A Great Dentist Goes to Washington

Capitol Hill Meeting Logistics&

Overview of Issues

Why Does Advocacy Matter?

• U.S. Government must address the needs of:– Millions of Americans– Infinite number of issues– Thousands of advocacy groups

• Limitations:– Time– Money– Manpower

• If you want your piece of the pie, you have to educate and advocate!

How Do Members of Congress Decide Which Issues to Support?

• Serves a compelling national interest

• Strong local support from constituents

• Factually-based

• Anecdotal evidence

How Do Members of Congress Decide Which Issues to Support?

• Constituent communications do make a difference

• Just 5 – 10 communications can put an issue on a Member’s radar screen

• 20 – 100 communications is nearly always enough to sway a Member

Background on Congress

What You Need to Know

The Basics

House of Representatives• 435 seats – elected by

district• Each district contains

approximately 650,000 people

• More populous states have larger delegations

• Reapportioned every 10 years by state

• 2-year term

Senate• 100 seats – elected by

state• 2 Senators per state• 6-year term - staggered

Division of Power

House of Representatives• 254 Democrats• 177 Republicans• 4 Vacancies

• Majority Rules

Senate• 57 Democrats• 41 Republicans• 2 Independents (Caucus

w/ Democrats)

• 60 votes to be “filibuster-proof”

Committee Structure

House of Representatives• Appropriations

– Labor, Health & Human Services, and Education

• Energy & Commerce– Health Subcommittee

• Ways & Means– Health Subcommittee

• Education & Labor

Senate• Appropriations

– Labor, Health & Human Services, and Education

• Health, Education, Labor, and Pensions (HELP)

• Finance

Congressional Office / Staff Organization

• Washington, D.C. Office– Policy

• State / District Offices– Casework

Washington Office Organization:Legislative Staff

Chief of Staffor

Administrative Assistant

Legislative Director

Legislative Assistant Legislative Assistant Legislative Assistant

Legislative Correspondent Legislative Correspondent

Legislative Assistant

Washington Office Staff:Non-Legislative Staff

Chief of Staffor

Administrative Assistant

Appointment Secretaryor

SchedulerOffice Manager

Communications Directoror

Press Secretary

Receptionistor Staff Assistant

Interns

State / District Office Staff

District Director

Caseworker Caseworker Caseworker

Scheduler

Tips for In-Person Meetings

• Be Prompt, Patient, and Polite – You have to be on time for the meeting; they do not. – Anger is not an effective advocacy tool, so focus on the positive.

• Be Prepared and Concise – You probably have no more than 15 minutes. – Make sure to have your facts straight - prepare or use "talking points".

• Be Responsive – Answer any questions to the best of your abilities. – If you do not know the answer to something, say so and offer to get back to

them. – Provide “Leave-Behind” materials. – Offer yourself as a resource to the Member and his/her staff.

Tips for In-Person Meetings

• Follow Up!

– Collect business cards from everyone in the meeting. – Write detailed thank you letters. – Hold the Member and his/her staff accountable. – Let AGD know about your meeting by filling out and

mailing in your “scorecards”.

The Issues

• ERISA Reform

• Red Flags

• McCarran - Ferguson

ERISA Reform

• Employee Retirement Income Security Act of 1974– Every Ridiculous Idea Since Adam

– Governs self-insured employee benefit plans• Most large employers• Health benefits

ERISA Reform

• Rep. Rob Andrews (D-NJ)

• Chair of House Education & Labor Subcommittee on Health, Employment, Labor, and Pensions

• H.R. 5000 – The Dental Coverage Value and Transparency Act of 2010

ERISA Reform – H.R. 5000

• Prohibits dental benefits carriers governed by ERISA from capping fees for non-covered services

• Other Items– Coordination of benefits– Designation of payment to non-participating dentist– Equal reimbursement for in-network and out-of-

network dentists– Prohibits bundling of payments – Prohibits changing benefit code

ERISA Reform – H.R. 5000: The Ask

• House: Please cosponsor H.R. 5000

• Senate: Please support H.R. 5000 if it comes before the Senate and/or support companion legislation when/if it is introduced

