[House Report 117-211]
[From the U.S. Government Publishing Office]


117th Congress   }                                      {      Report
                        HOUSE OF REPRESENTATIVES
 1st Session     }                                      {     117-211

======================================================================



 
             ORAL HEALTH LITERACY AND AWARENESS ACT OF 2021

                                _______
                                

December 8, 2021.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

 Mr. Pallone, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 4555]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 4555) to amend the Public Health Service Act to 
authorize a public education campaign across all relevant 
programs of the Health Resources and Services Administration to 
increase oral health literacy and awareness, having considered 
the same, reports favorably thereon without amendment and 
recommends that the bill do pass.

                                CONTENTS

                                                                     Page
  I. Purpose and Summary..............................................  1
 II. Background and Need for the Legislation..........................  2
III. Committee Hearings...............................................  2
 IV. Committee Consideration..........................................  3
  V. Committee Votes..................................................  3
 VI. Oversight Findings...............................................  3
VII. New Budget Authority, Entitlement Authority, and Tax Expenditures  3
VIII.Federal Mandates Statement.......................................  4
 IX. Statement of General Performance Goals and Objectives............  4
  X. Duplication of Federal Programs..................................  4
 XI. Committee Cost Estimate..........................................  4
XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits......  4
XIII.Advisory Committee Statement.....................................  4
XIV. Applicability to Legislative Branch..............................  4
 XV. Section-by-Section Analysis of the Legislation...................  5
XVI. Changes in Existing Law Made by the Bill, as Reported............  5

                         I. Purpose and Summary

    H.R. 4555, the ``Oral Health Literacy and Awareness Act of 
2021,'' would authorize a public education campaign across all 
relevant programs of the Health Resources and Services 
Administration (HRSA) to increase oral health literacy and 
awareness.

                II. Background and Need for Legislation

    Oral health, defined as the health of the teeth, gums, and 
the entire oral-facial system, is an integral component of 
general health and well-being. Cavities (tooth decay), gum 
(periodontal) disease, and oral cancer are the most common yet 
preventable diseases affecting oral health.\1\ More than one in 
four adults have untreated cavities, and nearly half of those 
aged 30 or older show signs of gum disease, which if left 
untreated can lead to tooth loss.\2\ The consequences of poor 
oral health for adults and children include an annual average 
of 34 million school hours lost due to emergency dental care 
and an over $45 billion loss in productivity in the United 
States due to untreated dental disease.\3\
---------------------------------------------------------------------------
    \1\Centers for Disease Control and Prevention, Oral Health 
Conditions (Nov. 3, 2020) (www.cdc.gov/oralhealth/conditions/
index.html).
    \2\Centers for Disease Control and Prevention, Cost-Effectiveness 
of Oral Diseases Interventions: Power of Prevention (May 13, 2021) 
(www.cdc.gov/chronicdisease/programsimpact/pop/oral-disease.htm).
    \3\Id.
---------------------------------------------------------------------------
    Regular preventive dental care can catch oral health 
problems early when they are easiest to treat.\4\ However, less 
than half of the American population uses the oral health care 
system.\5\ A key tool in increasing utilization of the oral 
health care system and preventing poor oral health is the 
promotion of oral health literacy (OHL), or ``the individual 
capacity to understand and use dental information to transform 
oral health behaviors.''\6\ Individuals with limited OHL have 
been found to have increased risk for poor oral health such as 
higher risk for periodontal disease.\7\ Emerging evidence 
suggests that improving OHL may help to increase adherence to 
medical instructions, self-management skills, and overall 
treatment outcomes.\8\
---------------------------------------------------------------------------
    \4\Vujicic M. & Nasseh, K, A Decade in Dental Care Utilization 
Among Adults and Children (2001-2010), National Library of Medicine, 
National Center for Biotechnology Information (Apr. 2014) 
(pubmed.ncbi.nlm.nih.gov/24299620/).
    \5\U.S. Department of Health and Human Services, Healthy People 
2020, Children, adolescents, and adults who visited the dentist in the 
past year (age adjusted, percent, 2+ years) (accessed Nov. 30, 2021) 
(www.healthypeople.gov/2020/data-search/Search-the-Data?nid=5028).
    \6\Yue Sun et al., Trends and Developments in Oral Health Literacy: 
A Scientometric Research Study (1991--2020), BDJ Open (Mar. 1, 2021) 
(doi.org/10.1038/s41405-021-00066-5).
    \7\Id.
    \8\Id.
---------------------------------------------------------------------------
    H.R. 4555 directs HRSA to implement a public education 
campaign across all relevant programs to increase OHL and 
awareness, including through the health center program, oral 
health workforce programs, maternal and child health programs, 
the Ryan White HIV/AIDS Program, and the rural health programs. 
The legislation authorizes $750,000 each year for fiscal years 
2022 through 2026 to carry out the awareness campaign. This 
bill will also help HRSA to identify strategies that will 
provide insight into the outcomes and effectiveness of targeted 
oral health literacy campaigns and will inform future efforts 
to improve OHL for all Americans.

