Lobbying on Capitol Hill is one of the most unique activities that happens in Washington D.C. Each year, the House of Representatives and Senate write bills that are passed into law by the President. As the political climate in Washington regularly fluctuates, it is essential that constituents address issues with consistency. Two weekends ago, we saw this in action. Thousands participated in the Tibet National Lobby Day, AIDS Foundation Lobby Day and ADA Dental Lobby Day. All were welcomed and given the ears and time of their elected officials.

For the past two decades, the American Dental Association (ADA) along with the American Dental Political Action Committee (ADPAC) have advocated for the dental profession on Capitol Hill. They have ensured that core concerns that effect our profession, providers and patients are voiced to our legislators. This year, for the first time, the American Student Dental Association (ASDA) joined with the ADA and ADPAC to voice the current issues important to our profession together. We took the following issues to our legislators; The Competitive Insurance Reform Act, the Student Loan Programs under the Higher Education Act and Health Care Reform: Supporting Oral Health.  

This year, a week before our Lobby Day, we saw years of the ADA’s hard work pay off as the 115th House of Representatives voted a 428 to 6 majority on H.R. 372. This repealed the Mccarran-Fergussan antitrust laws for medical and dental insurance companies. Since 1945, insurance companies have been exempt from the McCarran-Fergussan antitrust laws which prohibits companies and business owners to discuss and set similar prices for their products and services. Greater federal involvement in antitrust enforcement should encourage more competition in the healthcare insurance marketplace. More competition will promote lower prices and greater consumer choices for all Americans purchasing medical and dental insurance. This week, we thanked members of Congress for supporting this bipartisan bill and urged our senators to support or even sponsor a sister bill so that it can be passed in the senate as well. 

Rising student debt for undergraduate and graduate students is a prevalent concern for many of us. This concern is being voiced on Capitol Hill.  In 2016, the average student debt for recent dental graduates was $262,119. That is a 5% increase of average dental student debt in 2014. The weight of student debt limits many graduates’ professional pursuits, especially those who want to serve in public service, teaching and research positions. As Congress reauthorizes the Higher Education Act this year, we continued to voice our concerns regarding student debt as we met with members of Congress. Currently, there is a sponsored bill, H.R. 1614, that would allow students to refinance their graduate student loans at anytime through out the life of their loan. This would make keeping our student loans with the federal government more appealing and could save graduates thousands on accruing interest. Currently, the interest rate is fixed for the life of the loan. This week we tried to gather more representatives support for H.R. 1614 so that it will pass when it reaches the House floor. 

Since the instatement of The Affordable Care Act (ACA) the uninsured rate for Coloradans has dropped from 14.7% to 6.7%. Additionally the recent medicaid expansion in Colorado, passed in May of 2013, expanded coverage to more than 200,000 Colorado residents. As a direct result we have seen the number of hospital dental visits go from $11 million dollars to $1 million dollars annually in Colorado. We want to continue this progress as the expanding coverage reaches many of our small towns in eastern Colorado and in the Western slope. This was emphasized to our representatives by our doctors who practice in these areas. As health care is a hot topic on Capitol Hill right now we also discussed the importance and need for dental insurance transparency. Our doctors from the CDA have seen many patients who sign up for dental insurance and find out they aren’t covered until they pay for 24 months of premiums. Overall, we advocated for more transparent dental insurance plans so that our patients know what they are purchasing and what to expect from us.   

During our Lobby Day we were able to visit all 6 of our district representatives and both senator’s offices to discuss the issues above. It was great to see the impact we could make on organized dentistry by voicing our concerns to our legislators! It made me proud that we are included in a profession that stands united in protecting and advocating for our patients and doctors!

Like many other dental students, I’m from a state that doesn’t have its own dental school. Unfortunately, this leads to a very high lack of access to care for the residents of my home state, New Mexico. When speaking to several members of the NMDA about issues that are impacting our state, the words “mid level care providers” and “dental therapists” inevitably pop up. My basic assumption of these words (which are one in the same) at the time was “a non-dentist” that can perform “dentist” duties. Those are scary words to hear as a dental student, investing hundreds of thousands of dollars and four years of my life, only to have the same job done by somebody who has only received a bachelor’s degree. I decided to dive a little further into the subject about the pros, cons, regulations, and education requirements surrounding the dental therapist…so here we go!

The Basics….  

