A Great Dentist Goes to Washington

Review of Federal Issues for Hill Visits

Federal Issues

• Title VII Health Professions Programs

• Access to Care / Health Care Reform

• Legislation:– Meth Mouth Prevention and Community

Recovery Act (S. 450)– Dental Emergency Responder Act (H.R. 903)– Essential Oral Health Care Act (Not yet

introduced)

Title VII Health Professions Programs – Background and

Overview

• Programs authorized by Title VII of the Public Health Service Act

• Eight (8) major programs in total

• Provide grants to support health professions workforce enhancement

Title VII Health Professions Programs – Background and

Overview

• Two Title VII Programs of interest to dentistry:– Training in Primary Care Medicine and

Dentistry (TPCMD) Program– Public Health, Preventive Medicine, and

Dental Public Health Program

Training in Primary Care Medicine and Dentistry – About the Program

• Supports health professions training for five (5) disciplines

• “General and Pediatric Dentistry” is one of the disciplines supported by the TPCMD program– Provides grants or contracts to dental schools

or other approved programs to support the planning, development, and operation of residency programs in general and pediatric dentistry

Training in Primary Care Medicine and Dentistry – Historical Funding

Levels

• Last reauthorized in 1998• Annual funding has decreased from nearly

$90 million annually to under $50 million annually from FY 2005 – FY 2008

• To address declining overall TPCMD Program, FY 2007 and FY 2008 Labor-HHS-Education Appropriations bills carve out $5 million for general dentistry and $5 million for pediatric dentistry

Training in Primary Care Medicine and Dentistry – FY 2009 & FY 2010

Funding• FY 2009 Labor-HHS Appropriations –

carve out of $5 million for general dentistry and $5 million for pediatric dentistry

• American Recovery and Reinvestment Act– $200 million in FY 2009 and FY 2010, total,

for Title VII and Title VIII (nursing)– Joint Explanatory Statement indicates that

funding shall be used to increase funding for the TPCMD program

Training in Primary Care Medicine and Dentistry – The AGD Ask

• Thank you for carve out of $5 million in Labor-HHS Appropriations bill for general dentistry and for $200 million in ARRA for Title VII and VIII

• Please continue to carve out specific funds for general dentistry and support continued funding for all Title VII programs at the increased level in FY 2011 and subsequent years

• Reducing funding will:– Be disruptive to general dentistry residency programs– Reverse gains made from the ARRA funding– Limit the number of general dentists available to serve residents

of Dental Health Professional Shortage Areas

Public Health, Preventive Medicine, and Dental Public Health Programs

– Background and Overview• Support various training and residency programs

aimed at enhancing public health workforce development

• The Residency Training Program in Dental Public Health:– Provides support to assist accredited dental public

health programs in:• Developing new training programs• Maintaining or improving existing residency training programs• Providing financial assistance to trainees enrolled in such

programs

Residency Training Program in Dental Public Health –

Funding Levels

• Approximately $450,000 in grants provided in FY 2008

• Specifically identified as a program to benefit from the $200 million included in ARRA for Title VII and Title VIII programs in FY 2009 and FY 2010

Residency Training Program in Dental Public Health –

The AGD Ask

• Thank you for the funding included in ARRA• Please maintain these increased funding levels

in FY 2011 and subsequent years• Reducing funding will:

– Be disruptive to dental public health training programs– Reverse gains made from the ARRA funding– Limit the number of dental public health professionals

Access to Care – Health Care Reform

• Top priority for President Obama and Democratically-Controlled Congress

• President and Congressional leaders are making concrete plans, not speaking esoterically

• The AGD needs to be prepared to engage in this debate

Health Care Reform – How it Looked at the Start of the Year

• Coverage for uninsured and under-insured:– Expansion of SCHIP (DONE)– Increase in FMAP (DONE)– Possible New Insurance Pools– Possible Mandate

• Funding for EMR Infrastructure (DONE)• Cost Containment:

– Prevention and Wellness Programs (DONE)– Comparative Effectiveness (DONE)– Value-Based Purchasing - P4P

• Medicare Improvements and Enhancements– Physician Fee Schedule Fix– Reimbursement for Providers

