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Washington Report
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A
WASHINGTON
The Congress that couldn’t quit: what it did and didn’t do By any measurement, the 99th Congress was of great significance to dentistry. In the end, T he Congress That C ouldn’t Quit showed an unexpected sensitivity to the nation’s oral health needs. It approved the largest budget ever for dental research, established the first dental benefits for military dependents, provided for training of dentists to care for elderly and disabled patients, and banned the advertising of snuff and chewing tobacco. It also resisted the temptation to increase revenues by taxing employer-provided med ical and dental benefits and ignored antifloridation legislation. Legislation to im pose taxes on employees for their work place health care coverage, unsuccessfully offered in the past two congresses, would greatly reduce the availability of dental benefits. Rep. John Seiberling (D-OH), sponsor of unsuccessful legislation to pre vent the addition of fluoride to water sup plies, is retiring from Congress. Bills that died with Congress’ adjourn ment w ould have clarified the Employee Retirement Income Security Act (ERISA) of 1974 with regard to state freedom of choice laws; redefined the Federal Trade C om m ission’s legislative authority; re stricted contributions and activities of p ol itical action committees (PACs); allowed reimbursements to health care auxiliaries under the Federal Employees Health Bene fits Program (FEHBP); permitted override of state laws interfering with the develop ment of so-called preferred provider orga nizations, and prohibited Medicaid from treating dentists differently than physi cians for services both can legally provide. Legislation not passed by the 99th Con gress died with its adjournment but could 982 ■ JADA, Vol. 113, December 1986
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be reintroduced in the 100th Congress Follow ing is a dental look at the 99th Congress. TAX REFORM: This first major over haul of the nation’s tax laws since 1954 reduces individual and corporate tax rates and lim i ts or repeals many deductions. The Association successfully lobbied against efforts to impose taxes on employees for the value of health benefits provided by their employers. A new deduction for self-employpd persons for 25% of the am ount paid annually for health insurance premiums for themselves, spouses, and dependents takes effect for taxable years beginning Jan 1 but expires at the end of 1989. Deductions for consumer interest, includ ing interest on student loans and credit cards, are gradually eliminated beginning Jan 1. Also beginning with the 1987 tax year, salaried dentists w ill have to meet a new tax test. Dentists employed by the government or in health maintenance orga nizations, for example, w ill be allowed deductions for employee business expenses such as dues and professional journals only to the extent those deductions exceed 2% of adjusted gross income. (Public Law 99-514) MILITARY: Congress authorized (PL 99-145) and provided $18 m illion in start up funds (PL 99-500) for a voluntary dental insurance plan for military dependents to begin next summer. The Pentagon expects more than 1.4 m illion spouses and children of armed forces, Coast Guard, and Public Health Service personnel to participate when the program begins next summer. This culminates a 20-year Association ef fort and w ill provide more than $100 m il lion a year in dental benefits for military families. NATIONAL IN STITU TE OF D EN TAL RESEARCH (NIDR): The om nibus government spending bill for fiscal year 1987 (PL 99-500) provides $117,945,000 for the NIDR, including $2.7 m illion for re search on acquired immune deficiency syn drome (AIDS) and $1.8 m illion for Dentist Scientist Awards. The institute’s highest previous budget was $100,688,000 in FY 1985. GERIATRIC DENTISTRY: Congress approved an expansion of geriatric train ing to include the training of dentists and specified in the omnibus spending bill that dentistry should receive “a reasonable share” of the appropriated funds; it also ordered a study (PL 99-158) of the adequacy and availability of dental personnel to meet the oral health needs of elderly Americans
through the year 2020. H E A L T H CARE FO R SPE C IA L GROUPS: ADA's legislative efforts re sulted in recognition by Congress of reha bilitation dentistry as a new category in the long-term training grant section of the renewed Rehabilitation Act (PL 99-506), which authorizes services for disabled per sons. Long-term training grants are award ed for projects to train health professionals in the unique management and treatment of handicapped patients. Separate legisla tion (PL 99-129) orders a study, being con ducted by the National Academy of Sci ences’ Institute of Medicine, of the avail ability of health care services for the hom e less. T O R T /M A L PR A C T IC E LEG ISLA TION: Congress’ awakening interest in tort reform and medical malpractice issues resulted in legislation strengthening the peer review process and making it easier for professional organizations and businesses to form self-insurance mechanisms to pro vide liability coverage. The FY ’87 spend ing bill includes $1 m illion for studies of liability-related injuries and their com pen sation and for pilot projects in state liabil ity reform. D ENTAL STUDENTS: PL 99-498 re news the Higher Education Act for five years, m aking it easier to finance a dental education and repay loans. Loan lim its are increased for guaranteed student loans, national direct student loans, and “au xil iary” loans. Tax reform, as mentioned above, phases out the deduction for interest paid on student loans. Financial aid for needy dental and other health professions students was reauthorized by PL 99-129, which also provided a new funding source for disadvantaged students. DISEASE PREVENTION: Congress cre ated a President’s Council on Health Pro motion and Disease Prevention to evaluate the effectiveness of disease prevention pro grams and identify steps individuals can take to reduce their risk of disease. The bill directs the council’s attention to four areas of health including promotion of dental health and reduced incidence of oral disease. D EN TA L RESIDENCIES: The om n i bus government spending bill increases funds for the family medicine/general den tistry residency training program by $1.5 m illion to $35,960,000. The law requires that 7.5% of these funds go to dentistry programs. T h is re p o rt was prepared by C raig Palm er, director of c om m unications for the ADA W ashington Office.
