The following is from Ron Tankersley, DDS President of the ADA
I wanted to give you a quick update on where things stand on health care reform in the U.S. Senate.
In addition, I want to highlight some issues in health care reform legislation that we need you to contact your lawmakers about over the holidays. The American Dental Association does not support any of the bills that have been produced to date.
While each bill contains a number of promising provisions, they also remain deeply flawed.
The Senate is now in the process of 30 hours debate on the Reid substitute amendment (essentially a new version of the entire health care reform measure with all the changes needed to secure the 60 votes for passage), which was released Saturday morning. The next vote is scheduled to occur around 2pm on Wednesday.
There will be two votes – first on the Reid substitute amendment and the second vote will be for cloture on the final bill (H.R. 3590). A vote on final passage of the Senate’s health care reform legislation will occur on Christmas Eve.
The ADA has weighed in on a number of provisions that have been considered over the many months that this legislation has been debated, utilizing direct lobbying, grassroots action alerts and policy letters. While some of our worst fears have not been realized, we remain hard at work to see that the House and Senate leadership are well aware of the ADA’s policy position on those issues we support and oppose.
At this point, the mostly likely opportunity to get the changes we want will be after the holidays, when the House and Senate leaders work out the many differences between their versions of health care reform legislation.
As mentioned above, we expect a final vote on the Reid Substitute Amendment tomorrow. Among the changes to the bill that are of interest and concern to dentistry and on which the ADA has lobbied, are the following:
The bill does not include the public insurance option plan or the proposed expansion of Medicare that would have allowed 55-65 year old individuals to buy into the program. The ADA has consistently opposed any effort that could have lead to a government-run health care system.
The Indian Health Care Improvement Act (IHCIA) was included in the health care reform bill, and we are disappointed that the provision pertaining to dental health aide therapists has been changed to allow tribes in states that license dental therapists to establish a DHAT program (the Alaska program is grandfathered in).
This provision was changed at the behest of Sen. Al Franken (D-MN), who was adamant that the dental therapist created last year in Minnesota be allowed to work in tribal areas of Minnesota.
While ADA testimony at a recent Senate Indian Affairs Committee hearing on the IHCIA gave members pause in terms of supporting an amendment by Sen. Franken to open up the DHAT program to all tribes, the new language secured Sen. Franken’s support for health care reform. But, under that language, tribes still cannot start DHAT programs unless the relevant state law licenses them.
Another change made to assuage some of the ADA’s concerns stipulates that the Indian Health Service (IHS) may not fill any dental vacancy in a program operated by the IHS with a DHAT. Of course, we want the final health care reform bill to adhere to the House version of the IHCIA, which continues to wall-off IHS support for a DHAT program to Alaska.
The proposed 5% tax on cosmetic procedures has been eliminated in favor of a 10% tax on indoor tanning services. The ADA worked with other interested parties in a coalition to oppose this very bad idea and we are very pleased to see it dropped from the bill.
While the Senate bill caps Flexible Spending Accounts (FSAs)at $2500 per year,which we oppose, the Reid amendment at least indexes the cap for inflation. We still want the cap eliminated, or at least raised to the $5,000 amount that employers traditionally allow.
We are disappointed that a provision to repeal much of the McCarran-Ferguson antitrust exemption was dropped to secure a Senator’s vote on final passage of the bill, but there remains a strong antitrust repeal provision is in the House-passed bill.
Regardless, there is significant support for repeal that may lead to passage of a stand-alone bill even if it is not included in health care reform.
A 40% excise tax will be levied on health care plans and services that exceed $23,000 for a family and $8,500 for an individual. Medical and dental premiums, as well as Flexible Spending Accounts, would be counted together in determining whether the cap is exceeded. We oppose this “premium cap” and are working to have it eliminated or to have dental coverage and FSAs not count towards the cap.
The Senate bill has a provision to award 15 grants for demonstration projects for state-authorized alternative dental providers (meaning a state must pass a law authorizing the alternative provider before a demonstration project can occur).
The ADA has lobbied to have this provision deleted since its inclusion by the Senate Health, Education, Labor and Pensions Committee. The House version of health care reform does not have this provision.
Employers with 50 or fewer employees will continue to be exempt from offering coverage. The small business tax credits will begin a year earlier – in 2010 – giving eligible small businesses access to up to six years of tax credits to purchase health insurance for their employees and ensuring immediate access to tax credits for eligible small businesses.
The wage thresholds for small business tax credits will be expanded. The full credit will be available to employers with 10 or fewer employees and average annual wages of up to $25,000. The credits will be available on a sliding scale to small businesses with fewer than 25 employees and average annual wages of up to $50,000.
Both the House and Senate bills contain a number of provisions that organized dentistry can support, including expanded dental residency funding for general practice, pediatric and public health dentistry. For the first time, public health dental residency programs will be eligible for federal funds to cover the entire residency program.
The bills also provide loan repayment funding for dental faculty and funding for state dental infrastructure programs. The Senate bill includes authorization for an oral health care prevention education campaign, expanded school-based dental sealant programs, and a research-based dental caries disease management program which will include grants to private practicing dentists.
Of course, we remain extremely disappointed that the bills do not address the tragic underfunding of dental Medicaid programs.
It is important to note that we believe that some of these provisions can be changed as the House and Senate work out their differences after the holidays. Accordingly, we need you to contact your lawmakers and ask that they make the following changes to health care reform legislation before any final vote early next year:
- 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.
- Include the House-passed version of the Indian Health Care Improvement Act that limits the DHAT program to Alaska. The ADA opposes allowing any dental team member other than a dentist from performing surgical procedures and continues to believe that there are more cost-effective ways to improve access to dental care in underserved areas.
- Reject the mid-level dental provider demonstration project provision contained in the Senate bill for the same reasons mentioned immediately above.
- 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, we recommend that it not be lower than the $5,000 per year limit imposed by most employers.
- Eliminate the 40% 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. We support 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 we strongly recommend that it be included in the final bill.
- Adopt the Senate approach concerning employer mandates: do 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.
I know that I can count on you to take action and to help assure that dentistry’s voice is heard in the halls of Congress. If you have signed up to receive the ADA’s grassroots alerts (and if you haven’t, you can do so by clicking here), you will be sent further information on these issues in early January.
I thank you for your efforts, and I hope that you have safe and happy holiday season.
Ron Tankersley, D.D.S.