• Dental therapists operate under a dentist’s license in an office or satellite clinics. Their basic duties vary depending on each state’s rules.
  • Scope of practice includes fillings, seating crowns, performing extractions, adjusting dentures, diagnosing radiographs, making treatment plans
• Dental therapists are currently practicing in Minnesota, Maine, and Alaska. There are different names for the profession popping up in legislature all over the country (including Colorado)
• Two types:
  • Dental therapist-
    • Requires a bachelors’ degree in Dental Therapy with several licensure and competency exams in order to practice. May perform some services under “indirect supervision,” which means a dentist must be on-site to authorizes procedures, or under “general supervision,” which means the dentist is off-site and must still authorize procedures.
  • Advanced dental therapist-
    • Dental therapy degree along with a masters’ degree in Advanced Dental Therapy which requires 2,000 hours of clinical practice and a certification exam. They may do all that a dental therapist can do, and also perform oral evaluations, treatment plans, and non-surgical extractions of teeth.
    • Practices under the supervision of a dentist, but all procedures can be completed under “general supervision.”

The Case FOR Dental Therapists…

• Contrary to what many believe, there isn’t a lack of dentists in certain “at need” states, rather a lack of distribution. This can be alleviated by dental therapists working at satellite clinics in rural areas addressing basic needs of the community without patients being forced to travel to far-away dental offices.
• They only perform routine care, so it opens up the dentist’s schedule to perform more complex care like endodontics, prosthodontics, and implantology, while still addressing basic needs of the office’s patient pool. This is viewed as a way to expand a dentist’s practice and maximize profit.

The Case AGAINST Dental Therapists…  

• It is a common opinion within the dental community that if Medicaid and insurance reimbursements didn’t drive practitioners to lose money on certain procedures, many more would practice in areas where fee-for-service dentistry isn’t the norm. Many dentists believe that more changes to Medicaid and insurance reimbursements need to be made in order to drive practitioners to “low income” areas.
• States should address access to care issues by reimbursing dentists who work in rural areas. Dental therapists have the ability to work on simple cases, but comprehensive care is the only way to effectively provide dentistry that is at the standard of care.
• The ADA believes that the “one-size-fits-all” model provided by dental therapists is not the best way to reach populations that live in rural communities.
• Dentists do not want their profession’s quality to be in jeopardy with the addition of therapists who are less educated in dentistry.

In the end, it is up to YOU as a dental professional to decide what is best for you, and most importantly, the patients in your home state. Being involved in your local ASDA and ADA chapter will make a difference whether dental therapists become a reality where you live.

I have never been the type of person to be on student government or run for positions that required any sort of political understanding. Needless to say my knowledge about what we would be doing at National Lobby Day in Washington D.C. was at a minimum. I was chosen to go and figured that I would take more of a backseat approach, learning what it was like to be involved with ASDA at the national level while watching the experts do the lobbying, but I would do much more than that.

Monday was our first day in D.C., and it was spent entirely at the hotel. We had lectures, meetings, and breakout sessions that were all meant to be informative and help us in our lobbying efforts the next day. The two specific bills that we would be lobbying for were the H.R. 539: Dental Health Act and the H.R. 649: Student Loan Refinancing Act. H.R. 539 would allow programs like the Mission of Mercy (MOM) and Give Kids a Smile access to readily available funds ($15 million) from the CDC that they were previously not able to apply for. H.R. 649 would allow students to refinance their loans in the future if the federal student loan interest rate were to dip below what they had previously borrowed it for.

The morning was a mix of presentations on the details of both of these bills, what to focus on when speaking to legislators, and some presentations by different sponsors. We broke for lunch, where I had the opportunity to sit and eat with students from the University of New York at Buffalo along with the president of the ADA, Dr. Feinberg. Our afternoon session consisted of more presentations, mock meetings with legislators, and concluded with speeches by two dentists (now state representatives) from Texas. With that we broke for the day and were on our own. We met briefly as a group to discuss our tactics when meeting with legislators the following day, and then we were off to dinner.

The next day was an early one, with the buses scheduled to leave at 7:15am and our first meeting at 8:30. We had a busy day planned with seven meetings in all, the last one coming at three in the afternoon. Our first meeting was with Cory Gardner’s office, a senator from Colorado. We spoke with his aid for a bit about the two bills that we were advocating for. He was very receptive to what we had to say and the meeting was more relaxed than I expected, which reminded me of most of my dental school interviews; nervous at first, but merely conversational once I had settled in. We were lucky enough to have Cory Gardner stop in for a few minutes and hear what we had to say, even telling us about his experiences with COMOM. The first meeting of the day went really well, and we were off to a good start in our lobbying efforts.

