Dear Colleague:

As you are aware, health care reform has been at the forefront in Washington. Here's the short story: Our Washington staff have been working night and day to keep up with all the developments, including reviewing and commenting on the close to 3,000 pages of legislative language generated by lawmakers so far. Both the House and Senate are churning out draft legislation. The dental provisions they contain can best be characterized as the good, the bad and the undecipherable. The situation at this point is akin to the closing seconds in the first half of a basketball game—expect plenty of half-time adjustments and a lot more surprises in the second half (i.e. this fall).

Here's where things stand right now. The two Senate Committees with jurisdiction over health care reform are Health, Education, Labor and Pensions (HELP) and Finance. Last week, the former approved a bill along partisan lines (despite having adopted many amendments offered by Republicans). The Finance Committee is moving at a slower pace, with Chairman Max Baucus (D-Mont.) hoping to build a bipartisan consensus. But pressure is building from Senate leaders and the White House for Chairman Baucus to abandon that effort and produce a bill. Additionally, time is growing short for the slow-moving Senate to get a bill to the full Senate before the August recess (even if Finance acts next week, the HELP and Finance bills must be knitted together, for example.) The Sotomayor Supreme Court nomination is expected to take precedence, leaving little time for health care reform unless Senate leaders decide to stay in session later into August than planned.

In the House, three committees—Education and Labor, Ways and Means and Energy and Commerce—have created one joint draft bill; the first two completed their mark-ups on Friday (doing so in short order with limited amendments), while Energy and Commerce is expected to have a long and rancorous series of sessions this week while considering numerous amendments. Broadly speaking, Education and Labor handled the insurance reforms, Ways and Means the financing mechanisms and Energy and Commerce will be wrestling with the public health provisions. The committee work should be done by the end of next week, and Speaker Pelosi has indicated that the entire House will vote on a health care reform bill sometime the week of the 27th.

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). Both would be required to offer dental coverage to children, but that requirement needs much clarification for us to decide whether to support it.

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 health system. And none of the bills enhances dental Medicaid reimbursement, which translates as no significant access improvements for the poor and other vulnerable populations.

Even though we have concerns about the overall bill, and aren't prepared to take a position on it until things are much clearer, we are pursuing amendments to improve the dental provisions. Some of you might 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.

Accordingly, during the Education and Labor markup we tried to insert both a repeal of the McCarron-Ferguson antitrust exemption and a number of dental benefit reforms (including one to address the cap on the amount a participating dentist can bill a patient for non-covered benefits issue). Unfortunately, Education and Labor deemed the antitrust issue to be non-germane, meaning that the issue belongs to another committee. And the insurance reforms may have to wait until later in the legislative process to be addressed. But be assured that our lobbying staff isn't giving up on either issue.

In Energy and Commerce, we hope to have at least two amendments offered. One would tack our Essential Oral Health Care Act legislation, HR 2220, onto the bill, thereby providing federal financial support for states that choose to improve their dental Medicaid programs by increasing reimbursement and reducing administrative burdens. To give you a sense of the complexities up on the Hill, the amendment will not be offered by our House sponsor, Rep. Mike Ross (D-Ark.), even though he sits on the Energy and Commerce Committee.

Rep. Ross is a leader in the House Blue Dogs Caucus—a group of fiscally conservative Democrats. The Blue Dogs are working to constrain the health care reform effort in a number of ways, including reducing the bill's impact on small employers and its overall costs. Accordingly, even though Rep. Ross still supports our bill, he cannot work to add it to a bill that he may ultimately vote against. Since we are sympathetic to the Blue Dogs' overall approach, we are happy to find another sponsor for our amendment: Delegate Donna Christensen (D-VI).

Our second Energy and Commerce amendment would require that any dental benefits required in the public plan be reimbursed at market-based rates. We are still working on finding a sponsor for this amendment.  We have already sent out a grassroots alert on the Christensen amendment, and will follow suit with a second alert once a sponsor is secured for this other amendment.

We also continue to review and evaluate dozens of other provisions in the bill, including the small employer exemption that will dictate whether or not you have to provide health coverage to your employees. Right now, the various versions offer the potential that most dental offices could be exempted, depending upon how their practices are structured. We expect amendments to further broaden the exemption, which we will support.

I know that this was a long and complex message, but you need to know all the things that are happening on this critical issue, and you need to know that ADA is on the front lines on your behalf. Expect to hear more from us on this topic on a more regular basis as the legislative process moves forward.