Health Care Bill, Dentistry, and the ADA's response

[teeth63a]

Official letter to Speaker Pelosi from the ADA. Note that there is no dental provision in the new health care act.

Bottom line: ADA was not happy with the bill, thinks Medicaid reimbursements should be funded more, dental therapists are a bad idea, not happy that flex spending accts will be phased down.

In addition, the repeal of the McCarran-Ferguson Act was passed by the House last month (don't know if it's official) which is BIG news for our profession. Insurance companies are exempt from certain anti-trust laws, and for the past 60 years they were allowed to share fees and information between themselves. We as dentists, were obligated to the Act and we are not allowed to disclose discuss fees/fix fees/etc with each other. Now with the new Health Insurance Industry Fair Competition Act, insurance companies no longer have an unfair advantage over dentists.

http://image.adapubs.adamail.org/lib/fef61079726005/d/1/Letter%20to%20Spkr%20Pelosi%203-18-2010.pdf

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[MXDenty77]

This paper is useless.. Until the dentists stand up and act against the medicaid reimbursements why would the govt. change their practices. Has their ever been any legitimate retaliation from dentists on the medicaid reimbursements? Why not?

 

[mike3kgt]

...thinks Medicare reimbursements should be funded more

That's MedicAID. Big difference.

"Failure to properly fund Medicaid is the primary reason for the ADA's decision not to support this legislation. However the bill contains a number of other provisions that we have consistentlyopposed, including provisions to allow workforce pilot programs that may lead to non-dentists performing surgical dental procedures. Funding for these provisions would be better spent on increasing funding for Medicaid dental services."

So failure to fund adult medicaid benefits is the PRIMARY REASON the ADA isn't supporting this bill?

"We find it particularly disheartening that the Senate bill extends Medicaid eligibility to individuals in families with incomes up to 133 percent of the federal poverty level but does nothing to provide a basic adult dental benefit for existing or new Medicaid enrollees."

The bill for dues for the ADA are on my desk. I'm thinking about shredding it and saying goodbye.

So Dr. Tankersley, if adult Medicaid dental benefits were in the bill but midlevel providers were also still in it... that would've been OK? You would have supported it?


DrJeff... even you must notice the disparity in this letter!

 

[mike3kgt]

This paper is useless.. Until the dentists stand up and act against the medicaid reimbursements why would the govt. change their practices. Has their ever been any legitimate retaliation from dentists on the medicaid reimbursements? Why not?

Yeah, don't participate. Simple as that. Will be the best thing you will ever do to your practice bottom line and your stress level.

But we do this and the legislature think we are "greedy dentists" and will take it upon themselves to "solve the problem whether they will or not." There hopefully will be a lot of great things to come from the insurance reform parts of this bill. At least I hope so, so long as the good stuff doesn't get ruled unconstitutional and the bad stuff remains to crap it up.

Why do dentists get so caught up on Medicaid. Hopefully the bill will lead to an increase in community action, health centers and increased funding for dentists who wish to go into public health. I'd MUCH rather my money go into funding CHCs, dental school funding for dentist education, and to give financial incentive for dentists to work in low-income or rural areas than to throw money at a problem that will NEVER become resolved.

 

[DrJeff]

That's MedicAID. Big difference.

"Failure to properly fund Medicaid is the primary reason for the ADA's decision not to support this legislation. However the bill contains a number of other provisions that we have consistentlyopposed, including provisions to allow workforce pilot programs that may lead to non-dentists performing surgical dental procedures. Funding for these provisions would be better spent on increasing funding for Medicaid dental services."

So failure to fund adult medicaid benefits is the PRIMARY REASON the ADA isn't supporting this bill?

"We find it particularly disheartening that the Senate bill extends Medicaid eligibility to individuals in families with incomes up to 133 percent of the federal poverty level but does nothing to provide a basic adult dental benefit for existing or new Medicaid enrollees."

The bill for dues for the ADA are on my desk. I'm thinking about shredding it and saying goodbye.

So Dr. Tankersley, if adult Medicaid dental benefits were in the bill but midlevel providers were also still in it... that would've been OK? You would have supported it?


DrJeff... even you must notice the disparity in this letter!

Yup, and as I've said many, many, many times before, we as dentists need to stop just looking/micro-managing what is our small little world that exists inside of our own individual offices and start looking big picture, especially with respect to dentistry and politics both on a national and state level. Bottomline line (nationally) there's about 250,000 dentists (potential votes to a politician), there's about 300,000,000 millions americans (let's say 200,000,000 potential voters for arguements sake). Us just standing up and saying, "no, no, no" without having any factual data behind it/plans to attack what in the unrealistic mind of a dentally dumb legislator (one could easily argue just plain 'ol dumb ) won't work, and dentistry will be left out in the cold of the descision making process WHEN, not if some nationally scoped mid-level happens (remember, it's already inplace in a couple of states, so for many a dentally dumb congressional rep, that's all they need to know! Hopefully congress's dental knowledge will increase this fall as there's a dentist in Arizona who's running for congress this fall.

Secondly, even with good data showing what could work (or wouldn't) there's the emotional component of the debate. We in CT, just 2 days ago had a bill to create a DHAT-esque mid-level come out of committee, when the facts were against it, but one of the politicians on the committee told 2 blatant falsehoods about access to dental care for medicaid receiving kids in CT and the bill made it out of committee for consideration now by the CT state legislature. The bottomline, is that our dentally ignorant legislators have this grandiose ideas that 100% of the population should both have and WANT access to dental care, when the reality is that the true UTILIZATION rates is under 75%.

The ADA, and Dr. Tankersley inculded, has this BIG PICTURE in mind (I had a 20+ direct conversation with Dr. Tankersley at a reception at the Yankee Dental Congress less than 2 months ago about this). The problem is that many a dentist doesn't want to see the big picture, and if we don't, then not only will we have some type of national mid-level provider, but dentistry will be locked out of the discussion of the scope of treatment, the educational requirements, the certification process, etc (See the Alaska mid-level debacle for an example).

Secondly, one of the things that the ADA is working on is showing that a mid-level, working to just help increase the access to care for the underserved is a financially non-self supporting model, and the better alternative is to encourage dentists (via medicaid fees increases) to see more medicaid patients where we have the ability to do more, and quicker and hence make more of a dent in the access to care issue.

With the current political climiate in this country where argueably our politicians are out of control and not listening to what the people want, now, more than ever is the time that we need to present a united front, based on facts, and not be in denial that nothing will happen just simply because "we're dentists and we know whats best"

 

[NonTradHopeful]

Yup, and as I've said many, many, many times before, we as dentists need to stop just looking/micro-managing what is our small little world that exists inside of our own individual offices and start looking big picture, especially with respect to dentistry and politics both on a national and state level. Bottomline line (nationally) there's about 250,000 dentists (potential votes to a politician), there's about 300,000,000 millions americans (let's say 200,000,000 potential voters for arguements sake). Us just standing up and saying, "no, no, no" without having any factual data behind it/plans to attack what in the unrealistic mind of a dentally dumb legislator (one could easily argue just plain 'ol dumb ) won't work, and dentistry will be left out in the cold of the descision making process WHEN, not if some nationally scoped mid-level happens (remember, it's already inplace in a couple of states, so for many a dentally dumb congressional rep, that's all they need to know! Hopefully congress's dental knowledge will increase this fall as there's a dentist in Arizona who's running for congress this fall.

Secondly, even with good data showing what could work (or wouldn't) there's the emotional component of the debate. We in CT, just 2 days ago had a bill to create a DHAT-esque mid-level come out of committee, when the facts were against it, but one of the politicians on the committee told 2 blatant falsehoods about access to dental care for medicaid receiving kids in CT and the bill made it out of committee for consideration now by the CT state legislature. The bottomline, is that our dentally ignorant legislators have this grandiose ideas that 100% of the population should both have and WANT access to dental care, when the reality is that the true UTILIZATION rates is under 75%.

The ADA, and Dr. Tankersley inculded, has this BIG PICTURE in mind (I had a 20+ direct conversation with Dr. Tankersley at a reception at the Yankee Dental Congress less than 2 months ago about this). The problem is that many a dentist doesn't want to see the big picture, and if we don't, then not only will we have some type of national mid-level provider, but dentistry will be locked out of the discussion of the scope of treatment, the educational requirements, the certification process, etc (See the Alaska mid-level debacle for an example).

Secondly, one of the things that the ADA is working on is showing that a mid-level, working to just help increase the access to care for the underserved is a financially non-self supporting model, and the better alternative is to encourage dentists (via medicaid fees increases) to see more medicaid patients where we have the ability to do more, and quicker and hence make more of a dent in the access to care issue.