Health Care Reform – Key Players

• President Obama• Senate Finance Committee Chairman Max Baucus (D-MT)• House Energy & Commerce Committee Chairman Henry Waxman

(D-CA)• Others

– Sen. Edward Kennedy– Sen. Christopher Dodd– Sen. Charles Grassley– Sen. Michael Enzi– Rep. Charles Rangel– Rep. Fortney “Pete” Stark– Rep. Frank Pallone– Rep. Joe Barton– Rep. Dave Camp

Health Care Reform – President Obama

• Set aside $630 billion over 10 years in his budget as a down payment on health care reform

• Eight Principles:– Protect Families’ Financial Health– Make Health Coverage Affordable– Aim for Universality– Provide Portability of Coverage– Guarantee Choice– Invest in Prevention and Wellness– Improve Patient Safety and Quality Care– Maintain Long-Term Fiscal Sustainability

Health Care Reform – Congress

• House Energy & Commerce: Hearings

• Senate Finance: Roundtables

• Tentative Schedule:– March – May: Congressional Hearings– June – July: Congressional Markups– September – October: Floor Debate

Health Care Reform: What We’re Likely to See in Democratic Plan

• Universal Coverage:– Expansion of current programs– New public insurer– Mandate for coverage / subsidy– Mandate to provide coverage / fee– No single payer– No decoupling of health coverage from employer

• Changes in Policy– Changes in reimbursement policy:

• Reductions / carrot-and-stick• Value-Based Purchasing

– Prevention and Wellness– Comparative Effectiveness– Prescription drugs

• Generics• Medicare negotiation

Health Care Reform: Opposition

• Opposition is expected to be fierce, though all stakeholders are engaged in the debate at this time.

• House Republicans have little recourse - Senate Republicans are the key

• If insurers, employers, providers, others coalesce in opposition, the health care reform debate will collapse under its own weight

Health Care Reform: Outlook• Chances of success are limited …

– Window of opportunity is narrow– Opposition could be broad if mishandled

• But better than they ever have been– Political stars may have aligned – 20 years from idea to

implementation– Democrats in control of Federal Government– Public support (different environment from 1993 Hillary-Care

debacle)– Stakeholders on board for change: Providers, Insurers,

Employers– Budget is no obstacle

• “Stronger than all the armies is an idea whose time has come.” (Victor Hugo / Everett Dirkson)

Health Care Reform: AGD

• Must be prepared for this to move forward• Unlike in 1993, all stakeholders are

engaged – there is danger in being isolated if uninvolved

• Unlike 1993, several opportunities to engage policymakers

• Very important to inform and educate so that decisions are made with AGD input

• “No, because …” vs. “Yes, if …”

Health Care Reform: AGD

• A Great Dentist Goes to Washington is the beginning of an ongoing dialogue

• Let Members and staff know that you are ready to engage and available to participate

• Share the White Paper – Explain that AGD staff is prepared to follow up to answer any questions / concerns

Meth Mouth Prevention and Community Recovery Act (S. 450)

• Sponsored by Sen. Baucus• Creates three (3) new grant programs:

– Funds grants to determine whether, how, and to what degree educating youth about meth mouth is an effective anti-drug strategy

– Requires study to determine whether, how, and to what degree meth use affects demand for dental care

– Supports training to ensure dentists and allied health professionals can recognize signs of substance abuse in their patients

Dental Emergency Responder Act of 2009 (H.R. 903)

• Sponsored by Bart Stupak (D-MI)

• Amends several federal disaster response programs to include dentists in the definition of “emergency response provider”

Essential Oral Health Care Act• Not yet introduced• Authorizes grants to dental schools to purchase portable or mobile

dental equipment and support operation of volunteer dental projects that provide free dental services

• Increases FMAP by 25 percentage points (up to a maximum federal match of 90 percent) for states that meet various dental health goals:– Medicaid populations have same access to dental services as

the general population– Payment for dental services is made at market-based rates– At least 35 percent of practicing dentists in the state are

participating in the State Medicaid program– Administrative barriers to providing dental services are reduced– State provides services for educating caregivers on the

importance of oral health care and oral health care literacy issues are addressed