A Day in the Life

A Day in the Life

Edward J. Vigna, D.D.S.*:

There is something wrong with this picture. I’m writing this for the spring edition of your journal and still have the same snow and ice in my yard that has been there since Christmas. Sounds like just another typical Minnesota winter, but I’m from “down south”, and this has been anything but typical weather here in Nebraska!
Life at the ADA continues at a torrid pace as we continue to sort through some the internal issues facing the Association. I know the officers and ADA delegates have received an email from President-Elect Ray Gist giving you a general idea of what we are dealing with. I assure you that the business of the Association continues, and we will resolve the internal issues as expeditiously as possible.

Pew Foundation Report on Children’s Dental Care
The Pew Foundation has recently released their report entitled The Pew Children’s Dental Campaign - the Cost of Delay. In this report they graded each state from A to F on a list of criteria mentioned below. Receiving a C, as Minnesota did, indicates you met at least four of their eight criteria. Reading the report and listening to individuals from Pew, as you would imagine, I find areas of agreement and an equal number of questions. According to Pew, an estimated 17 million low-income children in America go without dental care each year. This represents one out of every five children between the ages of one and 18 in the United States. The problem is critical for these kids, for whom the consequences of a “simple cavity” can escalate through their childhood and well into their adult lives, from missing significant numbers of school days to risk of serious health problems and difficulty finding a job. Most low income children nationwide do not receive basic dental care that can prevent the need for higher cost treatment later. States play a key role in making sure they receive such care.

Pew assessed and graded all 50 states and the District of Columbia, using an A to F scale, on whether, and how well, they are employing policy approaches at their disposal to ensure dental health and access to care for disadvantaged children. These policies fall into four groups:
• Cost-effective ways to help prevent problems from occurring in the first place: sealants and fluoridation
• Medicaid improvements that enable and motivate more dentists to treat low income children
• Innovative workforce models that expand the number of qualified dental providers
• Information: collecting data, gauging progress, and improving performance
Only six states merited A grades: Connecticut, Iowa, Maryland, New Mexico, Rhode Island, and South Carolina. These states met at least six of the eight policy benchmarks - that is, they had particular policies in place that met or exceeded the national performance thresholds. South Carolina was the nation’s top performer, meeting seven of the eight policy benchmarks. Although these states are doing well on the benchmarks, every state has a great deal of room to improve. No state met all eight targets, and even those with good policy frameworks can do far more to provide children with access to care. Thirty-three states and the District of Columbia received a grade of C or below because they met four or fewer of the eight policy benchmarks. Nine of those states earned an F, meeting only one or two policy benchmarks.

Here are the benchmarks:
1. If a state has sealant programs in place in at least 25 percent of high-risk schools.
2. If a state does not require a dentist’s exam before a hygienist sees a child in a school sealant program.
3. If a state provides optimally fluoridated water to at least 75 percent of citizens on community systems.
4. If a state meets or exceeds the national average (38.1 percent) of children ages one to 18 on Medicaid receiving dental services.
5. If a state pays dentists who serve Medicaid-enrolled children at least the national average (60.5 percent) of Medicaid rates as a percentage of dentists’ median retail fees.
6. If a state Medicaid program reimburses medical care providers for preventive dental health services.
7. If a state has authorized a new primary care dental provider, and
8. Surveillance System. If a state submits basic screening data to the national database - the National Oral Health.

At this point we need to analyze this report and continue to find areas of common ground, yet not ignore the areas where I/we have disagreement, and work to improve the outcomes no matter what grade one received. I feel strongly that we must always remain the voice for oral health care in this country. This report grades and evaluates the states and not the state dental associations, and we should get our fair share of credit and by no means shoulder all the blame for any shortcomings.

