Friday Federal Roundup: CBO, CHIP, and More

As a partner to states and the largest Medicaid / CHIP dental benefits administrator in the country, we at DentaQuest must stay updated on the latest health care policy trends - in large part because anything in the health space affects the oral health space.

Recent federal health reform proposals could have significant implications for Medicaid programs, exchange populations, and oral health coverage for low-income families. We keep our employees apprised of the latest happenings in Washington D.C. with weekly federal newsletters, and thought this week was particularly relevant for more than our staff.

Here’s this week’s newsletter.

CBO Releases Report on Subsidies 

According to a report released earlier this week by the non-partisan Congressional Budget Office (CBO), insurance premiums for ACA plans would rise 20 percent next year and in some areas of the country, people would not have any insurance options if the Trump administration scraps key ACA subsidies. Trump has repeatedly threatened to pull the ACA subsidies, particularly since Congress failed to pass repeal and replacement legislation before the summer recess. CBO’s analysis also found that eliminating the payments would increase the federal deficit by $194 billion over a decade because of higher spending on premiums subsidies. Trump must decide by early next week whether or not to make next month’s payment.

Congress Turns Attention to CHIP

Funding for the Children’s Health Insurance Program (CHIP) expires September 30th. With Congress out on recess, this leaves few legislative working days to ensure that nearly 9 million children maintain their medical and dental coverage. While CHIP reauthorization has historically been a bipartisan issue through the years, the hotly-contested debates over ACA repeal and replacement have left state officials anxiously awaiting assurances from Capitol Hill that 2017 will be no different. We will continue to monitor federal discussions on the future of CHIP and advocate where possible for the vital inclusion of dental coverage in reauthorization efforts.

Trump Administration Encouraging Medicaid Redesign Efforts, State Innovation

As Congress takes a pause on repeal and replacement efforts while they are on recess, states are looking to the Trump administration in the interim for more regulatory flexibility. CMS is expected to soon approve a Medicaid waiver from Kentucky which among other things would require most Medicaid-eligible adults to work as a condition of receiving coverage. Arizona, Arkansas, Indiana, and Maine are considering similar work requirements. HHS Secretary Tom Price and CMS Director Seema Verma have both expressed that they are in favor of such Medicaid redesign proposals.

Last month Alaska became the first state to get increased flexibility from the administration to prop up its individual marketplace with a reinsurance program. Minnesota, New Hampshire, Oklahoma, and Oregon are some other states that have already filed or are considering similar waiver proposals to submit to CMS.

HHS Proposes to End Obama-era Payment Programs

HHS Secretary Price has announced plans to eliminate two Obama-era Medicare bundled payment programs and scale back on a third. This proposal would cancel initiatives that make hospitals more accountable for the cost of certain joint replacement surgeries and cardiac care, and shrink an existing program covering hip and knee surgeries. This is considered a victory for providers who oppose requirements to participate in new payment models. We will continue to monitor whether or not HHS will take further action to roll back requirements in order to slow down the transition to value-based reimbursement structures.

Congress: Protect Access to Dental Health Care

As the Senate debates health care bill proposals to transform our care delivery and financing systems, we must ensure they protect access to dental coverage for all Americans.

Over the past few years, more and more Americans have been able to access affordable dental coverage. In fact, since 2000, the percentage of children without dental coverage has been cut in half.

Medicaid has played a critical role in this progress. Dental services are considered an essential part of the Early Periodic Screening, Diagnostic and Treatment (EPSDT) program, which ensures that children receive regular dental care. Adults have also benefited in recent years, with 5.4 million adults gaining coverage through Medicaid expansion.

Other public programs have also helped. Because pediatric dental benefits are considered an essential health benefit on the exchanges, more kids have coverage. Further, many adults have selected dental coverage through the marketplaces.

As more of us gain access to coverage, we see the rate of untreated decay declining among low-income children, and research shows that costly emergency department visits for dental-related issues have declined. These improvements are in large part attributable to the fact that more people have access to dental coverage.

Over the past several months – continuing this week and for likely the near future – Congress has explored various avenues for health care reform. The value of oral health care and dental coverage cannot be overlooked in these conversations.

Let’s not overlook that tooth decay remains the most chronic condition among children, which can affect school performance and attendance.

Additionally, optimal oral health is not simply a goal in itself, but is vital to creating healthier communities. Research has shown that tooth decay can result in an elevated risk for diabetes, heart disease, and stroke. What’s more, recent studies demonstrate that treatment of gum disease can lead to better overall health management—as evidenced by lower health care costs and fewer hospitalizations—among people with common health conditions like those mentioned above or even pregnancy.