Red Flags

• Fair and Accurate Credit Transactions (FACT) Act of 2003: Prevent Identify Theft

• Federal Trade Commission (FTC) “Red Flags” Regulation (November 2007):– Requires financial institutions and “creditors” to

implement written policies to address “red flags”

Red Flags

• No mention of health care providers in FACT Act or Red Flags regulation

• FTC ruled that health care providers are “creditors”– Federal statute: Any person who regularly

extends, renews, or continues credit

Red Flags

• NOT the intent of Congress to include health care providers (especially small businesses) as creditors

• Red Flags implementation/enforcement delayed several times

• Currently, enforcement begins June 1, 2010

Red Flags – H.R. 3763

• Rep. John Adler (D-NJ)

• Excludes health care, accounting, and legal practices with fewer than 20 employees

• Passed the House in October 2009 by a vote of 400 – 0

• FTC supports passage

Red Flags: The Ask

• House: Thank you for supporting the Adler bill

• Senate: Please urge Senate Majority Leader Harry Reid to bring H.R. 3763 to the floor and pass it prior to June 1st

Overturn McCarran - Ferguson

• McCarran – Ferguson Act:– Passed in 1945– Reserves as the domain of the States the

“business of insurance”– Exempts insurers from federal antitrust laws and

regulations

Overturn McCarran – Ferguson

• States have proven unwilling or unable to regulate health insurers effectively

• Consolidation, monopolies / oligopolies

• Anti-competitive practices:– Price fixing– Bid rigging– Market allocation

• Providers and patients disadvantaged

Overturn McCarran – Ferguson

• Health care reform:– House included partial repeal of McCarran –

Ferguson– Senate did not include repeal– Final version: no repeal

Overturn McCarran – Ferguson: H.R. 4626

• The Health Insurance Industry Fair Competition Act– Rep. Tom Perriello (D-VA)

• Overturns the McCarran – Ferguson federal antitrust exemption for health insurers

• Permits antitrust oversight by the Department of Justice and the Federal Trade Commission

• Passed the House in February 2010 by a vote of 406 - 19

Overturn McCarran – Ferguson: The Ask

• House: Thank you for supporting H.R. 4626

• Senate: Please urge Senate Majority Leader Harry Reid to bring H.R. 4626 to the floor of the Senate and pass the legislation

– NOTE: In February, 18 Senators joined Senate Judiciary Chairman Senator Patrick Leahy (D-VT) in urging Sen. Reid to bring to the floor legislation overturning McCarran – Ferguson’s antitrust exemption for health insurers

Other Issues: Health Care Reform

Several outstanding issues in implementation for organized dentistry:

Insurance Reforms and New State Exchanges

• Implementation and definition of the new pediatric dental benefit

• Treatment of standalone dental benefit plans within the new state-run health insurance exchanges

Health Care Reform

New Public Oral Health Programs

• Implementation of the new Public Oral Health Programs:

– Oral health care prevention education campaign– Grants to support research-based dental carries disease management– Implementation of school-based dental sealant programs– Implementation of new funding for oral health infrastructure– Implementation of new authorities relative to oral health surveillance

programs

• Implementation of grant programs for school-based health centers

Health Care Reform

Dental Workforce Issues

• Changes to the Title VII dental workforce programs• Implementation of and appropriations for the

alternative dental health care providers demonstration

• Creation of the new National Health Care Workforce Commission

• Efforts to expand the dental health aide therapist (DHAT) program beyond Alaska

Health Care Reform

Employer Responsibilities and Small Business Programs

• Implementation of employer responsibilities• Implementation of new small business tax

credit programs and other assistance programs• Implementation of the Small Business Health

Options Program (SHOP)

Health Care Reform

Other Miscellaneous Matters

• Efforts to address Medicaid reimbursement levels

• Regulatory efforts regarding changes to medical equipment to increase accessibility for the disabled

• Expansion of Community Health Centers program

Final Note

• Please fill out and send back your “scorecards”• Good Luck!