Getting dental coverage for pregnant women: Institutions, actors, and mechanisms

Institutions and Statutory Mechanisms

How does this bill become a law? Lets break it down… The Arizona state government runs much like the United States federal government. The legislative branch of the state government is the main institution that impacts the policy that would increase access to dental care for pregnant women in Arizona. The legislative branch consists of two houses of Congress – the Senate and the House of Representatives (Longest, 2016). In order for a bill to even be considered, it must be introduced into Congress by a member of Congress. The Congress member who introduces the bill becomes the sponsor of the bill (Longest, 2016). The current proposed bill (SB1088) calling for dental coverage for pregnant women under Arizona’s Medicaid (AHCCCS) has just been introduced to congress for the third time by a member of the Senate, Heather Carter. Because Senator Carter introduced this bill, it must be passed by the members of the state Senate first. On January 30^th, the Senate Health Committee had a hearing and unanimously passed the bill (click here to view the hearing). This was the first step in getting it passed through the Senate. Next, the bill will go to the Senate Appropriations Committee, the Senate floor, then to similar committees in the House (Longest, 2016). The appropriations committees work with the state budget. This is an important step because not finding room in the budget to pay for this dental coverage is what caused the bill to fail before. Assuming it passes in both the Senate and the House, then its up to the governor, Doug Ducey. If the governor passes the bill, it becomes a law. (Yay!) If he denies the bill, there are ways around it, and Congress can still get it passed into law (Longest, 2016). (Few!) Every year in January, this process begins again with new bills. The actual process is much more complex, but you get the basic idea. Getting the bill through these complex steps is considered the statutory mechanisms of policy making (Longest, 2016).

Institutions and Regulatory Mechanisms

If the bill passes and becomes a law, regulatory mechanisms come into play. The Center for Medicare and Medicaid gets involved here with making sure the law is implemented as it should be (Longest, 2016). AHCCCS is a part of the complicated process of making sure pregnant women in Arizona who qualify actually get dental care covered. Its very important that the law does what it is intended to do.

Actors

This whole legislative process takes a long time and a lot of work from many different actors. Actors, unlike the ones seen on TV, are individuals and organizations who work to get bills passed into law. The important actors for this particular bill include: individual policy makers and legislators, political parties, lobbyists, health care and dental providers, researchers, health care associations and other interest groups, pregnant women, and individual advocates from the community. Actors who do not work for the government advocate and lobby for this bill to pass. They have a role in showing support, speaking on behalf of the issue, and providing anecdotal and scientific evidence. I had the opportunity to interview a very important advocate for with this bill, Kevin Earle, Executive Director of the Arizona Dental Association (ADA), and Chief Lobbyist. Kevin participated in the Senate Health Committee Hearing, speaking to the members of the senate on behalf of this bill (K. Earls, personal communication, January 30, 2019). He has worked to put specific language into the bill that allows for comprehensive preventative dental coverage without a monetary limit. Kevin and the ADA have been and continue to be involved with access to dental care issues by providing their advocacy and expertise (K. Earls, personal communication, January 30, 2019).

Actors can also work against a bill if they do not want it to pass. However, there are not many opposed to this particular bill. The majority of actors involved at all levels understand why access to affordable dental care is so important for pregnant women (see my first blog for more background). This year, Kevin is hopeful that there will be less competition for funding, meaning more room in the budget to make it happen (K. Earls, personal communication, January 30, 2019). As am I. As you can probably tell by now, getting through the legislative process is difficult, complex, and time consuming. But stay tuned, my next blog will include more from my interview with Kevin with additional insight on this important policy issue from someone who is an expert on the front-lines.

Now that you are pretty much an expert on getting bill passed in Arizona, I will leave you to enjoy this classic Schoolhouse Rock video as a review of this complex process:

Reference

Longest, B.B. Jr. (2015).  Health policymaking in the United States (6th ed.). Chicago, IL:  Health Administration Press.