Since we felt that having all seven of us in each meeting was a bit of overkill, we decided to approach the rest of the meetings as smaller groups, mostly consisting of three or four people. Another reason for this approach was that we were constantly walking the whole day, from house to the senate, senate to the house: it was a workout to say the least. Splitting into groups allowed us more time between meetings to make sure we were not late. We had six meetings scheduled for the rest of the day: a senator from Colorado, two senators from New Mexico, and three representatives from Colorado. Of these six remaining meetings, five of them went really well while one seemed like a complete disaster. All in all it seemed to be a pretty successful day that ended around 3:30 and with us heading straight to the airport from the senate building, back on a plane to Denver a mere 52 hours after we had arrived.

If you’ve read this far and are thinking to yourself, “this sounds like too much work, I’d want to at least do some exploring of D.C.”, you probably aren’t friends with me on ‘Snapchat’. The Washington Monument, Lincoln Memorial, Vietnam Veteran’s Memorial, and the National Museum of American History: these were just a few of the sites we got to see in our limited time in Washington. If you do know me personally then you probably saw most of these as low quality pictures from around D.C., showing just how much fun I got to have along with how much I learned while at National Lobby Day. This is something I hope to convey to you if you haven’t been involved much with ASDA, and it doesn’t have to be at the national level, nor a huge commitment. I encourage you to get involved in local events because they are a great networking experience, informative, and fun! All I know is that I would not have done it any differently and I’m so thankful to have been able to go.

 

Dental Lobby Day comes but once a year. Dentists from various districts throughout the state come together to share their opinions with their respective state Senators and State Representatives concerning bills that relate to dental interests and trepidations. We, as students, are invited to participate in this event, as our opinions and shining young faces can influence the decisions of Senators and Representatives and their support of these bills. The list of bills that were the hot topics this year are listed at the bottom of this article.

For those you of you who have never partaken in the Lobby Day experience, let me give you a brief synopsis of how it works…

The Schedule

7:45 a.m. Arrive at the state Capitol. Pass through security screening and proceed to the basement committee room.

• After paying a slightly absurd amount to park for this brief event (you will get reimbursed) you arrive at the State Capital building and walk through the entry security screening at any of the main entrance doors. After wandering around aimlessly for a few moments, you finally locate the hidden elevators and go down one level to the basement, where you proceed to the committee room. You pick up your color-coded folder filled with a list of talking points, legislator handouts, lobby cards, a name tag, and various reference materials including a map of the capitol and “Face Book” packets containing pictures of all of the members of the Senate and House. You enjoy a light Panera-catered breakfast and mingle with some of the familiar faces present, such as our very own Dr. Sessa.

8:00 a.m. The CDA will provide message training to discuss issues and messaging, and ask any questions. Groups are divided by their geographical location.

• This is basically to discuss and inform us on the issues we will be lobbying, and give us the opportunity to ask any questions. Then, according to the color of our folders (they are arranged by geographic location of the districts) we are broken into groups with a team leader. For example, my yellow folder was for the East Metro region of Colorado, and Dr. Karen Foster was my team leader.

9:00 a.m. Follow your group and group leader to the 2^nd floor lobby. Work with your team leaders to discuss dental issues.

• Everyone then heads upstairs to the Senate and House floor, and this is where the real “lobbying” and excitement begins. Lobbying literally is just that; you send in a lobby card where you have written the name of your respective Senator or Representative to the nice gentleman/woman guarding the doors into the Senate or House, these cards somehow are magically delivered to that person, then they come out to the lobby to hear you give your passionate speech concerning the topic of these pressing dental issues.
• Our group was lucky enough to be invited onto the Senate floor! Last year, I met a Senator named Bill Cadman who is from my very own hometown of Whitefish, Montana. So, I wrote his name on my lobby card and before I knew it, Senator Cadman was walking out the door holding my lobby card. Two really great things happened right then: #1 was that Bill remembered me. #2 was that Bill was apparently the newly elected President of the Senate. Neat! Bill then invited me, Annie Bielinski, Michael Murphy, and one of our baby pre-dental students that we had recruited into attending, to the Senate floor, where we sat on the perimeter of the room and watched the activity going on around us. And posed for a photo, of course. (See pic, I will email them). Bill then led us all through into his office, which was equipped with a speaker playing the discussions going on in the Senate floor. We sat in a circle and intermittently talked about the dental bills we were there to lobby, interspersed with topics varying from Paragliding, talking your way out of speeding tickets, skiing in Europe, and hearing about Bill’s various travel experiences. Hopefully Bill kept to his word and spread all of our extremely knowledgeable and convincing lobbying to the rest of the Senate.

