Health Care Reform and Health Care Reform and Oral Health: What’s New?Oral Health: What’s New?

American Public Health Association

October 31, 2011

Washington, D.C. 20001

The Dental Education Perspective

Presented byPresented by

Richard W. Valachovic, D.M.D., M.P.H.

Executive Director

American Dental Education Association

“The Voice of Dental Education”

2Information current as of 10/1/2011

Presenter DisclosuresPresenter Disclosures

The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

Richard W. Valachovic

No relationships to disclose.

Agenda:Agenda:The Education PerspectiveThe 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 LawThe ACA Becomes Law

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BackgroundBackground

• 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 ProvisionsOral Health Provisions

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Oral Health ProvisionsOral 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 ProvisionsOral 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 ProvisionsOral 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 ProvisionsOral Health ProvisionsNational 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 ProvisionsOral 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.”

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Opportunities to Create a Diverse Opportunities to Create a Diverse Workforce While Addressing Workforce While Addressing

Access to CareAccess to Care

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Oral Health ProvisionsOral Health ProvisionsPrograms increase minority representation in the healthprofessions. 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 DiversityOral Health Workforce Diversity

Percent of Practitioners

Percent of 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 ProvisionsOral 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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Health Care WorkforceHealth Care Workforce

National Center for Health Workforce Analysis

$7.5 million

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National Center for Health Workforce Analysis:

•Collect and analyze national data, identify and analyze workforce trends and support health workforce research

•Develop data collection guidelines and create a comparative state data registry

Oral Health Provisions

Information current as of 10/1/2011

Oral Health ProvisionsOral Health Provisions

National Health Service Corps

$535 million

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National Health Service Corps:

• ACA “trust fund” provides $535m, NHSC received $315m in 2011

• FY 2011 funded by $295 million from “trust fund” after Congress enacted $117m discretionary cut

• Permits part-time service to qualify for NHSC loan repayment

• Permits up to 8 hours per week of teaching to count toward service obligation

Information current as of 10/1/2011

Graduate Medical EducationGraduate Medical Education

Teaching Health Centers

$230 million

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Teaching Health Centers:

• Provides monies from the ACA “trust fund” for GME payments of expenses for residency training in primary and public dental health

• In FQHCs, CHCs, rural 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)

Oral Health Provisions

Information current as of 10/1/2011

What is the Future of What is the Future of Health Care Reform?Health Care Reform?

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Legislative Challenges to Legislative Challenges to the ACAthe ACA

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Legislative ChallengesLegislative 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 ChallengesLegislative 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 CommitteeThe Super Committee

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The Super CommitteeThe 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 Unfunded Provisions of the ACAthe 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

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Legal Challenges to Legal Challenges to the ACAthe ACA

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Legal Challenges to Legal Challenges to the ACAthe 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 Legal Challenges to the ACAthe 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 The Future of Health Care ReformHealth 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 YOUTHANK YOU

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