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NADP Advocacy in Action
Training WebinarTuesday, March 13, 2018
All participants will be placed in mutedmode.
? To ask a question, type into the chat feature on the left side of your screen.
Listen to the webinar via telephone: 1-877-286-11489672122103#
Slides and a recording will be made available for NADP members.
Speakers
• Eme Augustini, NADP Director of Government Relations • Artur Bagyants, NADP Government Relations Analyst • Evelyn Ireland, CAE, NADP Executive Director• Lisa Layman, Principal, Hooper, Lundy & Bookman, PC.
Host CommitteeStephanie Berry, ChairDelta Dental of California
Bethany DoughertyLife & Specialty Ventures
Suzanne Heckenlaible Delta Dental of Iowa
Bernard LaPineUnited Concordia
Bradley PeakSun Life Financial
Gary Pickard Pacific Dental Services
Lisa StrikowskyGuardian
Agenda• Event Schedule and Logistics • Advocacy Groups and Appointments• Congressional Meeting Format• Current Events and Industry Asks • Homework• Discussion / Q&A
Event Schedule
Wednesday, March 21Day Advocates Arrive
Hyatt Regency Washington2:30 PM Registration Opens
Columbia A Foyer 3-5:30 PM Advocate Training
Columbia A 5:30 PM Reception
Congressional C/D6 PM Dinner
Columbia A
Thursday, March 227-10 AM Breakfast available, Article One
American Grill, hotel lobby 9AM-12PM
Meetings with Members of Congress
Lunch Lunch or Smith Fundraiser (12:30-1:30pm)Capitol Hill Lunchrooms or Bistro Cacao
1-6 PM* Meetings with Members of Congress
6:30 PM Dutch treat dinner 701 Restaurant on Pennsylvania Ave
*Advocates should be available for potential 5:30pm meetings ending at 6pm. If your schedule limits availability, let us know at [email protected].
Senate Office Buildings
HouseOffice Buildings
Capitol Hill Map
Hyatt Regency Hotel
Reminders• Dress for the Hill is business professional
- Comfortable shoes- Consider bringing an umbrella
• Remember: NADP folder (with leave behinds), NADP pin, business cards, camera, your personal folder
• Gift rules• Social media: we encourage pics and highlights at #nadpaia18
• Congressional office building security- Like TSA, no sealed boxes, closed envelopes or weapons- Any bags may be searched, water is allowed
• If you plan to visit, there is additional security at Capitol Visitor Center and Senate and House Galleries (no water allowed)
- See more at: https://www.visitthecapitol.gov/plan-visit/prohibited-items
Advocacy Groups Advocates are organized in state/regional groups.
Groups are organized based on several factors: - Where an advocate lives and works (constituents are a priority for having
meetings scheduled)- Where a company is headquartered, employs staff, or does business
(ordered by importance)- Prior relationships with Members and their staff
Generally, volunteers from the same company are split among two or more groups. It is important that congressional staffers meet with a variety of companies active in their districts.
Staff will accompany groups dependent on availability.
Setting Appointments
NADP will schedule all your meetings with Members of Congress and staff. - Please DO NOT schedule your own meetings. This will avoid
overlapping or duplicative appointments. - Have a relationship? Let NADP staff know and we can work
together.
Advocate Group Example
Florida Team• Alissa Gavrilescu, Solstice
Benefits• Donna Hunter, UCCI• Beth Dougherty,* Life & Specialty
Ventures• Ron Bolden,* Cigna
Possible meetings -Sen. Bill Nelson-Sen. Marco Rubio-Rep. John Rutherford (FL-4)-Rep. Ted Deutch (FL-22)-Rep. Debbie Wasserman Schultz (FL-23)
Get to know your team: o Email introduction or conference call, connect on LinkedIn
Download the VoterVoice AppA new NADP Action Center app with VoterVoice will include your meeting schedule and a legislator look-up.
1. Search for "votervoice" (one word) in your App store, or you can use one of these links:Google PlayiTUNES
2. When you open the app for the first time, you will be prompted to choose whether you would like to receive notifications. Then, you will be prompted to enter your email address. A verification code will be sent to that email account.
3. After verifying your email, you will be brought to a 'Find Association' page. Start typing in 'NADP' and an option for 'NADP' will appear directly below where you were typing. Click/touch that full name & you'll then have access to the mobile app.
Homepage Menu > Scorecard Scorecard search
Scorecard also available online: https://www.votervoice.net/NADP/Scorecard
Menu > Meetings Meetings Page Meeting Detail Post-meeting Survey
UPDATE FROM THE HILL
Current policy and political landscape in DC
• Introductions: NADP & your Company• Industry and state facts• Make the asks• Provide leave-behind package • Offer yourself and NADP as resource• Thank them for meeting• Make a note of their reaction and any
follow-up
Congressional Meetings: Format
IntroductionsAdvocates each introduce themselves• Name, company, if you are a constituent, have
any employees in their state, number of enrollees or other business in their state, if you operate on their state Exchange or in a public program.*
• Then, we are here today as members of the National Association of Dental Plans or NADP, our national trade association representing a variety of companies who offer dental coverage.