9:45 a.m.: Switch to the lobby of the second chamber (Senate or House)

10:30 a.m.: Eat lunch with legislators and engage in more detailed conversations about dental issues

12:00 p.m. Depart the Capitol

This sums up our short, yet eventful, morning at the State Capitol. We mingled with some Senators, went onto the Floor of the Senate, sat and spoke personally with the president of the Senate, and met various dentists from throughout the state. Overall, Lobby Day is an incredible experience. It is an amazing opportunity to meet some very powerful and influential people and have an impact on legal processes that directly impact us and our future careers. I highly recommend that everyone partakes in this experience!

Lobby Day Hot Topics!

• Access to Care: Dental Provider Designation Systems (HB 1191)
  • Last summer, a dental insurer decided to implement a provider rating system that ranks dentists using a 1-3 star rating based only on cost of care. This bill is to regulate this designation program to include other factors, including quality of care, and patient demographics.
• Access-to-Care: Medicaid Reimbursement bill (HB 1151)
  • In 2013, the CDA launched the “Take 5” program to recruit dentists to enroll as Medicaid providers. However, Medicaid rates aren’t sustainable for dental practices. This bill is working towards better funding for Medicaid dental services.
• Access-to-Care: Loan Forgiveness (CDPHE Budget Request)
  • To provide for increased student loan forgiveness incentive packages to recruit dentists to serve in rural and underserved areas.
• Access-to Care: Incentives for Preceptors (no bill # yet)
  • Another step towards increasing dental access for rural and underserved areas, this bill is to increase opportunities for training in these areas by creating a provision of tax credit to preceptors.
• Scope of Practice: Minimizing Use of the Dental Team through ITR
  • This bill is to allow dental hygienists to do Interim Therapeutic Restorations (ITR), a procedure to stop decay on a temporary basis.

Many components have an effect on the profession and the day-to-day life of dentists, including changing technology and educational requirements, among others.  An often under-looked component regarding the dental profession, that may affect dentists and future dentists substantially, is the changing landscape of state and federal laws that impact the dental profession.

In most respects, state laws and policies have the most direct impact on dentists; the state regulates dentists who practice within it.  In Colorado, the State Board of Dental Examiners, a regulatory board under the Department of Regulatory Agencies (DORA), bears the authority for dental regulation.  The State Board of Dental Examiners is subject to the “Sunset Process”, meaning that the Board’s existence terminates if the state legislature does not act to continue the board by a certain date, usually after an extensive review of and often with modifications to how they operate.

The Colorado legislature completed its sunset review of the State Board of Dental Examiners earlier this year and voted to continue the Board through September 1, 2014 (Colorado House Bill 14-1227).  It also made changes to the Dental Practice Law of Colorado, many of them administrative or technical, but it also included changes which have a tangible impact on dentists.  For example, one change addresses discipline for certain, unauthorized anesthesia usage on patients; another change mandates 30 hours of continuing education, every 2 years, for dentists and dental hygienists.

The Colorado legislature implemented the changes, largely based on recommendations from DORA itself and other interested parties, such as the Colorado Dental Association.  One recommendation that the legislature did not address in its completed sunset review, however, was a recommendation from DORA to address potential alternatives for the clinical component of dental licensure testing.  In its recommendation to the legislature, DORA specifically requested the legislature to “Revise the clinical examination requirement to allow the Board to accept other methods of evaluating clinical competency….” In its recommendation, DORA noted that “[t]he notion that a clinical examination can be something other than a one-time, high-stakes examination performed on a real patient is gaining broader acceptance…the General Assembly should expand the law to allow the Board, at its discretion, to accept alternate methods of evaluating clinical competency…” (The entire DORA recommendation is available HERE.)

Despite DORA’s recommendation, the Colorado legislature failed to address changing certain clinical examination requirements.  The Colorado legislature may address this in a future piece of legislation; however, it is also possible that the legislature will not address this until the next sunset review deadline, around 2023.  If the Colorado legislature addressed this recommendation by DORA, the proposed changes to the clinical examination process would surely be in students’ best interest, as it could expand the opportunities for licensure applicants to demonstrate their clinical acumen.

This recent sunset review of the Colorado Board of Dental Examiners demonstrates how the law and legislature may have a large impact on our careers.

~Becky Bye, JD, Class of 2018, Colorado ASDA Alternate Delegate