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American Dental Education Association


Volume 3, No. 8, July 18, 2023

House Begins Health and Education Funding Debate
 
The U.S. House of Representatives’ Appropriations Subcommittee on the Departments of Labor, Health & Human Services (HHS), and Education (ED) funding held its markup of the fiscal year (FY) 2024 bill last week. The Subcommittee Chairman’s recommendation, which was not changed, calls for an overall reduction in HHS programs by $17.4 billion (14%) from the current fiscal year and a $22.5 billion (28%) reduction in ED programs.
 
Programs affecting higher education that are of interest were not spared from cuts. The bill proposes no increase in the maximum Pell Grant for the first time in over a decade. It also proposes the elimination of funding for the Federal Work-Study program, affecting 660,000 students, and the elimination of Research and Development Infrastructure Grants for historically black colleges and universities, tribal colleges and universities and minority-serving institutions.
 
For HHS, the bill proposes the following:
 
 • Eliminate the Agency for Healthcare Research and Quality;
 • Provide no funding for the Health Careers Opportunity Program or Centers of Excellence;
 • Cut $700 million in funding for the Health Resources and Services Administration, the agency that administers the Oral Health Training Program; and
 • Reduce funding for the National Institutes of Health by $2.8 billion.

One ray of sunshine is that the recommended funding for the National Institute for Dental and Craniofacial Research was not cut below the current year’s level. The recommended amount is $520.2 million, however, ADEA and its dental association partners are requesting the appropriation of $558 million in FY 2024.
 
The next step for the House bill will be a full Appropriations Committee markup, possibly as early as next week. After that, ADEA AGR will provide additional details about all program funding.
 
The Senate Appropriations Committee has not announced a schedule for consideration of its version of the bill as of yet.

Biden Administration Limits Duration of Short-term Health Insurance
 
The Biden administration issued a proposed rule [ [link removed] ] that limits short-term health insurance plans to four months. In the Affordable Care Act (ACA), short-term health insurance plans were initially limited to a three-month duration. This was followed by the Trump administration lengthening their duration to up to 36 months. These plans were initially intended to provide stopgap coverage while individuals transitioned between health plans and not year-round coverage as some do.
 
Because of their short duration, these plans were exempted from most of the coverage requirements established by ACA. These plans are not required to provide comprehensive coverage benefits, such as dental coverage for children, prescriptions, mental health or maternity care, nor are they required to accept individuals with pre-existing conditions. These plans tend to have very limited coverage and, because of this, they are generally significantly more affordable than health insurance plans offered by employers or offered in the ACA Marketplace. Additionally, a 2021 report [ [link removed] ] by the National Association of Insurance Commissioners noted that short-term health insurance plans paid only 70% of the premiums in claims, lower than the minimum of 80% required by the ACA. Though these plans are not held to the ACA requirements, these numbers highlight the weak coverage that these plans provide.
 
In addition to rolling back the duration of short-term health insurance plans to four months, this proposed rule also clarifies that short-term policies can only last a total of four months, after which individuals would have to find a longer-term insurer. This provision is meant to stop insurance companies from continuously “renewing” an individual’s four-month insurance plan.

Health Subcommittee Marks Up Dental Programs Reauthorization
 
Last week, the U.S. House of Representatives’ Energy and Commerce Committee’s Health Subcommittee marked up seventeen bills. Nine of the bills passed along ideological lines, while eight bills passed unanimously along bipartisan lines. Three bills were of interest to the dental community:
 
 •  H.R. 3843 [ [link removed] ] , the Action for Dental Health Act of 2023, introduced by U.S. Rep. Robin Kelly (D-Ill.), would reauthorize Section 340G of the Public Health Service Act for fiscal years 2024 through 2028. This program provides support for the dental health workforce, and it is one of the few bills that was passed with unanimous bipartisan support. The final vote was 27 to 0.
 •  H.R. 3887 [ [link removed] ] , the Children’s Hospital Graduate Medical Education (GME) Support Reauthorization Act of 2023, introduced by U.S. Rep. Dan Crenshaw (R -Texas), would reauthorize payments to children’s hospitals that operate Graduate Medical Education programs for fiscal years 2024 through 2028. However, the bill also prohibits Children’s Hospital GME program funding from going to children’s hospitals that offer “gender affirming care” to minors, including surgeries, hormone therapy and puberty blockers. Thus, those hospitals would not receive federal funding for their GME slots, which in turn would adversely impact pediatric dental residencies. The final vote was 15 to 12.
 •  H.R. 4420 [ [link removed] ] , the Preparedness and Response Reauthorization Act, introduced by U.S. Rep. Richard Hudson (R-N.C.), would reauthorize current programs to support public health security and all-hazards response, including Strategic National Stockpile (SNS), Biomedical Advanced Research and Development Authority (BARDA) and Public Health Emergency Medical Countermeasures Enterprise (PHEMCE). The bill also includes provisions aimed at enhancing transparency across the agencies, supporting targeted research into certain medical countermeasures and streamlining emergency response authorities. ADEA, along with other oral health partners, is advocating to have dentists and dental students automatically included in this bill as part of future emergency medical responses. The final vote was 16 to 12.

While H.R. 3843, the Action for Dental Health Act of 2023, was very helpful and supportive of the oral health community, H.R. 3887, the Children’s Hospital GME Support Reauthorization Act of 2023, has the potential to significantly harm dentistry. According to Health Resources and Services Administration [ [link removed] ] , in the academic year 2021 -2022 , there were 516 Children’s Hospital GME-funded advanced dentistry residents, including 415 pediatric dentists, 24 advanced general dentists and 23 pediatric orthodontists. The language in H.R. 3887 puts these GME-funded slots at risk.

