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					Put Your Money Where Your Mouth is!
 Securing the funding for ‗oral‘ health care reform in P.L. 111-148

                              Pew Children‘s Dental Campaign


                              May 12, 2010
Welcome: The battle is won but the fight has just begun!
P.L. 111-148 authorized new and
expanded federal programs to support oral
public health efforts and the development
of an adequate oral health workforce.
These programs are authorized for funding
but without specific appropriations.

Without further action by Congress, federal
agencies might not receive money to carry
out these new mandates. Congressional
appropriators must hear from constituents     Courtesy of New York Times

and interest groups that funding these
programs is critical.

 May 12, 2010                                                              1
In this Webinar, we will:

1.)       Walk through the provisions with authorizations for funding

2.)       Discuss the appropriations process and sources of funding for
          these provisions

3.)       Discuss advocacy efforts to help secure funding in Congress

4.)       Answer questions

May 12, 2010                                                              2
•         Shelly Gehshan – Director, Pew Children‘s Dental Campaign
•         Rebecca Alderfer – Senior Government Relations Associate,
          Pew Children‘s Dental Campaign
•         Kathy Patterson – Senior Officer for Government Relations,
          Pew Center on the States

•         Bruce Lesley – President – First Focus
•         Liz Rogers – Oral Health America

May 12, 2010                                                           3
                     Supporting Prevention

  5-year national, public education campaign focused on oral
  healthcare prevention and education (Title IV, Sec. 4102)

  Timing: Campaign will begin no later than March 23, 2012;
       campaign planning activities shall begin after March 23,

  Agency: Secretary of Health and Human Services, acting
      through the Director of Centers for Disease Control and

  Funding: Authorized such sums as necessary

  Authorization: New

May 12, 2010                                                      4
                      Supporting Prevention

Requirement that all states, territories and Indian tribes receive
grants for school-based dental sealant programs (Title IV, Sec.

                   Timing: March 23, 2010

                   Agency: Secretary of Health and Human Services,
                   acting through the Director of Centers for Disease
                   Control and Prevention

Funding: Authorized such sums as necessary

Authorization: Amended existing authorization to require grants to all
     states, territories, and tribes

May 12, 2010                                                         5
                      Supporting Prevention

Demonstration grants to show the effectiveness of research-
based dental caries disease management activities (Title IV,
Sec. 4102)

Timing: March 23, 2010

Agency: Secretary of Health and Human Services, acting through
    the Director of Centers for Disease Control and Prevention

Funding: Authorized such sums as necessary

Authorization: New - information will be used to support public
     education campaign described in slide 4

May 12, 2010                                                      6
                               Supporting Prevention
Expanded oral health surveillance collections (Title IV, Sec.

Timing:      PRAMS: State must submit report no later than 5 years
             after March 23, 2010 (and every 5 years thereafter)
             NHANES: updated every 6 years
             MEPS: verify dental findings
             NOHSS: nationwide collection

Agency: Secretary of Health and Human Services
                                                                     Courtesy of CDC

Funding: Authorized such sums as necessary for NOHSS and PRAMS

Authorization: Amendment of existing authorization

   May 12, 2010                                                                        7
                      Supporting Prevention

Expanded cooperative agreements to improve oral health
infrastructure (Title IV, Sec. 4102)

Timing: FY 2010-FY 2014

Agency: Secretary of Health and Human Services, acting through
        the Director of Centers for Disease Control and

Funding: Authorized such sums as necessary

Authorization: Expansion of existing authorization

May 12, 2010                                                     8
                        Supporting Workforce
Demonstrations and evaluation of alternative dental health care
providers (Title V, Sec. 5304)

Timing: 5-year program to begin no later than March 23, 2012

Agency: Secretary of Health and Human Services; Director of the
    Institute of Medicine contracted at end to study programs

Funding: Authorized; each grant will be at least $4 million, to be
     distributed over the life of the 5-year project – total of at least $60

Authorization: New

 May 12, 2010                                                              9
                        Supporting Workforce

Expanded dental training programs (Title V, Sec. 5303)

Timing: FY 2010 - FY 2015

Agency: Secretary of Health and Human Services

Funding: FY 2010: Authorized to be appropriated $30 million
         FY 2011-FY 2015: such sums as necessary

Authorization: New/Existing (creates a new line-item)

   May 12, 2010                                               10
                     Supporting Workforce

New or expanded primary care residency programs, including
dental programs (Title V, Sec. 5508)

Timing: FY 2010

Agency: Secretary of Health and Human Services

Funding: Authorized; $25 million for FY 2010, $50 million for FY
     2011 and FY 2012, and such sums as necessary for each
     fiscal year thereafter.

