While Congress stood in recess for the balance of this week, staff began trickling back into town to determine a strategy for reconciling the differences between health reform bills passed by the U.S. Senate and the U.S. House of Representatives.  Early reports indicate that lawmakers will forgo a formal "conference committee" process, where each chamber would send designees to negotiate on its behalf.  Instead they might undertake a "ping pong" approach, where the chambers take turns adopting versions of the other's bill until a final piece of legislation is developed.  On many key issues the House is expected to defer to the Senate, where the Democratic majority is weaker and consensus is more hard-won.  This process will determine the fate of various oral health provisions included in both the House and Senate bills.
 
Both bills contain a critically important pediatric oral health benefit but beyond that many differences remain.  Specifically, a key section authored by Senator Bingaman that is designed to prevent oral disease and provide funding to build a stronger state oral health infrastructure  was included in the final bill that the Senate passed on Christmas Eve.  That bill also included compromise language promoted by Senator Franken on the Indian Health Service's Dental Health Aide Therapist (DHAT) model in Alaska.  It allows the DHAT to be replicated in those states that have authorized these models and stipulates that no DHAT will take the place of a dentist in the Indian Health Service.  The Senate bill also funds demonstration projects to test new models of midlevel dental providers.
 
The House bill includes a key provision authored by Congresswoman DeGette requiring that multiple oral health experts must be included in the advisory committee that oversees the new marketplace for uninsured, the Health Benefits Exchange.  This will be critical to ensuring that the pediatric oral health benefit is robust and produces good outcomes for children.  The House bill also includes a provision offered by Congressman Butterfield that requires the Secretary of Health and Human Services to report to Congress on the cost and need of providing oral health care to adults under the Exchange.
 
Differences also remain between the two bills in their approaches to the participation of stand-alone dental plans in the Exchange.  The Senate bill requires that stand-alone dental plans participate in the Exchange but exempts dental plans from consumer protections and potentially eliminates competition in the marketplace.  The House bill provides for their participation as subcontractors to medical plans. CDHP is working with Capitol Hill to ensure that the pediatric dental benefit is robust, that cost-sharing and other consumer protections apply to dental as well as medical plans, and that competition among medical and dental plans is available to all who purchase insurance in the Exchange.  To achieve this, CDHP has advocated for the adoption of the House language with an additional provision to require the Secretary of Health and Human Services to address the competitive participation of dental stand-alone plans in an Exchange.  
 
The Senate will remain out of session next week and return the following week.  The House will convene briefly on Tuesday and Wednesday to take non-controversial procedural votes, only to recess again on Thursday for a two-day Democratic Issues Conference.  Leadership in both chambers has renewed a commitment to sending a bill to the President's desk by the State of the Union speech, which is scheduled for February 2nd.