Healthcare Reform: Dental Care for All Children

An Expert Interview With Jack Bresch, MALS

Laird Harrison

March 16, 2011

March 16, 2011 — Editor's note: the medical aspects of the law that passed last year to reform the American healthcare system have attracted a lot of attention. Less well known are the implications for dentistry, yet these too are far-reaching.

A presentation focusing on the dental aspects of healthcare reform was featured at the American Dental Education Association (ADEA) 2011 Annual Meeting, held from March 12 to 16 in San Diego, California. Medscape Medical News interviewed presenter Jack Bresch, MALS, associate executive director of the ADEA. The following are highlights of the conversation.

Medscape: What provisions of the healthcare reform bill affect practicing dental professionals?

Mr. Bresch: It requires that health insurance plans include an oral health benefit for children up to the age of 21. So dental professionals who are seeing uninsured children will be affected because these children will now be insured, at least for basic and essential services.

A new Medicaid and Children's Health Insurance Program commission is supposed to look into a more equitable reimbursement for dentists when they are seeing children. There is no doubt that Medicaid severely underreimburses dentists and physicians. So that would be an impact.

There will be a 5-year national oral healthcare campaign focused on education and prevention. There are grants for sealants and water fluoridation.

And there are some tax provisions in there. One — the 1099 — would have a real impact. It required healthcare providers to keep track of any payment to a vendor that is more than $600, so it would have been a real administrative burden. There are other tax provisions.

There is an employer mandate, so dentists who don't offer health insurance to their staff are going to have to do it, if their staff is eligible.

Lastly, the healthcare reform bill provides demonstration projects with regard to alternative healthcare providers. The debate about midlevel providers is very hot and controversial in our community. Healthcare reform would provide $4 million over 5 years to test various models, including one proposed by the American Dental Association, one by the American Dental Hygienists Association, and one that came from Alaska — the Dental Health Aide Therapists program.

Medscape: How will dental educators be affected?

Mr. Bresch: Residency training programs, which are very important to dental schools, would no longer have to compete with medical residency grants. Also, some dental public health and dental hygiene programs are now eligible for training grants.

There is a new faculty loan repayment program. Dental students come out of school with a huge amount of debt. Any program that offers them debt relief is an attractive incentive. We were able to get a loan repayment program for faculty of a dental school; it's only for general and pediatric dentists who agree to serve as full-time faculty.

There is also a provision dealing with graduate medical education that allows the time that medical and dental residents spend doing scholarly activities to count for reimbursement [by the federal government].

There is a national healthcare workforce commission. Its goal is to provide comprehensive unbiased information to Congress and the Administration on how to align workforce resources with healthcare needs. If we have 32 million new people who are going to be insured under healthcare reform, who is going to take care of them? There is a shortage of primary care dentists. The membership on the commission includes dentists, dental hygienists, and other oral healthcare professionals.

Medscape: How was the ADEA involved in the legislation?

Mr. Bresch: Our main message was that any comprehensive reform of the US healthcare system had to provide universal coverage to Americans. And as part of the benefit package, we wanted oral health to be included. We felt like we were partially successful. There are some provisions that need to be modified, such as the 1099, but the majority are good ones. We regret that it wasn't universal coverage when it came to adults with regard to oral healthcare.

One of the goals we had was to raise the profile of oral health. Not very many members of Congress understand the importance of oral health. We felt that we, along with other groups, were successful in that.

Medscape: What are the prospects for implementation?

Mr. Bresch: Some of provisions we are interested in have already gone into effect, but the funding hasn't been authorized. Others go into effect in 2012, 2013, and 2014.

The House of Representatives voted to appeal the healthcare reform act. The Senate voted not to appeal, and the vote was along party lines. The Republicans are going to continue trying to repeal the healthcare reform law and, if they can't repeal it — and at the moment it looks like they won't be able to — then they are going to try to defund it. So we fight the appropriations battle this year, next year, and in the coming years.

Apart from the funding, the implementation goes to the Department of Health and Human Services. A lot of the rulemaking that implements these provisions is important to the outcome as well.

Healthcare reform is also in the courts. Two judges have upheld the individual mandate and 2 judges have ruled it unconstitutional. If the individual mandate is judged to be unconstitutional, it's like a house of cards — all of the other provisions will fall.

Mr. Bresch is an employee of the American Dental Education Association.

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