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WASHINGTON
The Congress that couldn’t quit: what it did and didn’t do By any measurement, the 99th Congress was of great significance to dentistry. In the end, T he Congress That C ouldn’t Quit showed an unexpected sensitivity to the nation’s oral health needs. It approved the largest budget ever for dental research, established the first dental benefits for military dependents, provided for training of dentists to care for elderly and disabled patients, and banned the advertising of snuff and chewing tobacco. It also resisted the temptation to increase revenues by taxing employer-provided med ical and dental benefits and ignored antifloridation legislation. Legislation to im pose taxes on employees for their work place health care coverage, unsuccessfully offered in the past two congresses, would greatly reduce the availability of dental benefits. Rep. John Seiberling (D-OH), sponsor of unsuccessful legislation to pre vent the addition of fluoride to water sup plies, is retiring from Congress. Bills that died with Congress’ adjourn ment w ould have clarified the Employee Retirement Income Security Act (ERISA) of 1974 with regard to state freedom of choice laws; redefined the Federal Trade C om m ission’s legislative authority; re stricted contributions and activities of p ol itical action committees (PACs); allowed reimbursements to health care auxiliaries under the Federal Employees Health Bene fits Program (FEHBP); permitted override of state laws interfering with the develop ment of so-called preferred provider orga nizations, and prohibited Medicaid from treating dentists differently than physi cians for services both can legally provide. Legislation not passed by the 99th Con gress died with its adjournment but could 982 ■ JADA, Vol. 113, December 1986
_________________________ REPORT
be reintroduced in the 100th Congress Follow ing is a dental look at the 99th Congress. TAX REFORM: This first major over haul of the nation’s tax laws since 1954 reduces individual and corporate tax rates and lim i ts or repeals many deductions. The Association successfully lobbied against efforts to impose taxes on employees for the value of health benefits provided by their employers. A new deduction for self-employpd persons for 25% of the am ount paid annually for health insurance premiums for themselves, spouses, and dependents takes effect for taxable years beginning Jan 1 but expires at the end of 1989. Deductions for consumer interest, includ ing interest on student loans and credit cards, are gradually eliminated beginning Jan 1. Also beginning with the 1987 tax year, salaried dentists w ill have to meet a new tax test. Dentists employed by the government or in health maintenance orga nizations, for example, w ill be allowed deductions for employee business expenses such as dues and professional journals only to the extent those deductions exceed 2% of adjusted gross income. (Public Law 99-514) MILITARY: Congress authorized (PL 99-145) and provided $18 m illion in start up funds (PL 99-500) for a voluntary dental insurance plan for military dependents to begin next summer. The Pentagon expects more than 1.4 m illion spouses and children of armed forces, Coast Guard, and Public Health Service personnel to participate when the program begins next summer. This culminates a 20-year Association ef fort and w ill provide more than $100 m il lion a year in dental benefits for military families. NATIONAL IN STITU TE OF D EN TAL RESEARCH (NIDR): The om nibus government spending bill for fiscal year 1987 (PL 99-500) provides $117,945,000 for the NIDR, including $2.7 m illion for re search on acquired immune deficiency syn drome (AIDS) and $1.8 m illion for Dentist Scientist Awards. The institute’s highest previous budget was $100,688,000 in FY 1985. GERIATRIC DENTISTRY: Congress approved an expansion of geriatric train ing to include the training of dentists and specified in the omnibus spending bill that dentistry should receive “a reasonable share” of the appropriated funds; it also ordered a study (PL 99-158) of the adequacy and availability of dental personnel to meet the oral health needs of elderly Americans
through the year 2020. H E A L T H CARE FO R SPE C IA L GROUPS: ADA's legislative efforts re sulted in recognition by Congress of reha bilitation dentistry as a new category in the long-term training grant section of the renewed Rehabilitation Act (PL 99-506), which authorizes services for disabled per sons. Long-term training grants are award ed for projects to train health professionals in the unique management and treatment of handicapped patients. Separate legisla tion (PL 99-129) orders a study, being con ducted by the National Academy of Sci ences’ Institute of Medicine, of the avail ability of health care services for the hom e less. T O R T /M A L PR A C T IC E LEG ISLA TION: Congress’ awakening interest in tort reform and medical malpractice issues resulted in legislation strengthening the peer review process and making it easier for professional organizations and businesses to form self-insurance mechanisms to pro vide liability coverage. The FY ’87 spend ing bill includes $1 m illion for studies of liability-related injuries and their com pen sation and for pilot projects in state liabil ity reform. D ENTAL STUDENTS: PL 99-498 re news the Higher Education Act for five years, m aking it easier to finance a dental education and repay loans. Loan lim its are increased for guaranteed student loans, national direct student loans, and “au xil iary” loans. Tax reform, as mentioned above, phases out the deduction for interest paid on student loans. Financial aid for needy dental and other health professions students was reauthorized by PL 99-129, which also provided a new funding source for disadvantaged students. DISEASE PREVENTION: Congress cre ated a President’s Council on Health Pro motion and Disease Prevention to evaluate the effectiveness of disease prevention pro grams and identify steps individuals can take to reduce their risk of disease. The bill directs the council’s attention to four areas of health including promotion of dental health and reduced incidence of oral disease. D EN TA L RESIDENCIES: The om n i bus government spending bill increases funds for the family medicine/general den tistry residency training program by $1.5 m illion to $35,960,000. The law requires that 7.5% of these funds go to dentistry programs. T h is re p o rt was prepared by C raig Palm er, director of c om m unications for the ADA W ashington Office.