A Different Day
You know that saying, “What a difference a day makes”? Well, at least in a Senate race in Massachusetts! As you well know, ever since that day, health care reform has been in an even greater state on confusion. We are seeing some action, and by the time you read this, it may be different. Although we did not, and will not, support either the House or Senate package as they now stand, we did gain some ground in both of the existing bills. The President’s proposal appears to have no significant impact on the issues we have identified as important to the ADA, except the following:
• Consistent with the Senate bill, small businesses (fewer than 50 workers) would be exempt from any responsibility to contribute toward their employees’ coverage.
• It expands access to the data bank to quality control and peer review organizations and private plans that furnish items or services reimbursed by the federal health program.
• Dental and vision benefits would no longer be counted as potentially taxable under the high-cost plan excise tax (tax on “Cadillac” health plans). This is a real win for us - we were very active in a coalition that lobbied this issue.
• More federal funding for populations that are added to the Medicaid and CHIP roles due to the HC legislation.
• The medical device fee is dropped in favor of an excise tax to facilitate administration of the IRS.
The entire issue remains a moving target, and I assure you, the ADA Washington office will continue to follow the progress or lack thereof of this issue as it works its way through Washington, trying to achieve our goals for any reform legislation.

Landmark Legislation
During the last week of February, we enjoyed the results of a landmark piece of legislation. It was a nail-biter, but the House passed, by a 406-19 vote, H.R. 4626, which would repeal the McCarran-Ferguson antitrust exemption for health insurance companies. This overwhelming bipartisan margin provides great momentum for the bill as it heads to the Senate. The fact that House Republicans did not withhold support simply to deny the president a victory was a promising sign that the bill could face success in the upper chamber.

Although we cannot take all the credit for the passage of this bill, we did play a significant role. Thanks to all of you who responded to our action alert and sent your member of Congress a message. If your member was one of the 406 yes votes, please say thank you. A big thank you goes to Dr. Paul Gosar, an Arizona dentist who has pushed for some time for the ADA to make the repeal of this exemption a major part of our legislative agenda. Once it was decided that repeal of this onerous and unfair advantage, experienced by the insurance industry, would be part of our agenda, our Chief Legal Counsel put together a booklet that explained the facts of this 65-year-old law. This document was most instrumental in helping congressional staff and members understand the 1945 McCarran-Ferguson law. The ADA Washington office staff, along with dentist members, went to work and made a difference. I tell you all of this because it is a classic example of how ADA members and staff can work together and achieve positive outcomes. By the way, I mentioned how Paul Gosar pushed and pushed hard on this issue and made a difference. Well, Paul is running for the U.S. House of Representatives from his home district in Arizona. We need a bull dog like Paul when it comes to pushing for dentistry in Washington.

While on the topic of insurance, many states continue to wage the battle in their state legislatures against insurance companies being able to set fees for non-covered services.
• At this time, twenty-four states have bills addressing this issue.
• Nine have a recorded vote in at least one chamber of their legislature.
• Eight have passed (at least one chamber) with largely unanimous votes.
• One failed on a tie vote.
• One of the eight (Oregon) has completed conference committee action and appears to be prepared for the governor’s final action.

No one single issue has produced such a focused effort with respect to bill filings. With a bill in about one half of all the states in the country, dentistry has clearly made a point. The ability to set fees on non-covered services will negatively impact care in the long run. Few issues (possibly none) have had the clear and unabated support of the profession. This marketing scheme for insurers serves only their best interests.

Forward ...
I hope this brings you up to speed a bit on some of the critical external influences on the dental profession
and insight into how we are all working hard to preserve the profession. In my mind, no works harder and cares more than dentists. Together we will remain America’s leading advocate for oral health!

Always Available
As always, please contact me with your concerns and comments: vignae@ada.org or (402) 770-7070. n

P.S. I do have good news. I just heard a weather report, and the ice on my driveway will be gone by the Fourth of July.

*Dr. Vigna is the Trustee to the Tenth District of the American Dental Association, representing Iowa, Minnesota, Nebraska, North Dakota, and South Dakota.