Authorization: New authorization

May 12, 2010                                                       11
                        Two Potential Sources of Funding
1.     Funding from the Prevention and Public Health Fund – new
       direct/mandatory funding

The law establishes a fund, to be administered through the Office of the
Secretary at HHS, to provide for a sustained national investment in prevention
and public health programs (over the FY 2008 level). The Fund will support
programs authorized by the Public Health Service Act, for prevention, wellness
and public health activities, including prevention research and health screenings
and initiatives, such as the Community Transformation grant program, the
Education and Outreach Campaign for Preventive Benefits, and immunization

FY 2010:            $500 million
FY 2011:            $750 million
FY 2012:            $1 billion
FY 2013:            $1.25 billion
FY 2014:            $1.5 billion
FY 2015:            $2 billion and each fiscal year thereafter…

     May 12, 2010                                                            12
                    Two Potential Sources of Funding
2.      Discretionary funding -- Annual appropriations bill for the Department
        of Health and Human Services
      –     Top-line budget figure given to the Appropriations committee by
            the Budget Committee
           •    Usually governed by the Budget Resolution
      –     Sub-allocations given to the Appropriations Sub-committees
           •    Each sub-committee is expected to stay within the bounds of
                its funding allocation when marking up each appropriation bill

                                   Chip Somodevilla/Getty Images

May 12, 2010                                                                     13
               FY 2010 Federal Budget

May 12, 2010                            14
                          Projected Federal Spending 2020

November 8, 2010                                                                                                                       15
                   Source: Data obtained from ―Projected Federal Spending 2020,‖ (accessed 5/11/10)
                              Appropriations 101
Congress‘s formal process for allocating discretionary resources has two
    major steps:

•    Enactment of an authorization measure that may create or continue
     an agency or program or authorize the subsequent enactment of

         Authorizing legislation permits the enactment of appropriations for
         an agency or program. The amount authorized to be appropriated
         may be specified for each fiscal year or may be indefinite
         (providing ―such sums as may be necessary‖). The authorization
         of appropriations is intended to provide guidance on what amount
         is appropriate to carry out the authorized activity.

    May 12, 2010                                                           16
                             Appropriations 101 (cont.)

•          Enactment of appropriations to provide funds for the authorized
           agency or program.

               An appropriations measure provides budget authority to an
               agency for specified purposes. Budget authority allows federal
               agencies to incur obligations and authorizes payments to be
               made out of the Treasury. Federal agencies and programs are
               normally funded each year in appropriations acts.

There are exceptions to the formal process.

There is no requirement that an authorized program receives an
appropriation. P.L. 111-148 serves as an authorization bill for the oral
health programs.

    May 12, 2010                                                                17
                  Annual Appropriations Timeline
Example FY 2011 Appropriations Calendar

Feb. 1: President Obama submits his fiscal 2011 budget request to

Feb. 2: Congressional committees begin hearings on president‘s budget

April 15: Statutory deadline (though frequently missed) for each house of
     Congress to complete its annual budget resolution. The resolution
     sets a limit on discretionary spending and may include instructions
     for a reconciliation bill.

May 15: The date after which the House may consider fiscal 2011
    spending bills even if a final budget resolution has not been

  May 12, 2010                                                        18
                  Annual Appropriations Timeline (cont.)
July 3: Beginning of Congress‘ Independence Day recess. This is the informal
      deadline that House leaders set for passing all 12 regular appropriations

July 15: President submits his mid-session review of the budget to Congress,
      which includes revised deficit estimates.

Aug. 7: Beginning of the Senate‘s summer recess. This is the Senate‘s
     informal deadline for passing all 12 spending bills.

Mid-August: Congressional Budget Office issues updated budget projections.

Sept. 13: House and Senate return from summer recess with 18 days to
      negotiate their differences and clear all appropriations bills before the
      new fiscal year begins.

