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American Dental Education Association
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Volume 1, No. 37, November 4, 2019

Medicaid Expansion Likely Headed to Ballot in Oklahoma
 
On Oct. 24, organizers of a Medicaid expansion referendum in Oklahoma [ [link removed] ] claimed to have submitted more than enough signatures required for the initiative to appear on the 2020 ballot. The initiative would ask voters if the state should expand Medicaid to cover individuals who earn up to 138% of the federal poverty level as allowed under the Affordable Care Act.
 
Referendums have become a popular method for supporters to push for Medicaid expansion in states where it has not been implemented, as similar referendums have been passed in Maine, Nebraska, Idaho and Utah. A campaign for a Medicaid expansion referendum was also launched in Missouri [ [link removed] ] in early September, and the Missouri General Assembly [ [link removed] ] has begun exploring the issue as well.
 
To date, Medicaid eligibility has not been expanded in 14 states [ [link removed] ] .

Massachusetts Governor Calls for Dental Therapy in Wide-ranging Health Bill
 
In a wide-ranging health bill [ [link removed] ] filed with Massachusetts General Court, Gov. Charlie Baker (R) called for allowing the practice of dental therapy and implementing a value-based care model in the state. Under the Governor’s plan, licensed dental therapists would be allowed to practice under a collaborative agreement with a licensed dentist, if at least 50% of their patients receive coverage through MassHealth, or are considered “underserved” as defined in the bill. The 50% requirement would not apply if the dental therapist is operating in a federally qualified health center or a look-alike, community health center, nonprofit practice or organization or other public health settings as defined by the board of registration in dentistry by regulation, or as otherwise permitted by the board. Gov. Baker has supported dental therapy in the past [ [link removed] ] , but so far, his efforts to pass legislation that would allow the practice have not been successful.
 
Other issues [ [link removed] ] addressed in the bill are plans to increase spending on primary care and mental health services, implementing drug price controls and curtailing “surprise billing.”

Appropriations Bills Stall in Negotiations in U.S. Senate as Government Shutdown Deadline Draws Closer
 
The U.S. Senate is considering its versions of the 12 appropriations bills that fund the federal government that were passed by the U.S. House of Representatives. But there is a long way to go and a relatively short time to get there. The current government funding measure, the Continuing Resolution (CR), expires on Nov. 21. Either all bills must be completed and passed by then or another CR must be passed and signed into law—or the federal government will close.
 
The Senate passed a package of four bills on Oct. 31 by a vote of 84 – 9, demonstrating strong bipartisan support. But later that day, the senators failed to agree to proceed to debate regarding another four-bill package that includes the Labor, Health and Human Services, Education and Related Agencies bill that contains funding for the programs important to dental education. Senate Democrats insist that the two Houses must come to an agreement resolving the overall allocations to each subcommittee before the Senate proceeds to additional appropriations measures.
 
The sticking point in negotiations is the level of funding, or if there should be additional funding, for a wall at the U.S. southern border. President Trump requested an additional $8 billion in fiscal year 2020 for the project. The Senate Committee included $5 billion for the border wall, but the House bill provides no additional funding, saying there are enough funds to carry through the fiscal year. Democrats generally oppose the border wall policy.
 
How this will be resolved is unclear, but ADEA staff are closely monitoring the situation because of its potential to cause a shutdown of the federal government, interrupting biomedical research and halting the flow of expected grant funds.

House Republicans Unveil Their Healthcare Plan
 
The Republican Study Committee (RSC), the U.S. House of Representatives’ largest Republican caucus, released “A Framework for Personalized, Affordable Care,” a proposal [ [link removed] Health Care Plan - A Framework for Personalized%2C Affordable Care.pdf ] to overhaul the U.S. health insurance sector. The proposal would effectively replace the Affordable Care Act. Many of the ideas included in the proposal had previously been introduced by various Republican legislators. RSC noted that, though the proposal is supported by the White House, it is separate from the health care plan President Trump plans to unveil in the future. However, no release date for President Trump’s plan was given.
 
The Republican plan would center around block-granting Medicaid and give states the ability to determine benefit packages and the prices insurers can offer.
 
One contentious point between Democrats and Republicans in the health insurance debate centers on requiring coverage of pre-existing conditions. The Kaiser Family Foundation also recently published an analysis [ [link removed] ] that determines that 54 million people currently have pre-existing conditions. Under the Republican plan, states would have to require insurers to cover pre-existing conditions. However, the Republican plan does not provide guidelines controlling cost or plan benefit coverage. Therefore, though pre-existing conditions may be covered, the cost of health insurance for those with pre-existing conditions could be so high that it is unaffordable, and the benefits offered under such plans could potentially be limited.
 
To counter this argument, the Republican plan calls for states to establish high-risk pools to assist people with costly illnesses in affording coverage, but as also noted by the Kaiser Family Foundation, high-risk pools only work if they are well-funded and premiums are moderately priced.
 
The RSC’s proposal has not yet been introduced as a bill.

The House Education and Labor Committee Passes H.R. 4674, the College Affordability Act
 
Last week, the U.S. House of Representatives’ Education and Labor Committee held a three-day mark up of H.R. 4674, the College Affordability Act, the Higher Education Act Reauthorization. The bill passed [ [link removed] ] out of committee along partisan lines—28 Democrats voted for the bill and 22 Republicans voted against.
 
The partisan bill, introduced by the Democrats, would
 • Authorize $400 billion in spending,
 • Limit fees and paperwork associated with student loans,
 • Address predatory practices by for-profit colleges,
 • Block a Trump administration campus sexual assault and harassment rule,
 • Increase the value of Pell Grants by $625 to a maximum limit of $8,250 by 2029 and send funds to states to make two-year college tuition-free, and
 • Streamline multiple existing student loan repayment programs into just two plans—a fixed-payment plan and an income-contingent plan.

Details on how the new repayment programs will be administered were not included in the bill and will likely be left to the U.S. Department of Education’s discretion.
 
However, H.R. 4674 does not have the full support of the education community. Industry groups for colleges called the bill approved by the Committee a “mixed bag,” supporting the expansion of Pell Grants, but opposing how the measure favors two-year colleges.
 
The bill’s prospects for becoming law are slim, given that no Republicans on the House Education and Labor Committee voted in favor of the bill, signaling that Senate Republicans are also not likely to support the bill.

PLEASE NOTE: Today is Election Day for many state and local offices. Please exercise your civic duty to vote in your local elections. It is how "The Voice of Dental Education” is heard.
 
SAVE THE DATE: The 2020 ADEA Capitol Hill Day will be held March 17, 2020 in Washington, DC, at the conclusion of the 2020 ADEA Annual Session and Exhibition at National Harbor, MD. Registration information and more details will come within the next two weeks. Plan now to attend.

ADEA State Calendar [ [link removed] ]

ADEA Washington Calendar [ [link removed] ]

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

Key Federal Issues [ [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.
 
©2019
American Dental Education Association
655 K Street, NW, Suite 800
Washington, DC 20001
202-289-7201, 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
 
Phillip Mauller, M.P.S.
ADEA Director of State Relations and Advocacy
 
Brian Robinson
ADEA Program Manager for Advocacy and Government Relations
 
Ambika R. Srivastava, M.P.H.
ADEA/Sunstar Americas, Inc./Jack Bresch Legislative Intern
 
[email protected] [ mailto:[email protected]?subject=State%20Update%3A%20 ]

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