CDA Major Issues & Priorities 2020
1. MICRA Repeal Ballot Measure – Oppose
The Medical Injury Compensation Reform Act allows injured patients to receive unlimited economic damages for all past and future medical costs, lost wages and lifetime earning potential. MICRA also allows up to $250,000 in non-economic damages and includes a limit on attorneys’ fees, stabilizes liability costs and reduces incentives for frivolous lawsuits against health care providers. This year, wealthy trial lawyers are collecting signatures to qualify a ballot measure called the Fairness for Injured Patients Act for the November 2020 election. This is their latest attempt to end MICRA and its protections. FIPA would substantially increase health care costs for all Californians, reduce access to health care and harm patients who are most in need. The measure would effectively eliminate California’s MICRA limits, create a new, broadly defined and dangerous category of malpractice lawsuits and enable new financial windfalls for California’s trial lawyers. According to California’s nonpartisan Legislative Analyst’s Office, this initiative could cost taxpayers tens of millions “to high hundreds of millions of dollars annually” in health care costs. It will reduce access to care for those who need it most, including people who use Medi-Cal, county health programs, safety-net providers and school-based health centers. If passed, FIPA would:
Completely eliminate the non-economic damage cap in cases of “catastrophic injury,” which could be something as simple as a scar.
More than quadruple the existing non-economic damage cap.
Allow attorneys to be paid up front, forcing injured patients to take a lump sum payment rather than being compensated over time for their injuries.
Considerably increase attorneys’ fees (in some instances more than double or triple what they are now) to be paid out of money intended for injured patients.
Require trial attorneys to file “certificates of merit” declaring that the facts in the case have been reviewed by experts but prohibits a judge from independently verifying the truthfulness of the statements in that document.
CDA is part of Californians to Protect Patients and Contain Health Care Costs, a broad coalition including physicians, nurses, hospitals, safety-net clinics and other health care providers who are committed to fighting this initiative.
2. AB 2146: Improving Access to Dental Care for Special Needs Populations – Sponsor
CDA is sponsoring AB 2146 by Assemblymember David Chiu (D-San Francisco) to maximize available public funding for special needs dental clinics at University of California dental schools. People with developmental or intellectual disabilities face numerous barriers to health care. Their behavioral, cognitive and physical limitations can make completing daily tasks and receiving regular health care services challenging. This is especially true when it comes to oral health. According to the 2018 California Legislative Analyst’s Office report on Improving Access to Dental Services for Individuals with Developmental Disabilities, “Research has highlighted disproportionately high rates of dental disease and tooth decay among individuals with developmental disabilities and has noted that these individuals are more likely than the general population to lack access to regular dental care across their lifespan.” The bill will help reduce two of the barriers to dental care for people with special needs: lack of access to specialized dental clinics and lack of programs that train providers how to treat this population.
University dental school clinics are the safety-net site for care for California’s most vulnerable patients as well as the training ground for a dental workforce prepared to care for these patients. However, challenges exist in meeting both responsibilities and there is much room for expansion and improvement. Current dental school clinics are backlogged, with one- to two-year (or more) wait lists for treatment. Lack of funding combined with the additional time and skill required for treating this vulnerable population negatively affects sustainability for dental school clinics providing this care. There are a few ways to generate the funding to either expand a special needs clinic or sustain and increase the care currently being provided to people with special needs. One mechanism for generating funds is through an intergovernmental transfer, which allows a public entity (UC hospital or dental school) to obtain new federal matching dollars that are not currently being used, maximizing public dollars without an impact on California’s general fund. This bill would authorize UC dental schools to enter into an IGT agreement with the California Department of Health Care Services and federal Centers for Medicare & Medicaid Services in order to recoup a portion of uncompensated costs associated with providing care in their special-needs clinics.
3. AB 2007: Improving Access to Care Through Telehealth – Co-Sponsor
CDA, along with The Children’s Partnership, California Health+ Advocates and Children Now, is co-sponsoring AB 2007 by Assemblymember Rudy Salas (D-Bakersfield). AB 2007 supports access to dental care through telehealth, specifically in federally qualified health centers using the virtual dental home model. This bill clarifies that an FQHC can establish a new patient and bill for a virtual dental home visit when a billable Medi-Cal provider employed by the FQHC supervises or provides the services for the patient via telehealth either in real time or with store-and-forward technology. Recent guidance published by the Department of Health Care Services would significantly hinder the continuation and expansion of virtual dental homes in FQHCs. CDA was a co-sponsor of previous legislation that authorized the virtual dental home model and supports its continued use to increase access to care among some of the most vulnerable populations in California.