Oct. 1: Fiscal 2011 begins. A continuing resolution would now be required to
      finance any agency whose appropriations bill has not been enacted.

   May 12, 2010                                                                   19
                           We have our work cut out for us!
1.) Appropriations committees are ‗stuck‘ holding the bag…
   Excerpt from FY2011 Appropriations Committee Hearing – HHS budget (4/21)
     •REP. TIAHRT: How will you cover the cost of these programs that are not in the
     budget? It says in the law "such sums as required." Where are the such sums going to
     come from?
     •SEBELIUS: Well, my understanding is, the way the process works, if there isn't
     authorization in the bill itself, this will be a discussion that you and your colleagues will
     have here in Congress.
     •REP. TIAHRT: So we're going to have to come up with the funding for these
     •SEBELIUS: If the priorities of Congress are to move ahead on these programs, I
     assume they will be funded. But you have our 2011 budget submission before you.
     •REP. OBEY: But let me simply answer the gentleman's question by saying there's a
     big difference between programs that are authorized and programs that are mandatory.
     And these are not mandatory programs to my understanding.
     •TIAHRT: Well, are we not going to fund the Community Health Insurance Option? Are
     we not going to fund the Oral Health Care Prevention Activities? I mean, there's too
     many allocated programs...
     •REP. OBEY: I don't have -- I mean, given the fact that we have a good $17 billion hole
     in the budget on Pell Grants, I have no idea what we're going to be funding on anything.

     May 12, 2010                                                                            20
               We have our work cut out for us!
2.) The President has requested a 3-year freeze in
     discretionary spending along with a deficit
     commission to realign federal spending. Senate
     Budget Chairman Conrad hopes to push deficit
     reductions even further via the FY2011 budget

3.) The Senate Budget Resolution, passed by
    Committee, proposes less funding in FY 2011 and
    FY 2012 for the Function 550 Health programs than
    found in the FY 2010 budget resolution. (not yet
    broken out between discretionary and mandatory

May 12, 2010                                            21
                                               Discretionary vs. Mandatory Budget
                                                      Spending Projections

                                                                                                                                                              2010 BR –
                                                                                                                                                              2010 BR-
                                                                                                                                                              2011 BR -
                                                                                                                                                              2011 BR-

  $ (in
                                                    2011                       2012                           2013                           2014
                                                                           Fiscal Year
                               Sources: Data from House Report 111-060 – Concurrent Resolution on the Budget – Fiscal Year 2010,
            November 8, 2010 bin/cpquery/?&dbname=cp111&sid=cp111Jtsu6&refer=&r_n=hr060.111&item=&sel=TOC_58638& (accessed 5/7/10); ―Fiscal Year                  22
                               2011 Budget Resolution, Chairman‘s Mark, Total Spending, Revenues, Deficit/Surplus, and Debt‖
                  The Time is NOW – Speak up!
Therefore….Congressional Appropriators need to hear from
constituents and interest groups that providing funding for these
programs is expected.

Advocate Action:
Write and call Appropriations Committee Members
       Talking Points for calls and letters
       Template Letter to Appropriators


   May 12, 2010                                              23
                     Talking Points for Calls & Letters
•         Who YOU are may be the most important point to make to a
          lawmaker or staff since ―all politics is local.‖

      – Explain the local need:

       (1) Explain state needs for funding and improved oral public health
             and workforce
            •   Example: Dental professional shortage areas

       (2) Explain how these programs fit into state oral health plans

       (3) Clearly explain why your state needs to access these newly
             authorized resources
            •    Example: Recent state budget cuts to dental insurance,
                 public health programs, etc. – if any. Use the context of the

May 12, 2010                                                                     24
May 12, 2010   25
            Practitioners Needed to Remove Designation
               of Health Professional Shortage Area
     12                      110                                                                                 49
                                                42            11                                                       7
                                                                          41                                            97
                          118        52                                          109                     222
                                                              19                          270                          31
                                                     7                                                            67
                                                                           61                          279
                                                               4                            179                   22
                                85                                                   420 48                       27
                                           27            59                                       28
                       392                                                     244                     132       61
                                                                    92                     38
          30                                                         55        25                193
                                      109            105                                                          5
                                                                                      179 288 224
                                                                   512          236                               7 (NH)
Ratio of Underserved to Total Population                                                                          5 (DC)
       = <10%

       = between 10% - 20%

        = >20%

Numbers = Practitioners Needed to Remove Designation                                                              26
                        Talking Points -- Continued

•         Mirror back to Congress why they enacted Health Care
          Reform: ―The Patient Protection and Affordable Care Act, is
          based on the belief that comprehensive insurance coverage
          and sound prevention will reduce the burden of disease and
          the costs of preventable illness.‖

•         How to make that real: States can help eliminate the pain,
          missed school hours and long-term health and economic
          consequences of untreated dental disease –if they have the
          option of using new federal funds for targeted investments in
          effective policy approaches.

