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Entries in Health Care Reform (18)


Update on Health Care Reform in Washington State

Yesterday, the Supreme Court upheld the Affordable Care Act as constitutional. While the individual mandate was not determined to be constitutional under the commerce clause, the mandate was upheld under the constitutional provision which authorizes Congress to “lay and collect taxes.” Suffice to say, this all means implementation of the Washington State Exchanges and other health care reforms will continue as planned.

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State Health Exchanges: A Federal Perspective

Special to the WSDA News from Jon Holtzee, Director, State Government Affairs at American Dental Association

With the enactment of the Patient Protection and Affordable Care Act (PACA) on March 23, 2010, many questions have been asked and many remain on how the state health exchanges which are required to take effect on January 1, 2014 will impact the accessibility and delivery of dental care in our country. While the answer will vary, depending on the nature of the exchange in each state, there are some things that are certain:
• While the Supreme Court considers the case, work will continue on exchange development;
• States may create discrete individual exchanges and small business exchange or create one unified system;
• Those purchasing through the exchange can do so through the web, by phone or through an insurance agent;
• The only dental benefit required is what’s called the “Pediatric Essential Oral Health Benefit” for those children whose coverage is purchased through the exchange. With the recent announcement by the feds that instead of establishing a national benchmark for that benefit, they will instead permit states to choose between a variety of approved benchmarks. It has become vital for constituent societies to become vocal advocates to be sure the best option is selected for that state;
• If a state declines to submit an exchange plan for approval to Health & Human Services (HHS) by January 1, 2013 for activation on January 1, 2014, the federal government will establish the exchange in that state;
• That despite these deadlines, the federal process for rulemaking and guidance to the states will most likely continue to be painfully slow;
• With over 75 percent of dental coverage being family coverage, requiring only a pediatric benefit may change the dental benefit design and market for those in the exchange; and 
• The law requires that stand-alone dental plans be allowed as qualified plans within the exchange in addition to having a dental rider as an option to a medical plan.
A primary concern in the development of state exchanges is ensuring fair and robust competition among various plans offering dental benefits, and providing a variety of plan models within the exchange. Clearly an exchange that only offered a capitated benefit plan may have a difficult time creating a network of participating dentists to provide care to their enrollees. An example of these difficulties is highlighted by the existing exchange in Massachusetts, where a 2009 study funded by Blue Cross Blue Shield of Massachusetts found that access to dentists continued to be problematic. Only a limited number of providers are willing to accept the Dental HMO offered by Doral, which is the dental vendor for both Mass Health (the Massachusetts Medicaid & CHIP program) and three of the four Commonwealth Care (exchange) plans.

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