4. AB 1998: Direct-to-Consumer Orthodontic Protections – Support if Amended
AB 1998 by Assemblymember Evan Low (D-Silicon Valley) builds upon direct-to-consumer orthodontic consumer protections in last year’s dental board sunset review bill, AB 1519 (Low), by requiring that a treating dentist perform an in-person examination prior to approving an orthodontic treatment plan. AB 1998 recognizes the severity of the patient safety risks within the direct-to-consumer orthodontic business model by effectively prohibiting these businesses from providing care to Californians until proper safeguards are established.
Providing dental care that involves the movement of teeth without a proper evaluation can lead to serious patient harm, including loose or cracked teeth, bleeding tongue and gums, gum recession or a misaligned bite. With the emergence of new DTC business models offering various dental services that are ordered without an in-person clinical examination, it is imperative that dental treatment continues to meet a uniform standard of care regardless of whether a dentist provides treatment through telehealth or in person. CDA has a long history of sponsoring and advocating for the funding of various telehealth policies, including the implementation of the virtual dental home that established a new model of dental care through telehealth where specially trained dental auxiliaries provide care to patients under the remote supervision of licensed dentists. CDA supports AB 1998 and is engaging on amendments that ensure the DTC orthodontic business model has the same level of dentist oversight and patient safety as the virtual dental home model and in-person dental care.
5. California State Budget
The governor’s January budget proposal shows an overall commitment to increasing access to dental services and improving the health of vulnerable Californians. However, one area that concerns us is the proposed funding reduction to the Office of Oral Health. Proposition 56 intentionally secured funding to implement the OOH’s California Oral Health Plan with objectives that include establishing school-based dental disease prevention, expanding access to fluorides, dental sealants, tobacco-use counseling and developing programs that promote oral health literacy and greater access to services. We believe that the proposed reduction of $3.5 million risks the success of a nascent program that is just beginning to build out its activities and gain traction in achieving its goals. CDA is requesting a general fund backfill for the OOH to cover the declining revenue from Proposition 56, which funds this program.
Medi-Cal Dental Program: State investments in the Medi-Cal Dental Program over recent years, including the restoration of adult benefits, the Dental Transformation Initiative focusing on children’s prevention, Proposition 56 rate increases and administrative improvements, have made it a more sustainable program for dentists and resulted in significant increases in the utilization of dental services. The passage of Proposition 56 in 2016 — a tobacco-tax increase co-sponsored by CDA — has led to over $500 million per year in rate increases on hundreds of dental procedures, the first significant increases in Medi-Cal dental-provider rates in decades. Due to these improvements, 1,400 new dentists have enrolled as Medi-Cal providers since 2017, an increase of more than 10%. CDA strongly supports the governor’s budget proposal to build upon and extend existing provider rate increases and prevention incentives. This includes the extension of the supplemental provider rates funded by Proposition 56 through the 2022-23 budget year and CalAIM, which continues and expands upon successful elements of the current DTI that will end in December 2020.
Together, these budget proposals create additional stability in the Medi-Cal Dental Program, which is vitally needed to continue the upward trend of provider enrollment and expanded access to care.
6. SB 793: Flavored Vaping/Tobacco Ban – Support
CDA supports SB 793 by Senator Jerry Hill (D-San Mateo) which will prohibit the sale of all flavored tobacco products, including electronic cigarettes, in California. CDA is supportive of measures aimed at reducing the negative health impacts that are caused by tobacco use. Flavored products, especially e-cigarettes, have the potential to reverse years of decline in tobacco usage in the state. Of greater concern is the alarming rise in vaping and e-cigarette use among youth, who often use these flavored nicotine-filled products. According to the California Department of Public Health, youth who would otherwise not have smoked cigarettes or used other tobacco products are still choosing to use flavored, electronic smoking devices. While research is still in process on vaping devices, we know that traditional tobacco use is estimated to account for over 90% of cancers in the oral cavity and pharynx and represents the greatest single preventable risk factor for oral cancer. It also contributes to periodontal disease, heart disease and other cancers of the body.
