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May 26, 2009 | DentalProductsReport.com Exclusive
Politics

A seat at the table

Where the dental industry and oral care fit in the national health care reform debate

by Noah Levine

Firmly entrenched in the summer legislative agenda, health care reform is a hot topic of debate in Washington, D.C. and around the country.

President Barack Obama has been pushing for an overhaul of the nation’s health care system since the first days of his candidacy. Now with industry leaders making a voluntary pledge to reign in runaway costs and leaders in the Senate and House of Representatives promising to deliver a reform plan by the end of July, momentum for change seems to be growing.

However, the exact scope and shape this change will take remains to be seen as Congress and the industry have yet to release the details of any plans they hope to implement. Thus far the discussion has focused on changes to insurance coverage and care delivery in the medical realm, but that doesn’t mean dental health care will be unaffected by the final plan.

A part of the system
Whether specifically addressed in the plan, or simply swept up in the language of reform legislation, the dental industry is likely to be impacted by the reform bill. With that in mind, dental stakeholder organizations are engaging in lobbying and informational campaigns to ensure that changes don’t negatively impact dental patients and providers.

“We have found at both the state and the federal level, that when broad health definitions are used in legislation it often loops in dental by definition, but not by design. We’re not the bull’s-eye, but we can be hit. Because we’re on the target we get hit by the splatter,” said Evelyn F. Ireland, CAE, Executive Director of the National Association of Dental Plans.

NADP is among a number of dental organizations working both independently and collectively to make sure issues affecting the dental industry are considered during the debate over health care reform. The insurance association is focusing on preserving the aspects of dental insurance that already work well while trying to make sure any plan also expands access to dental care, especially for lower income Americans.

Medicaid expansion
Expanding that access has been the crux of the lobbying efforts from the American Dental Association as well. William Prentice, ADA Senior Vice-President for Government and Public Affairs said his efforts are currently focused on expanding Medicaid’s dental coverage for not just low-income children but also for their parents.

“The gapping hole in this, is the safety net,” he said. “For millions of low income Americans, the Medicaid program just doesn’t provide the resources for folks to be able to get to the dentist and we need to fix that. That’s why we’re really focusing our time on that safety net. If we can get that program to cover the parents as well, they’re much more likely to take their child to the dentist.”

Thus far lawmakers have not treated this message as a high priority. Earlier this year the federal government expanded dental coverage for low-income children through the reauthorization of the Children’s Health Insurance Program. With that already done, both Prentice and Ireland said lawmakers have been less inclined to consider further Medicaid adjustments. Still, Prentice said the reform debate is the perfect time for ADA to, “get in and tell our story and try to stand up for these Americans who aren’t getting the dental care they need.”

But while increasing access to dental care for low income Americans can have a big impact on the nation’s oral and overall health, any expansion of Medicaid coverage will not be effective if the program doesn’t work for the dentists needed to provide the care. To achieve this, Prentice said the reform plan must untangle bureaucratic issues within Medicaid and increase payments to participating dentists to a level that at least covers their costs. Increasing these reimbursements is especially critical if recent dental school graduates with student loans to pay back are ever going to be encouraged to provide that sort of public service dental care.

“I doubt that the Medicaid reimbursement will in any way mirror private fees, but I’m sure there are thousands of dentists out there that would like to participate in these programs, but they just need to at least break even in their costs to do so,” Prentice said. “We need these programs that were designed to provide care to be funded properly so that care is actually achievable.”

First do no harm
With money for health care reform in short supply, Ireland said NADP also believes expanding Medicaid to cover low income adults should be a high priority. It has a fair chance to succeed, because with oral health’s established preventive model and the link between oral health and some chronic medical conditions like diabetes, expanded oral care has the potential to lower Medicaid costs associated with the medical care for patients with those conditions.

However, that effort is the number two priority for her organization. As the health care debate continues to take shape, NADP is most concerned with making sure the reform plan doesn’t disrupt the current structure of the dental insurance industry that as of 2007 provided coverage to 57% of Americans.

Much of that coverage is provided through Americans’ employers and those benefits are not currently taxed. Ireland said NADP plans to push hard to maintain those tax benefits because if the coverage were suddenly subject to federal taxation, it would create a disincentive for employers to provide dental plans and for employees to participate in those plans.

“Our top priority is don’t harm the market that is there and don’t reduce the access that exists because we know that people with coverage are 2.5 times more likely to go to the dentist, so let’s not destroy that piece through disproportionate taxation,” she said.

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