                        III. Committee Hearings

    For the purposes of section 3(c) of rule XIII of the Rules 
of the House of Representatives, the following hearing was used 
to develop or consider H.R. 4555:
    The Subcommittee on Health held a legislative hearing on 
October 20, 2021, entitled ``Enhancing Public Health: 
Legislation to Protect Children and Families.'' The 
Subcommittee received testimony from the following witnesses:
           Bruce L. Cassis, D.D.S., President, Academy 
        of General Dentistry;
           Raymond DuBois, M.D., Ph.D., Former 
        President, American Association for Cancer Research;
           Donald M. Lloyd-Jones, M.D., Sc.M., 
        President, American Heart Association;
           Ellyn Miller, President and Founder, 
        Smashing Walnuts Foundation;
           Rick Nolan, Former U.S. Representative (MN);
           Jenny Radesky, M.D., Assistant Professor of 
        Pediatrics, University of Michigan Medical School; and
           Stacey Stewart, President and CEO, March of 
        Dimes.

                      IV. Committee Consideration

    H.R. 4555, the ``Oral Health Literacy and Awareness Act of 
2021,'' was introduced on July 20, 2021, by Representatives 
Cardenas (D-CA) and Bilirakis (R-FL) and referred to the 
Committee on Energy and Commerce. Subsequently, on July 21, 
2021, the bill was referred to the Subcommittee on Health.
    On November 4, 2021, the Subcommittee on Health met in open 
markup session, pursuant to notice, to consider H.R. 4555 and 
eight other bills. No amendments were offered during 
consideration of the bill. Upon conclusion of consideration of 
the bill, the Subcommittee on Health agreed to report the bill 
favorably to the full Committee, amended, by a voice vote.
    On November 17, 2021, the full Committee met in open markup 
session, pursuant to notice, to consider H.R. 4555 and 11 other 
bills. No amendments were offered during consideration of the 
bill. Upon conclusion of consideration of the bill, the full 
Committee agreed to a motion on final passage offered by 
Representative Pallone (D-NJ), Chairman of the Committee, to 
order H.R. 4555 reported favorably to the House, as amended, by 
a voice vote.

                           V. Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list each record vote 
on the motion to report legislation and amendments thereto. The 
Committee advises that there were no record votes taken on H.R. 
4555, including a motion by Mr. Pallone ordering H.R. 4555 
favorably reported to the House, without amendment.

                         VI. Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1) 
of rule X of the Rules of the House of Representatives, the 
oversight findings and recommendations of the Committee are 
reflected in the descriptive portion of the report.

