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CDS Member News and ArticlesProfessional News Articles : : ON PRACTICE MANAGEMENT by Janyce Hamilton : Possibility of Universal Healthcare spurs dental leaders to look, listen Possibility of Universal Healthcare spurs dental leaders to look, listenJanuary 22, 2009 Most private health insurance companies increase premiums annually. Estimates report that premiums increased an average of 87 percent between the years 2000-2006,1 or 12 percent per year.2 And coverage exceptions and limitations keep changing via “special notices” sent throughout the year. Income, however, is not rising proportionally to keep pace with insurance and the other costs-of-living increases. This is a situation that cannot continue indefinitely while maintaining the same numbers of insureds. The beginning of the year is typically the time when business owners must make tough choices: either tell employees they will have to pay a larger share of their medical benefit; or that effective immediately, their out-of-pocket deductible is going to be much higher; or announce that they now have a “new plan,” which they will learn is not improved (it costs less money). More and more Americans are dropping all but catastrophic coverage if not any type of plan, including dental, and saying “Hail Marys” that they won’t need emergency surgery, rehab or full restorative-type oral treatments. This trend of healthcare moving out of reach of the middle class has spurred discussion by the leaders of all healthcare professions. Leaders are beginning to ask some “What ifs?” Chief among them are what if the campaign promises of the advisors to the new president of guaranteed eligibility, that prescriptions can be purchased from across national border, and a new National Health Insurance Exchange begin to gel during the first term?3 Will a dramatically different form of national health care be proposed at a moment’s notice, then pass and be implemented in a way that directly affects small business owners such as dentists? Officers, administrators and the staff of three local dental organizations—the Chicago Dental Society (CDS), the Illinois State Dental Society (ISDS) and the American Dental Association (ADA) in Chicago—have been talking through their thoughts on the topic of universal healthcare. Below is some initial feedback provided by representatives of the tripartite group. Included is what might be coming down the pike, how dental business owners can prepare by staying informed, and whether it is too early or just the right time to make your voice heard loud and clear -- all the way to the White House. CDS News UpdatesThe good news is this: nothing has occurred yet in terms of the passage of legislation on universal health care. Thus, beyond this initial report, dentists are in a holding pattern.
News and future updates will be posted at www.cds.org. CDS will keep dentists abreast of any changes that impact insurance coverage in terms of dental services, and dental practice owners in terms of the economics of providing benefits to their employees. To make sure you keep receiving timely news, Will Conkis, Managing Editor, CDS Review, is pledging to provide information that is relevant to CDS members in the counties surrounding Cook in the CDS Review and on the Web site. ISDS Updates on State Medicaid Reimbursement Issues for DentistsISDS posts news of statewide impact at www.isds.org, where dentists find factual information on things that affect them, including Illinois legislation they may want to follow. ISDS, for example, is lobbying to increase Medicaid reimbursements through a program called Bridge to Healthy Smiles (www.bridgetohealthysmiles.com). ISDS is asking that the state increase funding for dental care. Greg Johnson, Director of Professional Services with the Illinois State Dental Society, commented, "Millions of indigent and working poor Illinois residents lack access to dental care because of extremely low government reimbursement rates.” Sufficient numbers of dentists throughout the state exist to treat all patients. The problem is inadequate funding for dentists to treat Public Aid patients. According to an ISDS spokesperson, with reimbursement rates at just 46-cents on the dollar, it puts dentists in the red. If funding were to be increased, more dentists could afford to treat Public Aid patients. There is a diverse group of coalition partners including HeadStart, the Illinois Maternal and Child Health Coalition, the City of Chicago, the Chicago Community Oral Health Forum and several others that are concerned about access to dental care in Illinois, making Bridge to Healthy Smiles a grass roots effort to solve the dental care crisis in Illinois. Leaders from ISDS have identified areas throughout the state that have an access issue and as a result have put together a three-point legislative strategy to ultimately fill those dental care gaps:
This is a genuinely compassionate and humanitarian call for change that will benefit underserved patients. However, this is not about charitable giving by dentists. Bridge to Healthy Smiles aims to help dentists get fair compensation so they will not lose money through their participation. A component of the Bridge to Healthy Smiles program is the "incentive program." In part, this includes offering deferred compensation. This would operate similar to how state employees pay into their retirement plan. Instead of getting reimbursed by the state for treatment they would opt to have the reimbursement put into a deferred comp plan. There are other incentives too. Said Mr. Johnson: “A key part of our plan calls for allowing dentists to receive student loan forgiveness in exchange for working in underserved areas, and we are also pushing for the tax deferral program similar to the deferred compensation plan offered to state employees.” He filled in detail on the deferred compensation plan as follows: dentists who treat Medicaid patients will be allowed to defer payment from the state directly into an investment portfolio where the amount deferred and any earnings are not subject to federal or state income tax until they are withdrawn at retirement.
