Transcript Health Care Reform and Oral Health: What’s New? The Dental Education Perspective American Public Health Association October 31, 2011 Washington, D.C.

Health Care Reform and
Oral Health: What’s New?
The Dental Education Perspective
American Public Health Association
October 31, 2011
Washington, D.C. 20001
Presented by
Richard W. Valachovic, D.M.D., M.P.H.
Executive Director
American Dental Education Association
“The Voice of Dental Education”
Information current as of 10/1/2011
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Presenter Disclosures
Richard W. Valachovic
The following personal financial relationships with
commercial interests relevant to this presentation existed
during the past 12 months:
No relationships to disclose.
Agenda:
The Education Perspective
• Background of the Affordable Care Act (ACA)
• Selected Oral Health Provisions of the ACA
• The Future of the ACA
• Legislative Challenges to the ACA
• Legal Challenges to the ACA
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The ACA Becomes Law
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Background
• March 21, 2010: Congress passed the Affordable Care
Act (H.R. 3590) on a strictly partisan vote
• March 23, 2010: President Barack Obama signed health
care reform into law (P.L. 111-148)
• ADEA major policy priority:
“ADEA believes that any comprehensive reform of the
U.S. health care system should provide universal
coverage to all Americans and access to high-quality,
cost-effective oral health care services”
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Oral Health Provisions
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Oral Health Provisions
Access Issues:
• Guarantees oral health services for children up to age 21
 HHS essential health benefits package must include oral pediatric
services; ADEA bases on EPSDT
• Expands Medicaid eligibility for adults and children
 133% of Federal Poverty Level (FPL)
Title VII Issues:
• Extends Children’s Health Insurance Program (CHIP)
 Through September 30, 2015
• Increases federal support to states to pay for expanded
Medicaid coverage
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Oral Health Provisions
• Creates separate dental section for “training in
general, pediatric and public health dentistry” (Sec.
748)
• Makes dental public health and dental hygiene
programs eligible to apply for training grants
• Creates new faculty loan repayment program for
general, pediatric and public health dentists who
agree to serve as full-time faculty
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Oral Health Provisions
• Establishes a National Health Care
Workforce Commission:
To provide comprehensive, unbiased
information to Congress and Administration
on how to align federal workforce
resources with national needs
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Oral Health Provisions
National Health Care Workforce Commission:
• Membership: 15 appointed by GAO, including at least
one rep from health care workforce, health
professionals, individuals skilled in health-related
research, and educational institutions
• “Health care workforce” includes dentists, dental
hygienists, and other oral health and public health
professionals
• “Health care professionals” include dentists, dental
hygienists, public health professionals; schools of
dentistry, allied health, and oral health industry
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Oral Health Provisions
• High priority topics include, among
others:
“the education and training capacity,
projected demands, and integration with the
health care delivery system of the oral health
care workforce capacity at all levels.”
Information current as of 10/1/2011
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Opportunities to Create a Diverse
Workforce While Addressing
Access to Care
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Oral Health Provisions
Programs increase minority representation in the health
professions. All were reauthorized in health care reform:
Centers of Excellence (COE) - Provide financial aid to health
professions schools with significantly higher enrollment of URM
students to encourage pursuit of careers in health professions.
Health Careers Opportunity Program (HCOP) - Funds “pipeline”
programs that identify and recruit individuals from disadvantaged
backgrounds and support their education and training in the health
professions.
