[Congressional Record (Bound Edition), Volume 152 (2006), Part 5]
[Extensions of Remarks]
[Pages 6494-6495]
[From the U.S. Government Publishing Office, www.gpo.gov]




 INTRODUCTION OF THE DEDICATED DENTAL SERVICE FOR HIV/AIDS ACT OF 2006

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                       HON. ELEANOR HOLMES NORTON

                      of the district of columbia

                    in the house of representatives

                        Thursday, April 27, 2006

  Ms. NORTON. Mr. Speaker, I am pleased today to introduce the 
Dedicated Dental Service for HIV/AIDS (DDS for HIV/AIDS) Act of 2006 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 enacted in the past to encourage other health 
professionals, such as physicians, nurses, optometrists and pharmacists 
to provide vital services in underserved areas.
  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, I 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.
  For HIV/AIDS patients the crisis is palpable. 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

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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 underfunded 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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