ADA: No Smiles for Health Reform Bills

  • by Washington Correspondent, MedPage Today

WASHINGTON -- Although the healthcare reform measures moving through Congress pay some attention to the nation's teeth, the American Dental Association (ADA) isn't smiling because neither measure would increase Medicaid reimbursement rates, a spokesman for the group said.

For the most part, dental care has flown under the radar in the current debate, but there are provisions in the House bill as well as language in the Senate Health, Education, Labor and Pensions (HELP) Committee's package that would expand dental care and affect dentists.

Still, they aren't nearly enough to to get the ADA's support because they don't offset the lack of movement on Medicaid payments, Mike Graham, managing director of government affairs for the organization, told MedPage Today.

"In most states, a dentist gets reimbursed below the cost of doing business," Graham explained. "There is no way a dentist can see a healthy number of Medicaid patients."

He said that only 15% to 20% of dentists participate in the Medicaid program, and some opt to treat Medicaid patients free of charge simply to avoid the paperwork.

He said the ADA is also pushing for programs that promote prevention, a less contentious issue.

The HELP bill, for example, expressly calls for an oral health prevention education campaign and a school-based sealant program.

Both the House and the Senate HELP bills establish a disease prevention task force. The HELP bill proposes spending $2.4 billion year, with $3.5 billion starting in 2014 for community based preventive care.

The provision does not explicitly mention dental care, but preventive dental services, such as routine cleaning, might be implied in the language.

The HELP bill also calls for no out-of-pocket costs for preventive services, such as routine cleanings, which the ADA supports.

In addition, the HELP bill also requires that all insurance plans participating in the insurance exchange cover oral care for people under 21. The insurance exchange would operate as a one-stop shop for private and public plans that must meet minimum coverage criteria.

The scope of the dental care coverage required of plans participating in the exchange would be determined by the Health Benefits Advisory Committee. The ADA would like to see an amendment that would require at least one dentist to serve on the Health Benefits Advisory Committee.

While expanding insurance coverage is a positive move, Graham cautions that it isn't the same as improving access.

"You can give someone a dental plan, but if there is no dentist there, you don't have access," he said, adding that the ADA supports funding to place more dentists in community health centers.

The HELP bill does grant authority for more oral health infrastructure funding. Meanwhile, the stimulus bill gave a boost to community health centers, but Graham said that money hasn't trickled down to the dentists yet.

Despite their piecemeal improvements to dental coverage, the ADA doesn't support the current healthcare reform measures because they don't improve the payment rates and eliminate administrative burdens of Medicaid.

"None of the bills addresses the number one priority: fixing Medicaid," Graham said, adding that "we've lobbied the heck out of Congress."

Moreover, the ADA opposes a public health insurance plan if it leads to a single-payer system, if the plan requires that dentists participate, and if it "directly or indirectly" dictates fees for private insurers.