November 8, 2010                                                          27
                        Talking Points -- Continued
•         The law authorizes funding for new and expanded programs
          to prevent dental disease and augment the dental workforce
          so that those most in need of care receive it.

•         FY 2011 appropriations, including an allocation from the
          Prevention and Public Health Fund, are necessary to fund the
          oral health programs contained in the law.

•         The consequences of poor dental health are far worse—and
          longer lasting—than many policy makers and the public
          realize; including impacts on early childhood development,
          school readiness and performance, overall health, and
          economic opportunity.

May 12, 2010                                                             28
                   Senate Appropriations – Labor, HHS
                        Subcommittee Members
•     Senator Tom Harkin (IA), Chair   •   Senator Cochran (MS), Ranking
    –   Chairs both the HELP and           Member
        Appropriations Sub-            •   Senator Gregg (NH)
        committee                      •   Senator Hutchison (TX)
    –   Committed to public health     •   Senator Shelby (AL)
        and community approaches       •   Senator Alexander (TN)
•     Senator Inouye (HI)                  (Republican members in italics)
•     Senator Kohl (WI)
•     Senator Murray (WA)
•     Senator Landrieu (LA)
•     Senator Durbin (IL)
•     Senator Reed (RI)
•     Senator Pryor (AR)
•     Senator Specter (PA)
                                                    Courtesy of

    May 12, 2010                                                                    29
                     House Appropriations – Labor, HHS
                         Subcommittee Members
•        Rep. Obey (WI), Chairman   •     Rep. Tiahrt (KS), Ranking
•        Rep. Lowey (NY)                  Member
•        Rep. DeLauro (CT)              –   Raised the issue of funding
•        Rep. Jackson (IL)                  for these provisions in the
                                            initial hearing with Sec.
•        Rep. Kennedy (RI)                  Sebelius
•        Rep. Roybal-Allard (CA)    •     Rep. Rehberg (MT)
•        Rep. Lee (CA)              •     Rep. Alexander (LA)
•        Rep. Honda (CA)            •     Rep. Bonner (AL)
•        Rep. McCollum (MN)         •     Rep. Cole (OK)
•        Rep. Ryan (OH)
                                        (Republican members in italics)
•        Rep. Moran (VA)

    May 12, 2010                                                          30
                    Other Members of Congress – Dental Supporters
These members have supported           Call or write -- request their
dental legislation/issues over their   support and advocacy with their
terms                                  peers on the Appropriations
•       House
    –        Rep. Cummings (MD)        •   Senate
    –        Rep. Dingell (MI)             –    Senator Bingaman (NM)
    –        Rep. Ross (AR)                –    Senator Collins (ME)
    –        Rep. Souder (IN)              –    Senator Snowe (ME)
    –        Rep. Upton (MI)               –    Senator Rockefeller (WV)
    –        Rep. Simpson (ID)             –    Senator Franken (MN)
    –        Rep. Alexander (LA)           –    Senator Murkowski (AK)
    –        Rep. Fudge (OH)               –    Senator Cardin (MD)
    –        Rep. Johnson (TX)
                                           (Republican members in italics)
    –        Rep. Bishop (GA)
    –        Rep. Waters (CA)
    –        Rep. Clay (MO)
    May 12, 2010                                                             31
                Links to Appropriations Committees

Senate Full Appropriations Committee
Senate HHS Sub-Committee

House Full Appropriations Committee
House HHS Sub-Committee

 May 12, 2010                                               32

May 12, 2010               33
                For More Information Contact:
Shelly Gehshan, Director

Kathy Patterson, Senior Officer

Rebecca Alderfer, Senior Associate

 May 12, 2010                                   34

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