Mr. Johnson believes that something is going to happen with healthcare, some sort of policy change during President Obama’s administration. This could be in the works at this writing, but if so, details are yet to be released. ADA Gathering and Sorting Ideas Circulating Around Universal Health CareOn Capitol Hill, ADA congressional lobbyist James Paluskiewicz agreed with Mr. Johnson’s sentiment, and said that there are healthcare changes in every Congress, such as when the President signs the SCHIP bill this winter that will contain policy revisions. Beyond reforming existing programs (Medicaid, Medicare, SCHIP) as far as how the government and private insurance interact to provide coverage in a broader sense—the bigger schema known as “Health Care Reform” (capital letters added for emphasis) —is less certain. In the interim, all levels of organized dentistry are looking and listening for indicators as to what the changes might be. In accordance with its role set forth by the House of Delegates, the ADA is to protect its member dentists and their patients. Exactly what this will entail in terms of taking an active role in crafting—or opposing—healthcare reform efforts by those on Capitol Hill or in the Obama Administration has yet to be defined. Accordingly, there are yet to be formatted letters and the like for dentists to use to contact their legislators to express concerns or weigh-in on positions. This is only because there is no rough draft or loose language in the works that has been publicly released by the new presidential administration for dentistry’s leaders to react to. Universal healthcare or healthcare reform may not even happen. Insiders report that there are no bills currently in congress (that have a ghost of a chance of passing.) Mr. Paluskiewicz explained that it is easy to get confused because there are healthcare reform bills in congress already, but these are old bills – he same bills that get reintroduced year after year. Insiders say they don’t have a chance of passing, but that their sponsors are “wedded to them” so they keep introducing them. The universal care bills that are cycling through repeatedly are by Congressmen Pete Stark, John Dingell, John Conyers and others. No new legislation has been introduced; but with their attention-grabbing headlines, some of the news media outlets frame their stories to make it appear this is occurring. There are only written plans such as the Baucus proposal,4 which entails a broad proposal of reforms, much like other plans that float about. Things buzz at the DC, office, especially during a presidential inauguration year with a change of political parties. There, the phone calls are made and the visits are scheduled with lawmakers. In the next year or two, more frequent posting of updates on the ADA Washington Office’s lobbying efforts and legislative activities may become a necessity. For now, however, there is an almost eerie quiet. Things may be happening behind closed doors on Capitol Hill in terms on universal health care. During the quiet before the storm of activity, dentists may want to:
One thing is for sure, the staff members of the ADA’s government office have their ears to the ground. If something is learned about the initiation of formulating new health care policy, the Washington, DC, staff of the ADA will be ready to lobby for the creation of wording and principles that are in the interests of ADA members and their patients. And if anything bad for dentists is proposed? It would be lobbied against. With so much talk on the Hill and currently no actual legislation on the topic of healthcare reform, according to Robert Raible, Public Affairs Manager, ADA Washington Office, the ADA staff is currently engaged in contacting congressional staff and reviewing everything coming out of DC on this issue. Much of this collecting and sorting work requires sifting through the various plans and positions put forth by legislators and think-tank leaders of both political parties. Figuring out how the disparate pieces might fit together and how this will ultimately impact the practice of dentistry (and when) is in progress as you read this. ConclusionKeep in mind that the outcome of any universal healthcare reform is likely to affect primary care and benefit plan costs more so than those of dental care. This isn’t to say that there could never be a surprise (good or bad) to impact dentists in a big way; however, it is more likely that changes would hit the U.S. pharmaceutical or medical insurance industries. To be sure, “universal coverage” is a people-pleasing buzz phrase to appeal to voters. The unease comes from the growing din of people asking real-life questions: Does everyone have the right to access a physician and hospital-based care, not just the two groups: those who qualify for public assistance benefits and those who can afford private insurance and out-of-pocket medical costs? That is, where will the growing “working poor” sandwiched in between these two groups get healthcare, including dentistry? How would ensuring every person gets healthcare, which involves more federal and state funding be funded? (These are days when schools and hospitals await late state and federal payments.) And, if nothing is done and so health insurance premiums continue to double every seven years,1 will small-business owners begin to drop employee benefits? There’s a growing segment, which may include some new dental school graduates with substantial debt—whether from a red state, a blue state, or not into politics—who did not anticipate today’s inequity between income and expenses. Imagine a mother who told her daughter in 1980, “Marry a doctor, a lawyer or a dentist!” aghast to find herself eating those words—paying her daughter and dentist son-in-law’s monthly health insurance premiums 29 years later. “Just until I can switch us to a lower cost plan, mom,” he says. Wake up, it was just a nightmare. But stay informed about universal healthcare reforms so you know when to act so it never comes true. References
Janyce Hamilton is an award-winning Chicagoland freelance dental writer and editor. Send suggestions for topics to be covered, or any comments on this column, to review@cds.org. |
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