 VII. New Budget Authority, Entitlement Authority, and Tax Expenditures

    Pursuant to 3(c)(2) of rule XIII of the Rules of the House 
of Representatives, the Committee adopts as its own the 
estimate of new budget authority, entitlement authority, or tax 
expenditures or revenues contained in the cost estimate 
prepared by the Director of the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974.
    The Committee has requested but not received from the 
Director of the Congressional Budget Office a statement as to 
whether this bill contains any new budget authority, spending 
authority, credit authority, or an increase or decrease in 
revenues or tax expenditures.

                    VIII. Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

       IX. Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to 
increase oral health literacy and awareness.

                   X. Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 4555 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111-139 or the 
most recent Catalog of Federal Domestic Assistance.

                      XI. Committee Cost Estimate

    Pursuant to clause 3(d)(1) of rule XIII, the Committee 
adopts as its own the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974.

    XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 4555 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                   XIII. Advisory Committee Statement

    No advisory committee within the meaning of section 5(b) of 
the Federal Advisory Committee Act was created by this 
legislation.

                XIV. Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

           XV. Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 designates that the Act may be cited as the 
``Oral Health Literacy and Awareness Act of 2021.''

Sec. 2. Oral health literacy and awareness campaign

    Section 2 amends the Public Health Service Act (PHSA) to 
direct the Secretary of Health and Human Services (HHS), acting 
through the HRSA Administrator, to establish a public education 
campaign across all relevant programs of HRSA (including the 
health center program, oral health workforce programs, maternal 
and child health programs, the Ryan White HIV/AIDS Program, and 
rural health programs) to increase oral health literacy and 
awareness.
    Section 2 instructs the Secretary to identify oral health 
literacy and awareness strategies that are evidence-based and 
focused on oral health care education and to design the 
campaign to communicate directly with specific populations, 
including children, pregnant women, parents, the elderly, 
individuals with disabilities, and ethnic and racial 
minorities, in a culturally and linguistically appropriate 
manner.
    Section 2 also instructs the Secretary to include a process 
for measuring outcomes and effectiveness and to submit a report 
on the outcomes and effectiveness of the campaign after three 
years to the House Committee on Energy and Commerce and the 
Senate Committee on Health, Education, Labor, and Pensions.
    Section 2 authorizes $750,000 for each of fiscal years 2022 
through 2026 to carry out these activities.

       XVI. Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (new matter is 
printed in italics and existing law in which no change is 
proposed is shown in roman):

                       PUBLIC HEALTH SERVICE ACT



           *       *       *       *       *       *       *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

           *       *       *       *       *       *       *


Part D--Primary Health Care

           *       *       *       *       *       *       *


Subpart X--Primary Dental Programs

           *       *       *       *       *       *       *


SEC. 340G-2. ORAL HEALTH LITERACY AND AWARENESS.

  (a) Campaign.--The Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration, shall establish a public education campaign 
(referred to in this subsection as the ``campaign'') across all 
relevant programs of the Health Resources and Services 
Administration (including the health center program, oral 
health workforce programs, maternal and child health programs, 
the Ryan White HIV/AIDS Program, and rural health programs) to 
increase oral health literacy and awareness.
  (b) Strategies.--In carrying out the campaign, the Secretary 
shall identify oral health literacy and awareness strategies 
that are evidence-based and focused on oral health care 
education, including education on prevention of oral disease 
such as early childhood and other caries, periodontal disease, 
and oral cancer.
  (c) Focus.--The Secretary shall design the campaign to 
communicate directly with specific populations, including 
children, pregnant women, parents, the elderly, individuals 
with disabilities, and ethnic and racial minority populations, 
including Indians, Alaska Natives, and Native Hawaiians, in a 
culturally and linguistically appropriate manner.
  (d) Outcomes.--In carrying out the campaign, the Secretary 
shall include a process for measuring outcomes and 
effectiveness.
  (e) Report to Congress.--Not later than 3 years after the 
date of enactment of this section, the Secretary shall submit 
to the Committee on Energy and Commerce of the House of 
Representatives and the Committee on Health, Education, Labor, 
and Pensions of the Senate a report on the outcomes and 
effectiveness of the campaign.
  (f) