National Network for Oral Health Access Fall 2009

National Network for Oral Health Access Fall 2009 Conference Nashville, TN Health Reform and Oral Health Myla Moss, MA, MSW American Dental Education Association November 4, 2009 AMERICAN DENTAL EDUCATION ASSOCIATION

Overview • The Problem • Turning a Problem into A Solution • The Legislative and Advocacy Process. • Advocacy Strategies • The Results AMERICAN DENTAL EDUCATION ASSOCIATION

Public Policy Problem: Dental Workforce Needs • • • The ratio of dentists to population has declined over the past 20 years; Dentists are aging—retiring at a 2 to 1 ratio to new dental graduates entering the workforce; Trends are not consistent with increases in the U. S. population; Closure of dental schools and reductions in class sizes between 1982 and 2000 had a long-term impact on the U. S. dentist workforce; and Concerns about the adequacy of the workforce to meet future demand improve access to care for vulnerable and at-risk populations. AMERICAN DENTAL EDUCATION ASSOCIATION

“While African Americans, Hispanic Americans, and American Indians, as a group, constitute nearly 25 percent of the U. S. population, these three groups account for less than 9 percent of nurses, 6 percent of physicians, and only 5 percent of dentists. The consequences of health disparities are grave and will only be remedied through sustained efforts and a national commitment. ” Source: Missing Persons: Minorities in the Health Professions A Report of the Sullivan Commission on Diversity in the Healthcare Workforce September 2004 AMERICAN DENTAL EDUCATION ASSOCIATION

Distribution of Dentists in the U. S. Dental Health Professions Shortage Areas (“Dental HPSAs”) • In 2000, ~1, 275 Dental HPSAs in U. S. in which 28, 000 people resided • In 2008, >4, 000 Dental HPSAs in U. S. in which 48, 000 people reside AMERICAN DENTAL EDUCATION ASSOCIATION Source: U. S. Health Resources and Services Administration, 2009

Public Policy Problem: Unmet Dental Needs • More than 130 million Americans lack access to dental insurance coverage; • 49 million people live in 4, 091 dental professional shortage areas (D-HPSAs); • Disease is concentrated in subsets of the population: minorities, rural populations, frail elderly, and persons with special needs. AMERICAN DENTAL EDUCATION ASSOCIATION

Health Reform in 2009 Legislative Process Options: Regular Order Conference Committee House Senate AMERICAN DENTAL EDUCATION ASSOCIATION

…in the real world… AMERICAN DENTAL EDUCATION ASSOCIATION

The Players AMERICAN DENTAL EDUCATION ASSOCIATION

Health Reform in 2009: The Key Players • President Barack Obama • House and Senate leadership (Pelosi, Reid) • Committee Chairs and Ranking Members (Baucus/Grassley, Rangel, Stark, Waxman, Pallone) • House “Blue Dog” Democrats (52 moderate Democrats) • House Progressive Democrats (83 liberal Democrats) • Senate “Gang of Six” (Baucus, Conrad, Bingaman, Grassley, Enzi, Snowe) • Congressional Budget Office/Joint Tax Committee AMERICAN DENTAL EDUCATION ASSOCIATION

Health Reform in 2009: The Key Players • • • Physicians Hospitals Other healthcare providers Health insurance industry Pharmaceutical/Biotechnology industry Medical device industry Consumer advocacy organizations Media Public perception AMERICAN DENTAL EDUCATION ASSOCIATION

Health Reform in 2009: Legislative Process: Current Status United States Senate: HELP Committee - Passed 13 -10 on July 15 (party line vote) Senate Finance Committee May 2009: Issued three policy option white papers June 2009: Issued draft proposal September 2009: Issued “Framework for Reform” –conducted mark-up October 2009 Bill passes out of Committee with one GOP vote Senator Olympia Snowe (R-MA) will need to Merge HELP, Finance proposals AMERICAN DENTAL EDUCATION ASSOCIATION

Health Reform in 2009: Legislative Process: Current Status House of Representatives: Ways & Means - Passed 23 -18 on July 17 (All Republicans opposed plus 3 Democrats [mostly Blue Dogs]) Education & Labor - Passed 26 -22 on July 17 (All Republicans opposed plus 3 Democrats [Blue Dogs/Freshman]) Energy & Commerce - Passed 31 -28 on July 31 (All Republicans opposed plus 5 Democrats [mostly Blue Dogs]) Merging Tri-Committee final legislation October 29 HR 3962 AMERICAN DENTAL EDUCATION ASSOCIATION

Presidential Activities • President Obama hosts stakeholder meetings at the White House—NO DENTAL REPRESENTATION. • In March 2009, the President Obama hosts six regional meetings California, Iowa, Michigan, Vermont, North Carolina. • ADEA alerts advocates to attend some members invited personally (e. g. , Dr. William K. Lobb, Marquette University is invited by Governor). • Town Hall Meetings AMERICAN DENTAL EDUCATION ASSOCIATION

Congressional Activities • Gang of Six starts to meet in the Senate [Max Baucus (D-MT), Jeff Bingaman (D-NM), Kent Conrad (D-ND), Olympia Snowe (R -ME), Charles Grassley (R-IA), Michael Enzi (R-WY)] • Sen. Jeff Bingaman coordinates meetings with oral health community—ADEA staff participates extensively in deliberations. • Finance Comte. holds Health Care Summit—ADEA petitions members to include oral health in summit concerns. • Town Hall Meetings AMERICAN DENTAL EDUCATION ASSOCIATION

Hearings • Spring 2009 --Senate Finance and House Health, Education & Labor Comtes. Hold Hearings on "Workforce Issues in Health Care Reform • ADEA submits statements for the hearing records. • ADEA testifies before the Senate Health Education Labor & Pensions (HELP) Comte. and the House Labor, Health and Humans Services Appropriations Subcommittee AMERICAN DENTAL EDUCATION ASSOCIATION

• • January 2009 ADEA BOD unanimously approves policy statement and principles. March 2009 ADEA House of Delegates adopts Statement and Principles. Health Care Reform Must Include Dental Care April 23, 2009, By Charles N. Bertolami Special to Roll Call “We urge President Obama, Members of Congress, and the health care community to make dental care an integral part of America’s health care system. ” AMERICAN DENTAL EDUCATION ASSOCIATION

Face to Face Meetings • Dr. Caswell Evans, University of Illinois at Chicago ADEA Legislative Advisory Committee and ADEA staff meet with Caya Lewis, HHS Office of Health Care Reform. AMERICAN DENTAL EDUCATION ASSOCIATION

ADEA Educational Forums • • • ADEA Deans Meeting—Bonita Springs, FL ADEA Interim Meeting (COHEAP, Faculties, Students, AFASA, Diversity and Access to Dental Careers Conference (DADC), and Section on Minority Affairs Task Force)—Philadelphia, PA Advocacy Day on Capitol Hill—Washington, DC Senior Symposium & Advocacy Day, Univ. Connecticut, Farmington, CT Field Advocacy Training (IA)—University of Iowa, Des Moines, IA AMERICAN DENTAL EDUCATION ASSOCIATION

• • • ADEA Coalitions & Collaborations National Coalition for Health Care in which ADEA is the only oral health care member releases a public statement supporting oral health in health care reform/ ADEA joins Oral Health America & the California Dental Health Foundation for Joint Hill Visits ADEA drafts letter for diverse coalition that includes ADEA, Oral Health America, and the Dental Health Foundation and the National Consumers League. AMERICAN DENTAL EDUCATION ASSOCIATION

ADEA Coalitions & Collaborations • • • ADEA accepts invitation from the American Hospital Association (AHA) to participate in its national effort to craft principles. ADEA accepts invitation of the Pew Charitable Foundation Center for the States to participate in its federal coalition efforts. ADEA works jointly with the American Dental Association, and the American Academy of Pediatric Dentistry on the dental changes in Title VII. AMERICAN DENTAL EDUCATION ASSOCIATION

Other ADEA Collaborations – – – – – Families U. S. A. Children’s Health Group Children’s Dental Health Project American Association for Dental Research National Dental Association Hispanic Dental Association American Academy of Public Health Dentistry State and Territorial Dental Directors Medicaid and SCHIP Dental Association American Dental Hygienists Association AMERICAN DENTAL EDUCATION ASSOCIATION

Overview – The Asks – Keep oral health benefits for children and add oral health benefits for adults in the health care reform legislation. – Keep the dental workforce provisions in the final version of the legislation. – Keep GME funding for didactic training and add language repealing the three-year rolling average and one-year lag in the final version of the legislation. Center for Public Policy and Advocacy AMERICAN DENTAL EDUCATION ASSOCIATION 23

Major Oral Health Provisions House (HR 3962) Senate HELP (S. ____) Children’s oral health benefit included. legislation would allow only for an optional adult oral health benefit at an additional cost in its “premium-plus” benefit package Children’s oral health benefit included. Dental has own title and is funded with other HPs at $240 m contingent upon Appropriations—NO SEPARATE FUNDING LINE. Dental has own title and separate funding line of $30 m in 2010. Dental schools eligible for new Title VII grants (AAUs, pre-doctoral, and postdoctoral and faculty loan repayment)—NO FACULTY DEVELOPMENT. Dental schools eligible for new Title VII grants (AAUs, pre-doctoral, and postdoctoral and faculty development and faculty loan repayment). Ensures funding for GME Didactic time. Surveillance, public health enhancements. AMERICAN DENTAL EDUCATION ASSOCIATION Funds 15 demonstration grants Requires oral health in school clinics.

Overview of Legislation Requires health Plans to allow young people to remain on their parents insurance policy up to their 27 th birthday Allows for the creation of State Health Insurance Compacts-permitting states to enter into agreements to allow for the sale of insurance across state lines Reduces the donut hole by $500 and institutes a 50% discount for brand name drugs in the donut hole (Medicare Part D) AMERICAN DENTAL EDUCATION ASSOCIATION

Overview of Legislation • Creates a prevention and wellness trust fund, providing $34 billion in mandatory funding over 10 years for community based prevention programs • Reauthorizes the Indian Health Care Improvement Act • Creates a long-term care insurance program to be financed by voluntary payroll deductions to purchase community-based services and supports for adults who become functionally disabled • Creates an insurance program with financial assistance for those uninsured for several months or denied policy due to preexisting conditions. • Discourages excessive price increases by insurance companies through review of rate increases. AMERICAN DENTAL EDUCATION ASSOCIATION

Challenges • Achieving separate funding line in authorization. • The effect and the cost associated with an “expensive” new adult dental benefit. • Concessions in Senate to avoid a filibuster. • Concessions in conference committee. • Divisions in the dental community about the message. • Muted grassroots voice for oral health compared to industry and other patient advocates. AMERICAN DENTAL EDUCATION ASSOCIATION

Advocacy Strategies l l l l Organized activities with the purpose of influencing the outcome of public policy, that educate Congress and build public support. Start Early Target Your efforts Build Coalitions Make Friends Where You Find Them Do Your Homework Utilize Local Constituencies Know Your Opponents Thank Those Who Help You. AMERICAN DENTAL EDUCATION ASSOCIATION

Ask Congress Keep oral health benefits for children and add oral health benefits for adults in the health care reform legislation Maintain Title VII Workforce Provisions Inform policy makers about the tragic Deamonte Driver incident and importance of improving access to dental services § AMERICAN DENTAL EDUCATION ASSOCIATION

Public Policy Solution: ADEA Reform Principles • • • The availability of oral health care fulfills a fundamental human need and is necessary for general health. The needs of vulnerable populations have a unique priority. Prevention is the foundation for ensuring general and oral health. The financial burden of ensuring coverage should be equitably shared by all stakeholders. A diverse and culturally competent workforce is necessary to meet the nation’s oral health needs. Reducing administrative costs and realigning spending can increase quality, improve health, and create savings. AMERICAN DENTAL EDUCATION ASSOCIATION

Future Outlook: Dental on Congressional Agenda § Appropriations § Dental access bills may be combined AMERICAN DENTAL EDUCATION ASSOCIATION

Keep Dental On Congressional Agenda As health care reform legislation is aimed at helping those in most need, dental care cannot be forgotten. Increasing awareness of the relationship and importance of good oral health to good physical health is a public policy imperative. AMERICAN DENTAL EDUCATION ASSOCIATION

Thank You AMERICAN DENTAL EDUCATION ASSOCIATION

FOR MORE INFORMATION CONTACT: ADEA Center for Public Policy and Advocacy 1400 K Street, NW, #1100 Washington, DC 20005 Phone: 202 -289 -7201 www. adea. org AMERICAN DENTAL EDUCATION ASSOCIATION