1. Health Care Reform and Oral Health: What’s New? American Public Health Association October 31, 2011 Washington, D.C. 20001 The Dental Education Perspective

2. Presented by Richard W. Valachovic, D.M.D., M.P.H. Executive Director American Dental Education Association “The Voice of Dental Education” 2 Information current as of 10/1/2011

3. Presenter 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.

4. 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 4 Information current as of 10/1/2011

5. The ACA Becomes Law 5 Information current as of 10/1/2011

6. 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” 6 Information current as of 10/1/2011

7. Oral Health Provisions 7 Information current as of 10/1/2011

8. 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 8 Information current as of 10/1/2011

9. 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 9 Information current as of 10/1/2011

10. 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 10 Information current as of 10/1/2011

11. 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 11 Information current as of 10/1/2011

12. 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.” 12 Information current as of 10/1/2011

13. Opportunities to Create a Diverse Workforce While Addressing Access to Care 13 Information current as of 10/1/2011

14. 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 14 Information current as of 10/1/2011

15. Oral Health Workforce Diversity Percent of Practitioners Percent of Faculty African American3.4%3.7% Hispanic3.4%6% Asian/Pacific Islander6.9%12.7% American Indian.12%.34% White86.2%75% 15 Information current as of 10/1/2011

16. 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 16 Information current as of 10/1/2011

17. Health Care Workforce National Center for Health Workforce Analysis $7.5 million 17 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

18. Oral Health Provisions National Health Service Corps $535 million 18 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

19. Graduate Medical Education Teaching Health Centers $230 million 19 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

20. What is the Future of Health Care Reform? 20 Information current as of 10/1/2011

21. Legislative Challenges to the ACA 21 Information current as of 10/1/2011

22. 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 22 Information current as of 10/1/2011

23. 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 23 Information current as of 10/1/2011

24. The Super Committee 24 Information current as of 10/1/2011

25. 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 25 Information current as of 10/1/2011

26. 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 26 Information current as of 10/1/2011

27. Legal Challenges to the ACA 27 Information current as of 10/1/2011

28. 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 28 Information current as of 10/1/2011

29. 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 29 Information current as of 10/1/2011

30. 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 30 Information current as of 10/1/2011

31. THANK YOU 31 Information current as of 10/1/2011