North Carolina Debates Changes to Licensure Reciprocity and Other Changes to Dental Practice Act
 
Legislation that would make significant changes to North Carolina’s Dental Practice Act is currently being debated by the state’s General Assembly. While both the House of Representatives and Senate have passed SB 382 [ [link removed] ] , the chambers have passed different versions.
 
Both versions of the bill do the following:
 
 • They require individuals seeking licensure as dental instructors to be affiliated with an accredited dental school for at least three years before getting licensed. The three-year requirement would be waived if the individuals only performed research at the dental school.
 • They make changes to licensure reciprocity laws by altering current law that requires the Board of Dental Examiners (Board) to issue a license by credentials to individuals who hold an instructor’s license. These bills would instead allow rather than require the Board to issue a license by credentials to anyone who holds an instructor’s license and who has been engaged in the teaching and practice of clinical dentistry for a minimum of 2,000 hours in the two years immediately preceding the date of an application.
 • They make changes to licensure reciprocity laws by altering current law to allow, rather than require the Board to grant a license by credentials to individuals who meet specified criteria that includes graduation from an advanced dental education program.
 • They permit the Board to allow individuals seeking licensure as dentists to complete a clinical skills examination on an approved alternative to an examination that involves a human subject, including manikin examinations.
 • They allow dental students at out-of-state schools to practice as interns or externs at specified facilities, such as long-term care facilities, federally qualified health centers and designated state or county-operated facilities, after providing proof to the Board that they had an agreement with a supervising dentist and permission from the dean of their dental school.
 • They require dentists who practice in multiple offices to display their dental license in their main office and their current renewal certificates in all other offices.
 • They allow the Board to discipline dentists who were unable to safely practice dentistry due to illness, substance abuse or physical or mental abnormality. The Board would be able to require licensees and applicants to submit to medical exams, as necessary.

The version of the bill that passed the House contains several provisions that are not included in the version that passed the Senate. The House version does the following:
 
 • It allows the Board to discipline dental hygienists who were unable to safely practice dentistry due to illness, substance abuse or physical or mental abnormality. The Board would be able to require licensees and applicants to submit to medical exams, as necessary.
 • It alters the types of facilities dental students are permitted to practice.
 • It eliminates a provision under current law that requires dentists connect to the state’s Health Information Exchange [ [link removed] ] .

 
The Senate has refused to agree to the amendments made by the House and a Conference Committee is currently working out the differences between the two bills. Both chambers must pass the same version before it can be sent to the governor.

Unified Health Care Financing Bill Moving Through California State Legislature
 
The California State Legislature is considering a bill [ [link removed] ] that if enacted, could eventually lead to a unified health care financing system. Under the bill, the Secretary of the California Health and Human Services Agency would be required to pursue discussions with the federal government to obtain a waiver that would allow the creation of a comprehensive health care system with unified financing.
 
Waiver discussions would be required to include the goal of creating a system that does the following:
 
 • It includes a comprehensive package of medical, behavioral health, pharmaceutical, dental and vision benefits.
 • It eliminates the distinctions among Medicare, Medi-Cal, employer-sponsored insurance and individual market coverage to the greatest extent possible;
 • It guarantees services that will not vary by age, employment status, disability status, income, immigration status or other characteristics.
 • It prohibits cost sharing for covered essential services and treatments.
 • It includes assurances that no individual will pay more than a specified percentage of their income on a progressive sliding scale for the cost of financing the health system.
 • It includes a rate-setting process that uses Medicare rates as the starting point for the development of final rates that avoid disruptions in the health care system and expand the availability of high-quality vital services by sustaining a stable, experienced and equitably compensated workforce. This process would also be required to include policies and payments to support those providers that serve a disproportionate percentage of low-income Californians and other disadvantaged communities.
 • It meets additional requirements established by the bill.

The bill has already passed the Senate, as well as the Assembly Committee on Health, and is viewed by some supporters as an incremental path [ [link removed] ] toward a single-payer model or something similar. Opponents of the legislation [ [link removed] ] have argued that a system created under the legislation would be untested and potentially expensive.

ADEA Advocacy in Action
This appears weekly in the ADEA Advocate to summarize and provide direct links to recent advocacy actions taken by ADEA. Please let us know what you think and how we might improve its usefulness.
 
Issues and Resources
 • ADEA report [ [link removed] ] on teledentistry
 • ADEA report [ [link removed] ] on the Impact of the COVID-19 Pandemic on U.S. Dental Schools
 • ADEA policy brief [ [link removed] ] regarding overprescription of antibiotics
 • For a full list of ADEA memos, briefs and letters click here [ [link removed] ] .

Key Federal Issues [ [link removed] ]

ADEA U.S. Interactive Legislative and Regulatory Tracking Map [ [link removed] ]

Key State Issues [ [link removed] ]

The ADEA Advocate [ [link removed] ] is published weekly. Its purpose is to keep ADEA members abreast of federal and state issues and events of interest to the academic dentistry and the dental and research communities.
 
©2023
American Dental Education Association
655 K Street, NW, Suite 800
Washington, DC 20001
Tel: 202-289-7201
Website: www.adea.org [ [link removed] ]

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B. Timothy Leeth, CPA
ADEA Chief Advocacy Officer
 
Bridgette DeHart, J.D.
ADEA Director of Federal Relations and Advocacy
 
Phillip Mauller, M.P.S.
ADEA Director of State Relations and Advocacy
 
Zachary Fessler
ADEA Program Manager for Advocacy and Government Relations
 
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