The Affordable Care Act and the Dental Industry

***UPDATED November 30, 2013*** It’s no secret that the new healthcare law, The Affordable Care Act, has stirred a lot of controversy nationwide.  The country is torn over the concept of universal healthcare, but whether you’re for it or against it, one thing most people have in common is that they are confused by it.  No one is entirely sure what the impending changes to health insurance will mean to them, and individuals in the dental industry are no exception.  Fortunately, the American Dental Association (ADA) has provided a resource to help decode what the ACA will mean for dentists.  The ADA Center for Professional Success is providing information and news about the ACA specifically for dentists at their website, Success.ADA.org. Additionally, if you have a specific question and can’t find an answer, the Association is welcoming personal questions sent to their email address, [email protected].

As fall quickly approaches, so too does the federal deadline for all health exchanges across the United States to be up and running for the full implementation of the Patient Protection and Affordable Care Act.  Also known as the ACA or Obamacare, the health care reform law set out to expand medical insurance coverage, move toward integrated care delivery, and change the financing of health care nationwide.  The law is expected to significantly alter the medical industry as we know it, including the world of dentistry, and because most Americans are still unclear about the new regulations, many are asking, “How will this affect me?” The American Dental Association (ADA) is releasing a series of articles focusing on the potential effects of the law on dentistry and the delivery of dental services to patients, with the first installment being published just yesterday.  The articles will be written in a Q & A format, with the introduction being offered by ADA President, Dr. Robert A. Faiella.  Here is a brief summary of some of the key points mentioned in the first piece.

The article spells out the basic goals of the ACA, describing in detail the health benefit exchanges and how they are being established.  In order to remain concise, I will only discuss the health care law as it applies to dentistry.  If you’re interested in reading all the details, please see the original ADA News article here.  Many of the initial policies of the ACA are directed at the medical and hospital systems of America, but experts agree that changes will likely trickle down to all medical arenas, including dentistry.  For example, systemic changes, such as paying for outcomes and not procedures and increasing the use of technology (such as electronic health records), are targeting primary medical fields now, but are likely to affect dentistry down the road.  According to federal regulators, individuals who purchase coverage in the exchange, even those with children, are not required to buy dental benefits, a stipulation the Association firmly disagrees with.  When the health benefit exchanges first open, it the hope of the ADA that insurers will use dental benefits to increase competitiveness within the marketplaces.

Dentist employers are not expected to feel effects of Obamacare as greatly as their larger corporate counterparts.  The law does not require small businesses with less than 50 full-time employees to provide health insurance for their workers.  Considering that roughly 99% of all dental practices have less than 50 employees, most aren’t expected to offer benefits.  Those who do pay at least 50% of the premium for employee coverage may qualify for a small business tax credit, which will only be available until 2016.  Businesses that do have more than 50 full-time employees are required to provide health coverage, however the administration has recently announced that they will not enforce this mandate until 2015 in order to give businesses more time to prepare.  Because the ACA prohibits insurers from imposing pre-existing condition limitations, excessive waiting periods, and copayments or deductibles for certain preventive services, many more individuals will be eligible for care, meaning the number of patients being seen will likely skyrocket, affecting all aspects of the medical industry.  Obamacare is coming, and while it will certainly change the face of primary medical fields initially, the dental industry will surely be impacted eventually.