Tuesday, March 30, 2010

The Health Care Bill

Hey all,

I am so sorry about Friday. I know all of you are all waiting for my blog, with baited breath, on Fridays.
I took the day off to go on a field trip with my 6-year-old Noah.
I got half of the blog written but.....

I had something in mind for today, but with the whole Health Care bill thing brought up, I decided to change gears.
One thing before the blog.
Last week I wrote about Brican. The last thing I wrote in the Brican blog was about my financial adviser. Remember he was kidding around about his advice about skinning his knee, and I was kidding around and calling him a bad name. Well, it was kind of the tone of the blog entry, you know my attitude toward the whole thing. This is not how I truly feel about him.
I will tell you about our relationship.
I love this guy. I love how he does business. I love how he has treated me and my family and my business for the last 14 years. I apologize to him and his peeps if I ever gave the impression that I didn't appreciate his knowledge and advice.

Okay Health Care bill.
I have told you in the past that I am not politically savvy. I won't even pretend to be. But I wanted to have someone that is in the know about things like this.
So I asked Vinny Mayher DMD, MAGD (who I think is a pretty smart cookie and knows something about politics), the past president of the AGD to write for us a blog that tells us what he knows about the bill.
So without further ado....

Okay, I admit it. After years if THINKING I understood the legislative process, I am crying “uncle.” Having spent dozens of hours trying to read and understand the healthcare legislation, it is time to humbly admit that I really don’t know how, for sure, it will affect me.

Unlike the vast majority of individuals, dentists are potentially affected by this legislation in three separate ways: First, as healthcare providers, how does it affect us in the delivery and care of our patients, if at all? Second, as small business owners, is this legislation a help, a hindrance, or a nonentity when it comes to the bottom line of our practices? And, third, as individuals and family members, will this legislation deliver better quality healthcare to ourselves and our loved ones?

Having read all the bills including the CBO report of these bills, (Yes, I really don’t have a life), the best description I can use would be a modification of the age old “peeling back an onion" analogy; only one has to jump from one onion to another as facets of these bills change or as interpretations change.

I did breathe a sigh of relief when I read that the reconciliation bill; and its mandates did not subject small businesses with fewer than 50 employees to the mandate to provide health coverage or pay a fine. The House bill used a payroll amount of $500,000 as the yardstick. Clearly, some dental practices would exceed that and be subject to the requirements if that qualifier was enacted.

Providing dental coverage for all children is a good thing in concept. But, how this fits into the insurance “exchange” is rather confusing. Initially, stand alone dental plans, such as the Delta’s, were not included in this exchange. This would mean that children’s dental coverage would be managed by medical plans. Does this sound scary to you?

I personally asked my Congressman to make sure dental plans are stand-alone ones. He assured me that he would try to implement this. Depending on what you read, stand alone dental plans were allowed into the exchange. But, I’m still not sure how and, to what extent, this will happen. And, will these plans dictate how we will treat these children? We all know the answer to that. Dental plans were excluded from the so called, “Cadillac tax.”

The American Dental Association rallied its members to lobby their Congressman against this legislation mainly because it does not increase funds for dental Medicaid. In my opinion, this says a whole lot about the Congressional priorities. While there are all sorts of “feel good” measures for dentistry such as increased finding for Title VII dental residencies, (something we have been lobbying for about a hundred years!), and all sorts of special commissions, grant programs, and the like, by and large, dental care has been given a minuscule piece of the apple.

Which leads me to the point, is it a bad thing that dentistry is not “in the cross hairs” when it comes to healthcare reform? Should inclusion be a legislative priority? I guess if you feel that government has all the answers to dentistry’s needs, then your answer would be “yes.” If, however, you are of the “point that thing somewhere else” mindset, you can breathe easy.
For example, if the concept of midlevel providers concerns you, then there is a “bad news/good news” reality in this bill. Bad news: the bill creates a “demonstration program” to train and employ “alternative dental health care providers.” Good news: they are only allocating 4 million dollars for this program. Given the billions of dollars spent in this bill this is a pittance. Even the ADA has committed many times this amount in its furtherance of their “Community Dental Health Coordinator” midlevel provider program. So, I wouldn’t be expecting an army of midlevel providers marching down your street any time soon.

So, as general dentists “in the trenches,” what do we do now? For one thing, we can stay as informed as possible. This is not easy. Given all the complexities of this bill and possible future interpretations, it will be like playing on a basketball court during an earthquake!
One thing for sure, something’s coming down the track. We don’t know exactly what. And, we don’t know exactly when. For now, we need to continue to support AGD and ADA advocacy efforts through the AGD’s Advocacy Fund and ADPAC.

I won't say anything. I will let you marinate on this.
If you have any questions or comments, we welcome them.
Have a great Wednesday.

john (and vinny)


Michelle Fratamico said...

Hello all,

We just wanted to note that the AGD's lobbyists have prepared a summary of how the health care reform legislation will impact general dentists and small business owners.

It is available on AGD's web site at http://www.agd.org/files/webuser/website/advocacy/healthreform2010.pdf.

Michelle Fratamico
Manager, Government Relations
Academy of General Dentistry

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