Introduction Statement for HIV/Aids Dental Service Bill

Floor Speech

INTRODUCTION STATEMENT FOR HIV/AIDS DENTAL SERVICE BILL -- (Extensions of Remarks - May 04, 2007)

* Ms. NORTON. Madam Speaker, I introduce the Dedicated Dental Service for HIV/AIDS (DDS for HIV/AIDS) Act of 2007, to establish a loan repayment program for dental school graduates in exchange for their agreement to remedy a critical shortage of dentists for the poor, particularly in areas with a high incidence of HIV and AIDS, by agreeing to serve such patients. This bill is similar to legislation Congress has previously enacted to encourage other health professionals, such as physicians, nurses, optometrists and pharmacists to provide vital services in underserved areas. This bill is being introduced in conjunction with a series of HIV/AIDS town hall meetings that I am hosting in the District of Columbia.

* I am introducing the bill on the same day when I am hosting a Men's Town Meeting on HIV/AIDS. This public meeting is one of a series of town meetings I am holding to increase awareness and individual responsibility at a time when 50 percent of AIDS cases today are African American. Howard University professors of dentistry inform us that the first indicators of HIV/AIDS infection are often oral health problems. Oral health problems often not only constitute an important early signal of HIV/AIDS symptoms; they also serve as benchmarks for disease progression. One of the most serious problems with the spread of HIV/AIDS is the reluctance of people to be tested for such a disease, especially in the African-American community and other big city and rural areas. Access to dental care, therefore, is critically important from the earliest onset, especially in high impact areas. Access, of course, minimizes long-term oral health complications for patients, but it also provides important linkages to good overall medical care to combat the disease in the community.

* A recent RAND health study on HIV costs and services found that the vast majority of patients received care at their local AIDS clinic, not a primary dentist. Moreover, these disfavored patients must look for service within the context of a nationwide drop in dental school applicants and graduates, and a projected 60 percent loss of active dentists due to retirement. As a result, the average American, especially those with HIV/AIDS, will, or already are, having difficulty in obtaining dental care.

* The crisis is palpable for HlV/AIDS patients. They have even more difficulty than other Americans finding dentists who will accept Medicaid or treat patients at reduced cost.

* Some dentists are reluctant to provide care. Although only one case of transmission between dentist and patient has been documented, problems of access are acute. Many patients must travel long distances to find care. Many states do not include dental care as part of their Medicaid coverage. Patients often must search for providers such as schools of dentistry or local community clinics which receive some funds from the Dental Reimbursement Program (DRP), administered through the Ryan White CARE Act.

* My bill would create a loan forgiveness program for dental school graduates who agree to serve HIV/AIDS populations in areas where there is a high incidence of such cases, as defined by the Department of Health and Human Services. This program is drawn from the nurse loan forgiveness program passed by Congress in 1998. The crisis for the dental profession, especially in the distribution of dentists in underserved areas, is even greater than for physicians. Dental school graduates incur an average loan debt of $100,000. Under the guidelines of the program, the Secretary of the Department of Health and Human Services is authorized to pay 60 percent of the principal and interest on the loans in exchange for service for a period of no less than two years. If a dentist agrees to participate in a third year of service, another 25 percent of the principal and interest on his loans will be paid. Loan forgiveness programs bring important added value because many recipients remain in practice in the area to which they are assigned. The Secretary of HHS is to submit to the Congress a report on the program, with information including the number of dentists enrolled, the number and amount of loan repayments, the placement location of loan repayment recipients, and the evaluation of the overall costs and benefits of the program.

* With more than one million Americans with HIV/AIDS, and over 16,000 in the District of Columbia, and its impact among people of color, these health providers need greater attention. We are proud of the overworked and under-funded services that are available in the District of Columbia. The Howard School of Dentistry has a long history of providing dental services to the poor here, and the HU CARES program provides care for nearly 1,200 patients a year. The vital Whitman-Walker Clinic, the largest provider of comprehensive HIV/AIDS services in the District and the region serves over 1,500 dental patients a year.

* I urge my colleagues to join with me in establishing this dental loan repayment program that will meet an immediate and pressing need in communities across the country, as we have for other professions.

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