Any health care reforms must ensure dental remains a priority.

By improving access to dental coverage for low-income families in the past few years, we as a nation have made tremendous strides to

• ensure children are well-positioned for a lifetime of optimal health;  

• decrease poor quality, high-cost emergency department visits for dental-associated issues; and

• improve the oral and overall health of vulnerable populations.

We hope Congress pursues solutions that protect these improvements.

Dental Coverage has Bipartisan Support among Voters

As the new Trump Administration and Republican Congress begin their work this month, they will have the opportunity to advance conservative priorities through major legislative changes. At the top of their list is repealing the Affordable Care Act (ACA), which will have implications for the dental health and overall health of many Americans.

ACA replacement proposals from President-elect Trump, Speaker Paul Ryan, and the nominee for Secretary of Health and Human Services Rep. Tom Price should signal major changes forthcoming to the health care industry.

The ACA’s Medicaid expansion, essential health benefits, and exchange provisions have increased access to dental care for both children and adults. While the future of these elements is uncertain, we at DentaQuest want to ensure that replacement proposals do not jeopardize this important access to oral health. We’ve made great strides in eliminating barriers to dental coverage for millions of Americans who gained access through the ACA.

As policymakers consider different replacement plans, the role of oral health must remain a priority. 

In a recent survey of 2,000 registered U.S. voters conducted by DentaQuest via Morning Consult, the inclusion of dental coverage in public programs received widespread support from voters of both parties.

The survey showed that:

• 83 percent of respondents think dental coverage should be a part of Medicare
• 83 percent of Republicans agree
• 86 percent of Democrats agree
• 81 percent of Independents agree
• 73 percent of respondents believe dental coverage should be a required benefit in Medicaid
• 64 percent of Republicans agree
• 82 percent of Democrats agree
• 71 percent of Independents agree

Dental coverage is not currently included in Medicare, nor is it a required benefit for adults in Medicaid. A full repeal of the ACA could compound oral health access issues by eliminating Medicaid expansion and the exchanges— two important sources of affordable dental coverage.

Research continues to show a connection between oral and overall health. Dental coverage is a critical first step to improve both oral and overall health outcomes, reduce persistent health disparities, and contain systemic costs.

As policymakers seek to improve our existing health care system, oral health must be a part of the solution. 

It is clear: Dental coverage has demonstrated itself to be a bipartisan priority for the American public. As we enter a 2017 legislative session with significant health care policy changes on the agenda, dental coverage must also remain a priority for Congress.


The full survey conducted by DentaQuest and Morning Consult will be released in 2017.

Advocacy Efforts Encourage U.S. Treasury to Address Pediatric Dental

Earlier this month, the U.S. Department of Treasury released a proposed rule clarifying that pediatric dental benefits should be part of the calculation for marketplace tax credits. If implemented, this rule will be a major victory for low-income families in need of access to affordable dental coverage for their children.

Pediatric dental coverage is one of the 10 essential health benefits for marketplace plans that are subsidized based on income level under the Affordable Care Act (ACA).

Unfortunately, the cost of pediatric dental coverage is often not included in the total subsidy amount that roughly 85 percent of those purchasing coverage through the marketplace receive to help pay for the total cost of coverage for their family.

Without the full subsidy to cover all 10 essential health benefits promised under the ACA, many families struggle to get access to dental coverage for their children.

And Congress noticed.

A few months ago, Sen. Debbie Stabenow (D-Mich.) took the lead with a group of Senators who co-signed a letter urging the Treasury to make sure that the advanced premium tax credits under the ACA accounts for the cost of pediatric dental benefits.

The National Association of Dental Plans (NADP) and Delta Dental Plans Association (DDPA) led a coalition of organizations, including DentaQuest, to garner support for Sen. Stabenow’s efforts on this issue.

So, what’s changed for pediatric dental benefits?

The latest proposed rule ensures pediatric dental is included in the subsidy calculation for all families. 

Once finalized, this rule will mean that more families have the financial support they need to get the coverage they need to #ExpectOralHealth.

Industry advocates resoundingly supported the announcement. The American Dental Association (ADA), the Children’s Dental Health Project (CDHP), DDPA, and NADP released a joint press release applauding it.

And Sen. Stabenow said:

“For young children, early dental care is especially important, and this decision will help make dental coverage more affordable for families in Michigan and across the country.”

As policies aimed at improving access and affordability continue to evolve, it is equally critical that they are implemented effectively. We are pleased to see the Treasury Department taking steps to ensure that low-income children get access to the dental coverage they need to lead productive, healthy lives. 

As health care continues to undergo significant changes, oral health is too important to be forgotten.