• We appreciate your time today to talk about dental benefits in [State or District] and also discuss a couple of specific issues and their impact to us and our consumers in your state.
*HOMEWORK
• Introductions: NADP & your Company• Industry and state facts• Make the asks• Provide leave-behind package • Offer yourself and NADP as resource• Thank them for meeting• Make a note of their reaction and any
follow-up
Congressional Meetings: Format
• Dental benefits are the most requested health benefit after medical and pharmacy coverage.
• Dental benefits deliver access to the specific care needed by children and adults to lower their overall dental treatment costs as well as lower costs for emergency room treatment and the treatment for high cost and chronic medical conditions.
• Consumers with dental benefits are more likely to go to the dentist and take their children to the dentist as well.
• Over 90% of employees with dental benefits pay some or all of the premium for their dental benefits.
• Dental benefits deliver value at low and stable premiums.
About Dental Benefits
Industry and State Facts
• There are approximately 249 million Americans or 77% of the population with dental benefits.
• Americans with dental coverage are more likely to go to the dentist, take their children to the dentist, receive restorative care and experience greater overall health.
• Provide some specific data from the state fact sheet, which will be included in the leave-behind folder.
• Introductions: NADP & your Company• Industry and state facts• Make the asks• Provide leave-behind package • Offer yourself and NADP as resource• Thank them for meeting• Make a note of their reaction and any
follow-up
Congressional Meetings: Format
• HOUSE: “Today, we wanted to speak with you about a few topics important to dental benefits consumers and let you know our thoughts as these issues may advance in the coming year. We also wanted to relay our concerns with a specific of legislation, HR 1606.”
• SENATE: “Today, we wanted to speak with you about a few topics important to dental benefits consumers and let you know our thoughts as these issues may advance in the coming year.”
Summary of the Asks
• HIT moratorium: express thanks for the 2019 HIT moratorium and advocate for a 2020 moratorium, which should be provided with enough lead-time to implement in 2020 products.
• Tax policy and the value of dental benefits: support the tax exclusion for employer-sponsored health and dental benefits and other incentives that encourage dental coverage.
• Public programs: – CHIP: Express thanks for Children’s Health Insurance Program Funding – Medicaid: for Republicans, ask for continued conversation if changes to program financing
are discussed this year particularly as child and adult dental benefits are provided in the program. For Democrats, thank for their work in preserving the financing structure of Medicaid and explain importance of this to dental benefits as provided in the program.
• Exchanges: support decoupling and independent purchase of dental benefits on public health insurance Marketplaces
• Only in the House: – H.R. 1606: explain and state opposition to this legislation on provider contracts.
Summary of the Asks
Background: • Fully insured dental plans are included in the definitions of “covered entity”
subject to the ACA’s Health Insurance Providers Fee (aka HIT).• For the dental benefits industry, whose average annual change in premiums over
the last five years has been in the +1.5% to -.9% range, the approximate 2% HIT fee is significant.
• In late January 2019, Congress passed a Continuing Resolution (H.R. 195) to fund the government through February 8 and included a moratorium on the HIT for calendar year 2019.
• Year-to-year swings in the application of the tax are cumbersome to administer and confusing to both individuals and employers.
“Ask” or Talking Point: express thanks for the 2019 HIT moratorium and advocate for a 2020 moratorium, which should be provided with enough lead-time to implement in 2020 products.
Health Insurance Tax
Background: • Early drafts of ACA repeal/replace legislation and think tank reports proposed: eliminating or
capping the deductibility of employer-sponsored insurance • This was NOT included in later iterations (AHCA, BCRA, etc.)
• The deductibility of benefits is a popular ‘pay for’ • Tax treatment of insurance cost the federal government about $275 billion in forgone revenues in
2016. --CBO
• Over 93% of the 157.5 million Americans with private dental benefits receive them through their employer.
• If consumers were taxed on the dental benefit premiums they pay for themselves and their families, 54% or 85 million indicated they were likely to drop their existing dental benefits. --NADP 2009 survey
“Ask” or Talking Point: Tax policy should provide incentives for employers and individuals to purchase dental coverage. We were happy to see several proposals last year did not include any change to the tax deductibility of employer-sponsored benefits and would appreciate staying in touch with your office in the event this is considered this year.
