version and does not contain this exclusion language.  The ADA has been in touch with the Alaska tribes who have assured us that they will still join the ADA in seeking to have the exclusion language restored to the Senate bill. You will receive further updates as both the IHCIA and health care reform move.

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The House of Representatives on Tuesday by a vote of 400-0 passed H.R. 3763, a bill introduced by Reps. John Adler (D-N.J.), Mike Simpson (R-Idaho) and Paul Broun (R-Ga.) that would exempt small businesses, including most private practicing dentists, from having to comply with the Federal Trade Commission's 'Red Flags Rule.'

After listening to health care providers and other small businesses from across the country, lawmakers came to the conclusion that the original legislation establishing the Red Flags Rule was never intended to affect small businesses. Instead, it was meant to encourage primarily large businesses like banks, credit firms and national retailers to implement best practices to protect customers' from identity theft.

Over the past year, the ADA worked with numerous health care organizations and small business groups in urging Congress to quickly fix this problem. The ADA is working to ensure that the Senate acts with similar alacrity to protect dentists and other small businesses from having to adhere to an FTC rule that was never intended to apply to them.

For its part, the FTC recently extended its moratorium on enforcing the Red Flags Rule until June 1, 2010.

• ADA News: U.S. House passes ADA-backed Red Flags exemption legislation

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