Here are some of the key advocacy issues the ADA addressed in 2019:
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McCarran-Ferguson reform: For the first time, the ADA was successful in getting bipartisan legislation introduced in the Senate and House that would remove the antitrust exemption for dental and medical insurance companies. The Competitive Health Insurance Reform Act, S 350 in the Senate and HR 1418 in the House, is gaining cosponsors in both chambers with legislative action expected in early 2020.
Student loan reform: The ADA worked with other dental and medical organizations on the Resident Education Deferred Interest Act, which was introduced by Rep. Brian Babin, R-Texas, a dentist and ADA member. The bill, which currently has 79 bipartisan cosponsors, would allow dental and medical residents to defer interest accrual on their federal loans while they are in their residency programs. In addition, the College Affordability Act, which is the comprehensive higher education reauthorization bill being put forth by the House Education and Labor Committee, currently includes student loan reform provisions — among them, improving and expanding the Public Service Loan Forgiveness Program and allowing dental students to have access to federally subsidized loans.
U.S.-Mexico Tourism Improvement Act: The ADA and the Organized Dentistry Coalition wrote to the bill’s sponsor to express concerns about the bill, which would direct the Secretary of State to develop a strategy to promote tourism, including dental tourism, between the United States and Mexico. After outreach by the ADA and the Organized Dentistry Coalition, the language on dental tourism was taken out of the revised bill, which passed the House of Representatives in June 2019.
For the dental practice
Sec. 1557 of the Affordable Care Act: This provision requires health care providers to post notices in 15 languages. The ADA, along with state dental associations and organized dentistry, expressed concern about the burden this requirement places on dentists, and lobbied the U.S. Department of Health and Human Services to remove the requirement. In May, the agency issued a proposed rule that would remove the language requirement.
Noncovered services: HR 3762, the bipartisan Dental and Optometric Care Access Act, prohibits ERISA dental and vision plans from setting fees for noncovered services, from forcing doctors into participating in contracts of excess of two years and setting limits on a doctor’s choice of lab referral. ERISA stands for the Employee Retirement Income Security Act of 1974, a federal law that sets minimum standards for employee benefit plans maintained by private-sector employers. The legislation currently has 51 cosponsors, including the five dentist members of Congress.
Robocalls: The ADA wrote to the Federal Communications Commission to express concerns that the commission’s ruling on robocalls could affect dental offices’ ability to call their patients about upcoming appointments or to remind them to schedule an appointment. In December, Congress passed legislation that would not change the exemption that allows robocalls to be made to individuals who have a prior relationship with the caller – such as a dentist to a patient. The law requires the FCC to enact rulemaking on this exemption.
Medical device tax repeal: The spending bill that Congress passed at the end of 2019 included a permanent repeal of the 2.3% medical device tax that was created by the Affordable Care Act. The ADA and other stakeholders have long advocated for this permanent repeal. These advocacy efforts included meetings on Capitol Hill, numerous letters and coordinated grassroots efforts. Repeal of the medical device tax will ensure that the cost of a 2.3% tax for medical device manufacturers will now not be passed onto providers and their patients.
For dental patients and the public
Appropriations: In December, the White House signed into law two legislative spending bills totaling $1.4 trillion to keep the government running through the remainder of 2020. The bills include funding for many of the Association’s key advocacy issues affecting oral and overall health, including $477 million for the National Institute of Dental and Craniofacial Research – up $15 million from the 2019 enacted level; $210 million for the Indian Health Service Division of Oral health, a $6 million increase; and $10 million for military dental research. Also, the Indian Health Service Health Professions account that includes recruitment and retention programs received $65.3 million, an increase of nearly $8 million over current funding. According to the Indian Health Service, this funding would enable them to hire around 200 more health care providers. The bill also included report language requested by the ADA and other dental groups asking the Health Resources and Services Administration and the Centers for Medicare and Medicaid Services to appoint chief dental officers and language urging the Centers for Disease Control and Prevention and Health Resources and Services Administration to explore opportunities to advance Action for Dental Health initiatives.
Health reimbursement arrangements: In December 2018, the ADA wrote to the U.S. Department of Health and Human Services in regards to a rule on health reimbursement arrangements, or HRAs. The rule outlined the ways HRAs could be recognized as “limited excepted benefits” and used for dental expenses. In June 2019, the department finalized the rule and incorporated most of the ADA’s recommendations.
Surprise billing: The ADA has asked Congress to ensure that dental practices are not included in the definition of an emergency department as it is already defined by existing law. The ADA educated members of Congress on the billing practices of private dental offices and submitted comments to both the House Energy and Commerce Committee and Senate Health, Education, Labor, and Pensions Committee asking that their legislation on surprise billing not include private dental practices. As drafted, neither piece of legislation would include private dental practices.
Ensuring Lasting Smiles Act: This legislation was reintroduced in 2019 and now boasts 37 Senate cosponsors and more than 270 House cosponsors. The bill aims to guarantee health insurance coverage for needed treatment and procedures for individuals born with congenital anomalies or birth defects. It also closes a coverage gap to ensure that health plans cover medically necessary services related to a patient’s anomaly or birth defect, including any necessary dental and oral-related procedures.
Anti-vaping efforts: The ADA joined the bipartisan Congressional Caucus to End the Youth Vaping Epidemic, which will review needed legislative solutions to protect American youth from the dangers of vaping and nicotine addiction. The Association is supporting three bills to help curb the youth vaping epidemic: HR 2339, the Reversing the Youth Tobacco Epidemic Act, to create stricter regulations for vaping devices and liquids; HR 4742, to impose a tax on the nicotine used in electronic nicotine delivery systems; and HR 3942, to require online retailers to verify the age of their customers upon delivery of e-cigarettes and other electronic nicotine products. In December, Congress updated the Federal Food, Drug, and Cosmetic Act to increase the minimum age of sale of tobacco products from 18 to 21 years of age.
Drug monograph reform: The ADA continues to support legislation to modernize the over the counter drug monograph. S 2740, the Over-the Counter Monograph Safety, Innovation, and Reform Act, passed the Senate by a vote of 91-2 in December. The legislation would help streamline the approval process and allow for the submission of non-narcotic pain relievers with a combination of two or more active ingredients, which is particularly important in the context of preventing opioid abuse. The bill would also provide an innovative pathway for federal safety and effectiveness regulations that can directly align and benefit the ADA Seal of Acceptance program.
Medicaid funding for the territories: The ADA joined the Partnership for Medicaid coalition in asking Congress to address the Medicaid funding cliff in the U.S. territories. In December, Congress included this funding in the 2020 appropriations package.
Follow all of the ADA’s advocacy efforts at ADA.org/advocacy.