Scholarships for Disadvantaged Students (SDS) - Provides
scholarships for disadvantaged students to work in medically
underserved areas as primary care providers
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Oral Health Workforce Diversity
Percent of Percent of
Practitioners Faculty
African American
3.4%
3.7%
Hispanic
3.4%
6%
Asian/Pacific Islander
6.9%
12.7%
American Indian
.12%
.34%
White
86.2%
75%
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Oral Health Provisions
• Establishes Medicaid and Children’s Health
Insurance Program Payment and Access
Commission (MACPAC)
 Topics to be reviewed by MACPAC include, assessment of
adult services in Medicaid, payments for dental services, and
process for updating payments to dental health professionals
 MACPAC membership includes dentists
 Authorizes $11 million for FY 2012
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Oral
Health
Health
Care Provisions
Workforce
National Center for Health Workforce Analysis:
National Center for Health
Workforce
Analysis
• Collect and analyze national data, identify and
analyze workforce trends and support health
workforce research
$7.5 million
• Develop data collection guidelines and create a
comparative state data registry
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Oral Health Provisions
National Health Service Corps:
ACA “trust fund” provides $535m, NHSC received $315m in 2011
•
•
•
•
National
Health
FY 2011 funded by $295 million from “trust fund” after Congress
enacted $117m discretionary cut
Service Corps
Permits part-time service to qualify for NHSC loan repayment
$535 million
Permits up to 8 hours per week of teaching to count toward service
obligation
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Oral Health
Provisions
Graduate
Medical
Education
Teaching Health Centers:
Teaching
Health
• Provides monies from the ACA “trust fund” for GME
payments of expenses for residency training in
Centers
primary and public dental health
• In FQHCs,$230
CHCs, rural million
health and mental health
clinics, IHS or tribal health centers, Title X clinics
• 11 grants totaling $12m through 2015
(1 dental grant at Penobscot in Bangor, ME)
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What is the Future of
Health Care Reform?
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Legislative Challenges to
the ACA
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Legislative Challenges
January 2011: GOP-controlled House votes to
repeal health care reform law
-All Republicans vote to repeal
-All Democrats, except 3, vote against repeal
January 2011: Senate votes against repeal on party
line vote
January 2011: House votes to direct four (4) of its
committees to draft a health care law to replace
the one repealed; no time frame
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Legislative Challenges
House leadership committed to repealing health
care reform law in long term
February 2011: House attempts to defund law
through appropriating funds (Continuing
Resolution and appropriations process) for
federal agencies and programs
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The Super Committee
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The Super Committee
ADEA Wrote the Super Committee and Requested Continued
Support and Funding for:
 Title VII Health Professions Programs of the Public Health
Service Act
 Postdoctoral residency programs for health professionals
through Medicare GME
 Biomedical Research (National Institutes of Health and National
Institute of Craniofacial Research)
 The Medicaid Program
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Unfunded Provisions of
the ACA
• Five (5) year, national public oral health education campaign
focused on prevention and education
• Oral health infrastructure – cooperative grants to develop oral
health leadership; build oral health data systems; implement
dental sealants and water fluoridation
• Demonstration grants for research-based dental caries disease
management activities and alternative workforce models
• Grants for school-based dental sealant programs in all 50 states
Information current as of 10/1/2011
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Legal Challenges to
the ACA
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Legal Challenges to
the ACA
Legal questions will ultimately be decided
by the Supreme Court:
• The issue of the individual mandate for health
insurance is the primary focus of the legal challenges
• 28 states, several private groups, and as many as 26
separate lawsuits have been filed related to the ACA
• Five (5) District Court decisions have been appealed to
various U.S. Courts of Appeals
• The outcome of these challenges has yet to be
determined
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Legal Challenges to
the ACA
• There was August decision by an 11th Circuit three-judge panel
that found the individual mandate provision of the Affordable
Care Act (ACA) unconstitutional
• If the Supreme Court were to take up the ACA challenge in the
term that begins in October 2011, a decision would be expected
no later than June 2012
• In addition to the 11th Circuit decision, the 6th Circuit Court of
Appeals has upheld the law, and the 4th Circuit Court of
Appeals has ruled that people who would be affected by the
mandate can't sue until after the mandate actually goes into
effect in 2014
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The Future of
Health Care Reform
The prescription for “universal health care” was thought to
be the enactment of the ACA, but its future has yet to be
determined
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THANK YOU
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