[Congressional Record (Bound Edition), Volume 153 (2007), Part 8]
[Extensions of Remarks]
[Page 11345]
[From the U.S. Government Publishing Office, www.gpo.gov]




        INTRODUCTION STATEMENT FOR HIV/AIDS DENTAL SERVICE BILL

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                       HON. ELEANOR HOLMES NORTON

                        of district of columbia

                    in the house of representatives

                         Thursday, May 3, 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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