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Washington State Dental Association

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.

One provision that the Supreme Court did modify was the expansion of Medicaid. The court ruled that individual states are not required to raise Medicaid eligibility to 133 percent of the federal poverty level. Instead states will be given the option of whether they want to raise their eligibility and receive additional federal funding. Since Washington’s Medicaid eligibility already exceeds this new threshold in most programs, the state is all but certain to opt in to this provision to receive additional federal funding for Medicaid expansion.

Under the federal law, the individual mandate only covers pediatric dental services and does not include a requirement that adults have dental insurance coverage. This likely means that only pediatric dental insurance will be sold in the health benefit exchanges for the immediate future. Federal regulations prohibit dental insurance from having either annual or lifetime coverage maximums.

Implementation of the Health Benefit Exchanges and other health care reform provisions is well underway in Washington state. The Exchange Board of Directors has been working on implementation for nearly six months and recently appointed a Dental Technical Advisory Committee (TAC). This TAC will be charged with providing recommendations on the rules for providing dental plans in the exchanges. Four dentists and one representative from the Washington State Dental Association will join representatives from insurance companies on this TAC.

Over the next several months, WSDA will be providing free member webinars on health care reform. The first webinar will be held on Friday, July 20 at noon and will focus on how health care reform will impact dentistry in Washington state. Click here to sign up for this webinar. A second webinar will be offered on how small businesses (including dental practices) will be impacted by health care reform. Information on this second webinar will be provided at a later date. Check back to WSDA for more updates on this important topic. Please contact WSDA Director of Government Affairs, Bracken Killpack, with immediate questions at

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