In conjunction with CDA’s support of SB 793, we also support Governor Newsom’s budget proposal to create parity in taxation between combustible nicotine products, like traditional cigarettes and cigars, and e-cigarettes.
7. Dental Plan Transparency
Over the past several years, CDA has worked to improve transparency of dental plans for dentists and consumers. AB 1962 (2014) required commercial dental plans to annually disclose to the state how much premium revenue they spend on patient care versus administrative costs, which is known as a dental loss ratio (DLR). The reported data show a wide range of premium revenue spent on patient care, with a quarter of all California dental plans spending less than 50% of premiums on care and some plans even falling below 10%. SB 1008 (2018) builds upon this by requiring all dental plans to use a uniform matrix to disclose their benefits directly to consumers, similar to the one used by medical plans. This will provide plan beneficiaries with a uniform summary of plan details, including covered services, reimbursement levels, estimated enrollee cost share, limitations and exceptions. In 2019, CDA successfully sponsored AB 954 (Wood) which requires dental benefit plans to be more transparent about the common practice of “leasing” access to a network of contracted dentists from another dental benefit plan to provide clarity for patients and providers, reduce confusion and help preserve trust in the dentist-patient relationship. These transparency measures help level the playing field for consumers and providers, are consistent with standards that apply to medical plans and help hold dental plans accountable for how they spend premium dollars.
8. Universal Health Care
CDA is committed to building upon the existing health care delivery system to extend health coverage to all Californians. We support recent actions taken to expand coverage, increase affordability and stabilize the individual insurance market. The 2019-20 budget included new and larger subsidies for middle-class Californians to purchase insurance through Covered California, a state-level individual mandate to purchase health insurance and an expansion of Medi-Cal benefits to all young adults through age 25 regardless of their immigration status. In Governor Newsom’s 2020-21 budget proposal, he further extends Medi-Cal eligibility to income eligible seniors aged 65+ regardless of their immigration status. Also included in the governor’s 2020-21 budget proposal is the creation of the Office of Healthcare Affordability which will focus on transparency in the health care industry. We will continue working with lawmakers to achieve universal coverage that includes dental care and to protect the significant progress the state has made under the Affordable Care Act (ACA). Under the ACA, California has achieved a larger reduction in its uninsured rate than any other state by creating the country’s largest and most robust state health insurance exchange (Covered California) that includes stand-alone family dental plans. We are urging the state to pursue universal health care in a way that is sustainable, that does not upend the progress made under the ACA and that maximizes funding from the federal government, which currently provides more than half of the state’s health care dollars.
Updated March 2020
ADA Response to "The Truth About Dentistry" article in The Atlantic
ADA communications staff is currently preparing a response to a story in The Atlantic titled, “The Truth About Dentistry.” The article alleges dentistry lags behind the medical profession and is not largely scientific and evidence-based in regard to diagnoses and treatment. The story also serves to reinforce negative stereotypes of dentists and focuses on one example of a dentist (now a retired life ADA member) who is currently being prosecuted for insurance fraud and has settled multiple lawsuits related to overtreatment and fraudulent billing activity.
ADA communications staff was not contacted by the reporter, who began working on this story two years ago. We learned of the story when he contacted an employee in the ADA Science Institute. The reporter interviewed this ADA employee, but he was not quoted – likely because his quotes did not support the apparent slant the reporter was pursuing.
ADA staff is currently working on a response to the article. A standby statement is in development and we will share when it’s finalized. If you receive a media inquiry and would like assistance, please don’t hesitate to contact me. These pages on MouthHealthy.org may also be helpful if you see any negative chatter on social media and would like to respond:
The ADA is engaging a number of communications tactics to share positive stories about the amazing work dentists are doing, including posting on Facebook and Twitter, which you can feel free to share from your own channels. We are also spreading the word to the public about how to be an informed consumer of dental care – look for a new infographic on social media in the next couple days. When sharing these positive stories, we would advise against mentioning The Atlantic story, as we do not want to give it more credence than it’s already received.
Thanks for your time. As always, please let me know if we can be of assistance. Thank you!
Mike Bittner firstname.lastname@example.org
Division of Integrated Marketing & Communications