ESI Tax Exclusion
Background: • CHIP operates in every state and U.S. territory. • Along with Medicaid, it has helped reduce the number of uninsured children from 10
million in 1997 3.3 million in 2015. –MACPAC • Children with CHIP coverage are more likely than children without insurance to have a
usual source of care, including dental. • Federal funding authorization for CHIP expired 9/30/17. Some states came close to
exhausting existing funding before Congress passed a six-year extension of CHIP funding on 1/22/18. As part of a broader budget agreement in early February, Congress lengthened this to a full 10 years of funding.
“Ask” or Talking Point: Thank you for providing funding for CHIP, which assures oral health coverage for children in the program.
Public Programs: CHIP
Background: • ACA repeal/replace proposals in 2017 would have moved
Medicaid to a per capita or block grant program. The policy goal was to limit and make more predictable federal spending on Medicaid and provide states flexibility to manage spending.
• To reduce spending in lieu of federal dollars, states would have had to restrict eligibility criteria, reduce payment rates or eliminate optional services, such as dental care.
“Ask” or Talking Point: • For Republicans, ask for continued conversation if changes
to program financing are discussed this year particularly as child and adult dental benefits are provided in the program.
• For Democrats, thank for their work in preserving the financing structure of Medicaid and explain importance of this to dental benefits as provided in the program.
Public Programs: Medicaid
Also see, MACPAC report on Medicaid Adult Dental Benefits: https://www.macpac.gov/wp-
content/uploads/2015/06/Medicaid-Coverage-of-Dental-Benefits-for-Adults.pdf
Background: • More than 50 million Americans have dental through publicly
funded programs. • Medicaid expansion offered support for states to provide
adult dental benefits. • Covering adults can offer ER savings and reductions in
treatment costs for chronic and high-cost medical conditions.– See NADP MEPS analysis: bit.ly/2APeqde
“Ask” or Talking Point: • For Republicans, ask for continued conversation if changes
to program financing are discussed this year particularly as child and adult dental benefits are provided in the program.
• For Democrats, thank for their work in preserving the financing structure of Medicaid and explain importance of this to dental benefits as provided in the program.
Public Programs: Medicaid
Also see, MACPAC report on Medicaid Adult Dental Benefits: https://www.macpac.gov/wp-
content/uploads/2015/06/Medicaid-Coverage-of-Dental-Benefits-for-Adults.pdf
Background: • In Exchanges, consumers have options to purchase dental
benefits including as part of a medical plan or through a separate dental policy.
• This was specifically allowed in the ACA to provide consumers access to the same policies and expertise of a typical employer plan available in the commercial market.
• In PY 2017, more than 1.9 million Americans gained dental coverage through SADPs on state and federal Exchanges. Majority of enrollees are adults, demonstrating demand.
“Ask” or Talking Point: To stabilize dental coverage on public insurance Marketplaces, dental and medical purchases on the Marketplaces should be decoupled. This could help populations without access and in need of dental coverage, like Medicare enrollees, to purchase dental coverage. Would your office be able to work with us and HHS to work towards this goal?
Exchanges
Background: • Unfortunately, the technical design of Healthcare.gov linked medical
and dental enrollment functions, thereby not allowing for the independent purchase of SADPs.
• The technical design limitations lead to unintended and terminations in dental coverage whenever there is any change made to medical coverage.
• In discussions with HHS over several years, the agency has expressed no policy objections to decoupling medical and dental purchase.
• Fixing or ‘decoupling’/‘uncoupling’ the purchase of medical and dental would also help the Marketplaces provide independent purchase of dental where consumers can enroll in an SADP and checkout of the Marketplace without having to purchase a medical policy.
Exchanges
“Ask” or Talking Point: To stabilize dental coverage on public insurance Marketplaces, dental and medical purchases on the Marketplaces should be decoupled. This could help populations without access and in need of dental coverage, like Medicare enrollees, to purchase dental coverage. Would your office be able to work with us and HHS to work towards this goal?
Background: • In one section, the bill does not allow dental plans to credential providers. By state law,
we are required to credential providers – we look into the provider’s background and make sure they are licensed and their education is up to date. These activities are a core component of providing safety for our enrollees and your constituents.
• In another section, the bill would allow for providers to opt out of various sections of their legal contract with a dental plan. A provider has the opportunity to negotiate their contracts, but to have legislation stating they can opt of portions they don’t like undermines the point of having a contract.
• Note current sponsors: https://www.congress.gov/bill/115th-congress/house-bill/1606/cosponsors
“Ask” or Talking Point: We wanted to also take this opportunity to make sure you were aware of a bill that we are opposed to, H.R. 1606. While the bill is being advocated by providers who primarily focus on services carriers do not cover (known as non-covered services), there are other sections which are anti-consumer and would drive premiums so high that they would become unaffordable.