With the current political climiate in this country where argueably our politicians are out of control and not listening to what the people want, now, more than ever is the time that we need to present a united front, based on facts, and not be in denial that nothing will happen just simply because "we're dentists and we know whats best"

...or offer dentists student loan forgiveness or reductions for serving in a designated under-served area for a certain number of years (like 2 years service will give 40% loan forgiveness...5 years service would give 100% loan forgiveness, etc...).

I can't begin to tell you how many dentists I've seen on forums who are forced to work for corporate dentistry or other dental mills because they HAVE to do it in order to pay their student loans and survive.

I guarantee you that many dentists would jump at the opportunity to serve in a designated under-served area if the government offers loan reimbursement or reduction to them if they serve in these areas.

This would eliminate the need of mid-level providers altogether (simply from the sheer volume of dentists who would probably take this option). And it would be great for the dentist, because he still has the option to leave after he's done serving the area.

Do you all agree, or am I missing something with this idea?

 

[teeth63a]

That's MedicAID. Big difference.

"Failure to properly fund Medicaid is the primary reason for the ADA's decision not to support this legislation. However the bill contains a number of other provisions that we have consistentlyopposed, including provisions to allow workforce pilot programs that may lead to non-dentists performing surgical dental procedures. Funding for these provisions would be better spent on increasing funding for Medicaid dental services."

So failure to fund adult medicaid benefits is the PRIMARY REASON the ADA isn't supporting this bill?

"We find it particularly disheartening that the Senate bill extends Medicaid eligibility to individuals in families with incomes up to 133 percent of the federal poverty level but does nothing to provide a basic adult dental benefit for existing or new Medicaid enrollees."

The bill for dues for the ADA are on my desk. I'm thinking about shredding it and saying goodbye.

So Dr. Tankersley, if adult Medicaid dental benefits were in the bill but midlevel providers were also still in it... that would've been OK? You would have supported it?


DrJeff... even you must notice the disparity in this letter!

thx for the correction.

The ADA had a hand in the repeal of McCarran-Ferguson, so yay ADA.

I'm involved in local state society events, so I still do see how the work ADA does, and I'm happy with it.

Yeah, and because this is a free market system, nonparticipation with medicaid is the best way to walk away.

 

[teeth63a]

...or offer dentists student loan forgiveness or reductions for serving in a designated under-served area for a certain number of years (like 2 years service will give 40% loan forgiveness...5 years service would give 100% loan forgiveness, etc...).

I can't begin to tell you how many dentists I've seen on forums who are forced to work for corporate dentistry or other dental mills because they HAVE to do it in order to pay their student loans and survive.

I guarantee you that many dentists would jump at the opportunity to serve in a designated under-served area if the government offers loan reimbursement or reduction to them if they serve in these areas.

This would eliminate the need of mid-level providers altogether (simply from the sheer volume of dentists who would probably take this option). And it would be great for the dentist, because he still has the option to leave after he's done serving the area.

Do you all agree, or am I missing something with this idea?

There is an existing fed loan forgiveness program after 10 years of "public service" which is loosely defined. Search the Military Dentist forum.

 

[mike3kgt]

Excellent... I love the state of Florida.

From: http://weblogs.sun-sentinel.com/news/politics/dcblog/2010/03/lemieux_enroll_members_of_cong_1.html

LeMieux: Enroll members of Congress in Medicaid

How about forcing all members of Congress to enroll in Medicaid, just like poor Americans across the country?

That’s Florida Senator George LeMieux’s latest proposal, one of the more creative Republican jabs taking place on the Senate floor this week as part of the on-going debate on health-care reform.
George%20LeMieux%20with%20flags.jpg
George LeMieux

The Senate is considering the House-passed fix-it bill, which would amend the sweeping reform bill signed into law on Tuesday by President Obama. Much of the point of this second bill is to mollify liberal Democrats who don’t like some aspects of the new law.

That makes it a favorite target for Republicans like LeMieux who warn against a government takeover of the health-care system.

The Senate debate this week is peppered with a host of amendments from Republicans. It’s their last chance to alter the course of the Democratic reform legislation, or at least make some points along the way to this year’s elections.

LeMieux introduced his Medicaid proposal on Wednesday, surely not with a straight face. He argues that the overhaul will “force” another 16 million Americans onto Medicaid, so members of Congress should join them.

Democrats hail the expansion of Medicaid as way to cover millions of uninsured Americans who cannot afford insurance.