1. Health Care Reform and its Impact on Dentistry

2. © 2010 American Dental Association, All Rights Reserved November, 2008 – The Political Landscape Highest voter turnout since 1960 Largest Electoral College Margin since 1996 Largest Popular Vote Margin Since 1988 60-40 Partisan Split in the Senate 77 Vote Majority in the House Indiana, Virginia and Nebraska* Vote Democrat

3. © 2010 American Dental Association, All Rights Reserved ADA Decides to Engage “…a responsibility to assert leadership when an issue of this magnitude is on the national agenda…” ADA Is Not the Only Oral Health Advocate In Washington If the ADA Was Not Representing Dentistry, Someone Else Would If You’re Not At the Table You’re On the Menu

4. © 2010 American Dental Association, All Rights Reserved What Will Guide ADA Policy? “Fundamentally, our advocacy is guided by ADA policy based on a belief that the dental delivery system works extremely well for most Americans and should be left untouched by any reform effort.” HOD Resolutions Board of Trustees Guidance from ADA Washington & Chicago Staff Whether the Legislation Would Have a Major, Positive Impact on Oral Health

5. © 2010 American Dental Association, All Rights Reserved ADA’s Priorities in HCR Debate Mending the Tattered Medicaid Safety Net Rebuilding the Dental Public Health Infrastructure Adequately funding community-based prevention measures, such as water fluoridation, school-based sealant programs, and oral health promotion and education programs.

6. © 2010 American Dental Association, All Rights Reserved What Happened in Congress? Three Committees in the House, Two Committees in the Senate Work to Create Two Separate Bills November 7, 2009 House Passes Its Version 220- 215 December 24, 2009 Senate Passes Its Version 60- 39 January 19, 2010 Scott Brown Elected March 24, 2010 House Passes Senate Bill 219-212

7. © 2010 American Dental Association, All Rights Reserved What Does the ADA Support in the Bill? 5 YR National Education Campaign focused on Oral Health Care Prevention and Education Increased Funding for Public Health Infrastructure, including Centers for Disease Control and Prevention Programs Additional Funding for School-Based Health Center Facilities and Federally Qualified Health Centers Increased Title VII Grant Program Opportunities for General, Pediatric or Public Health Dentists National Health Service Corps Loan Repayment Programs Liability Protection for Individuals Working At Free Clinics

8. © 2010 American Dental Association, All Rights Reserved Title VII “Dental Cluster” Title VII is amended to provide a dental specific provision - grants to plan, develop, and operate dental training programs Financial assistance for dental students and dentists in these programs Grants that will fund financial assistance and loan repayment for dental faculty Funding for FQHC’s

9. © 2010 American Dental Association, All Rights Reserved What Are the ADA’s Primary Concerns? FAILS TO FUND MEDICAID Extension of Medicaid Eligibility to Individuals in Families With Incomes Up to 133% of FPL Yet No Basic Adult Dental Benefit for Existing or New Medicaid Enrollees Fails to Address Administrative Barriers In Medicaid System Provisions to Allow Workforce Pilot Programs That May Lead to Non-Dentists Performing Surgical Dental procedures Restrictions on FSAs, Lack of Patient Protections in Group Plans, Lack of Medical Liability Reform

10. © 2010 American Dental Association, All Rights Reserved Title VII Alternative Dental Health Providers 15 Grant Opportunities for Entities to Establish Demonstration Programs to Train “Alternative Dental Health Providers” The Program Must be Accredited by the Commission on Dental Accreditation or be Housed Within a Dental Education Program in an Accredited Institution

11. © 2010 American Dental Association, All Rights Reserved Impact on Dentists As Providers: Secretary of Department of Health and Human Services Tasked With Writing Rules and Regulations –Reporting Requirements Regarding Plan Coverage and Provider Reimbursement Structures Designed to Improve Outcomes –Provider Level Outcomes Unclear What Impact This Will Have on Dentistry

12. © 2010 American Dental Association, All Rights Reserved Impact on Dentists As Employers: 50 or Fewer Employees, No Requirement to Provide Insurance 2014 States May Develop Exchanges May Provide An Opportunity for Small Businesses to Purchase Coverage Employers Who Do Provide Coverage for Dependent Children Must Now Provide Coverage For “Children” to Age 26 Prohibition on Refusal to Cover Pre-Existing Conditions Employers With <25 Employees and Average Annual Wages of less Than $50K Eligible for Tax Credits

13. © 2010 American Dental Association, All Rights Reserved Impact on Dentists as Consumers: If Your Plan’s Premium Exceeds $10,200/Individual $27,500/Family You May Be Subject to Additional Taxes ADA Successful in Removing Dental/Vision Plans From The Total Amount FSAs Limited to $2,500/yr in 2013

14. © 2010 American Dental Association, All Rights Reserved Next Steps: Regulatory/Rule Making Process Underway – ADA Engaged At Every Level –11 Committees and Commissions Created to Address Workforce, Quality and Prevention Political Events May Change Much of What Was Passed –Repeal –Replace –Defund Some Efforts Already Undertaken –1099s –Possible Tax on Dental Devices QUESTIONS?

15. © 2010 American Dental Association, All Rights Reserved Get Involved: Join the ADA’s Grassroots Team Make a contribution to ADPAC Today (www.ada.org)www.ada.org Serve on ADA Boards, State Boards, as an Extern Do it for Your Practice! Do it for Your Education! Michael Brzica brzicam@ada.orgbrzicam@ada.org 202.898.2404