If attendance is any indication at a CDA Presents lecture on national health care reform, dentists are eager to learn more about the issue and its impact on their practices as well as employee and personal health coverage.
CDA Legislative Affairs Manager Nicette Short presented “National Health Care Reform: How Will It Affect Your Practice?” — a course designed to provide information about the Affordable Care Act and its potential impact on dentists, the oral health care delivery system and the dental benefits market — last month at CDA Presents in Anaheim.
“Health care reform will require most U.S. citizens and legal residents to have health insurance, which means 32 million additional people will gain coverage, mostly through private insurance offered through Exchanges and an expansion of Medicaid. This coverage must include pediatric oral health benefits,” said Short. “Reforms are being phased in with big things happening between now and January 1 when employer and individual mandates take effect and the online insurance marketplace becomes available.”
The implementation process that began with ACA’s passage in March 2010 continues today:
- dependent coverage for children until age 26;
- prohibits denial for pre-existing conditions for children;
- prohibits a lifetime dollar limit on coverage and canceling policies except for fraud;
- expands Medicaid; and
- tax credits for small businesses.
During the presentation, Short explained the key financing mechanisms of health care reform, which include:
- excise tax on medical device manufacturers and a 2.3 percent sales tax on medical devices;
- hospital insurance tax on earned income (more than $200,000 a year for individual filers or $250,000 a year for joint filers); and
- 3.8 percent tax on unearned income (more than $200,000 a year or $250,000 jointly).
Under the reform, there are five ways people can satisfy the individual mandate to purchase health insurance:
- accepting employer coverage;
- purchasing coverage in the individual or group market;
- purchasing coverage through the Exchange;
- government coverage – Medicare, Medicaid or Veterans Administration; and
- paying a penalty for not having coverage.
Approximately 20 million American households, between 133 to 400 percent of the federal poverty level, will qualify for subsidized insurance if they purchase through health benefit Exchanges. That translates to an income of up to $44,000 a year for an individual and $90,000 for a family of four. In addition, incomes below 133 percent of poverty level will be eligible for Medicaid benefits.
“The goal under ACA is to have people pay less than 10 percent of their income for their health insurance,” Short said.
Short added that CDA has advocated for pediatric oral health benefits to be included in the list of essential benefits that must be covered in order for plans to be certified and offered in the Exchanges and Medicaid state plans.
“It’s estimated that approximately one million more California children will get coverage under health care reform and pediatric dental benefits are included,” Short said. “The mandatory coverage does not extend to adults, but they will have the option of purchasing oral health care coverage in the Exchange in 2015.”
As an employer, mandates under ACA require businesses with more than 200 employees to enroll each employee in a health insurance plan that includes pediatric oral health benefits. Small businesses of less than 25 employees that offer health benefits to employees may be eligible for tax credits for at least two years.
As far as individual health plans, Short explained that there is much speculation without solid answers as to ACA’s impact just yet.
“Some insurers have indicated their premiums will increase in certain markets, possibly to accommodate for any losses they may have trying to compete in the new emerging markets,” said Short. “One Wall Street Journal article recently reported that one insurer announced at its annual investor conference that some market premiums could go up as much as 100 percent.”
Short cautioned that there are provisions in the ACA designed to curtail large rate increases, should they occur because the new law requires that independent experts and regulators review proposed increases to monitor if they are reasonable. In addition, medical loss ratio provisions instituted in the ACA require health plans to provide at least 80 percent of the premium revenue to actual patient care or provide rebates to consumers.
“While much is unknown about the impact on premiums, one study commissioned by California’s Exchange (Covered California) indicated families earning more than $90,000 a year are likely to pay more for their coverage,” said Short. “Low-income Californians who can’t afford insurance today will benefit the most, while many middle-income consumers will likely see lower rates.”
In addition to the potential impact on premiums, the ACA contains oral health prevention provisions, including school-based health centers in which half of the $30 million allocated has gone to California:
- oral health prevention education campaign;
- research-based dental caries disease management;
- school-based health center funding; and
- school-based dental sealant programs.
There are also oral health provisions in the ACA related to workforce, including $3 million to support oral health education programs that train future faculty in general, pediatric, public health or dental hygiene, which will increase training capacity in dentistry programs. Other provisions include:
- national health care workforce commission;
- HRSA competitive workforce grants;
- loan forgiveness programs; and
- workforce grants for alternative providers.
Short summarized the California Exchange Board’s critical policy decisions that still need to be made regarding dental benefits that will be for sale in the Exchange marketplace to ensure the patient-dentist relationship is maintained and that families have options when purchasing the pediatric dental essential health benefit.
CDA is actively engaged in discussions with the Exchange Board members and staff, Legislators and key stakeholders and will continue to support the development of access to dental coverage as the ACA is fully implemented.
For more information about the Affordable Care Act, visit the issues and policies page. You also can contact Nicette Short, MPA, CDA manager, legislative affairs at firstname.lastname@example.org.