For House Only: H.R. 1606 on Provider Contracts
Senators Alexander (TN) and Murray (WA) continue to develop a potential agreement to (1) fund ACA Marketplace cost-sharing subsidies, (2) increase flexibility for ACA Section 1332 State Innovation Waivers and (3) pay for reinsurance programs to help cushion insurers’ losses.
We will know more next week about whether these measures could be included in the Omnibus legislation, which must be passed by March 23.
Potential Addition: Market Stabilization
Policymakers and staff may ask your opinion on current policy trends and proposals.
Association Health Plans: The proposed rule did not specifically address inclusion or offer of a standalone dental benefit. While it is difficult to determine a direct impact to dental benefits/markets, medical insurance markets including their health and stability can tend to underlie the health of a dental benefits market. We will closely monitor the final regulation and implementation with an interest in stable markets and will be interested in the role of state regulation (including financial stability and impact to guaranty funds).
Short-term limited duration plans: We are reviewing the proposed rule for potential comment and would be happy to get back in touch with you regarding any industry position.
Equitable Treatment (2016 H.R. 3463 / S. 3244): We appreciate you remembering this and checking in. At this time, we’re very focused on achieving independent purchase on the Marketplaces and see this is as a real opportunity to expand availability of important benefits for purchase by those who may not already have such access (i.e. Medicare beneficiaries).
Other Topics
Remember: if you do not have an answer to any given question, please use that as an opportunity and offer to follow-up with the Congressional office later.
1. Public programs: – CHIP: Express thanks for Children’s Health Insurance Program
Funding – Medicaid: Thank for their work in preserving the financing
structure of Medicaid 2. Exchanges: support decoupling and independent purchase of
dental benefits on public health insurance Marketplaces 3. Only in the House:
– H.R. 1606: explain and state opposition to this legislation on provider contracts.
4. HIT moratorium: express thanks for the 2019 HIT moratorium and advocate for a 2020 moratorium, which should be provided with enough lead-time to implement in 2020 products.
5. Tax policy and the value of dental benefits: support the tax exclusion for employer-sponsored health and dental benefits and other incentives that encourage dental coverage.
Before leaving, thank again for work on CHIP and Medicaid
Order of Talking Points1. HIT moratorium: express thanks for the 2019 HIT moratorium and
advocate for a 2020 moratorium, which should be provided with enough lead-time to implement in 2020 products.
2. Tax policy and the value of dental benefits: support the tax exclusion for employer-sponsored health and dental benefits and other incentives that encourage dental coverage.
3. Exchanges: support decoupling and independent purchase of dental benefits on public health insurance Marketplaces
4. Only in the House: – H.R. 1606: explain and state opposition to this legislation on
provider contracts.5. Public programs:
– CHIP: Express thanks for Children’s Health Insurance Program Funding
– Medicaid: Ask for continued conversation if changes to program financing are discussed this year particularly as child and adult dental benefits are provided in the program.
Before leaving, thank again for work on HIT moratorium
Democrats Republicans
• Introductions: NADP & your Company• Industry and state facts• Make the asks• Provide leave-behind package • Offer yourself and NADP as resource• Thank them for meeting• Make a note of their reaction and any
follow-up
Congressional Meetings: Format
Meeting Survey
Do’s and Don’ts Helpful tips for meeting with Members of Congress and Congressional staff.
Do: research and practice Don’t: be nervous Don’t: be late Do: be prepared to wait Don’t: take it personally Do: be flexible Don’t: drone on Do: tell a story and make it personal Do: make the ask and be a resource
Training videos provide more depth online here: http://www.nadpadvocacy.org/advocates/education-training
Next StepsResearch your company’s footprint in the various states
and state-specific information on “asks”Get to know your teammatesResearch your members of Congress
Coming soon… Scripted talking pointsList of team members with contact informationAdditional handoutsAny follow-up from today’s webinar
Sen. Tina Smith (MN)
Contact Us Advocacy in Action webpage: http://www.nadpadvocacy.org/home* Search legislation at congress.gov, for your Representative at house.govand your Senators at senate.gov
Other resources: • NADP Advocacy webpage: nadp.org/Advocacy.aspx • Dental Interact (DI) online community: mynadp.org/home*
*Login at nadp.org required
Eme Augustini [email protected] x111
Artur [email protected] x106
Use the chat feature to ask a question or
press #6 to unmute your line
Legal reference: Am I a lobbyist?
It is very rare that attendance at a fly-in alone would trigger the requirements to register as a lobbyist.
All three conditions must be met: • Employee spends 20% or more of his or her working time
engaging in lobbying activity;• That same employee must have 2 or more lobbying contacts; and • The company must spend more than $12,500 on such lobbying
activity over a 3-month period (or $3,000 individually).
If your company files with the LDA, it’s a good idea to update your employer about your time in DC. It is still extremely unlikely that fly-in attendance would trigger including you as a registered lobbyist.
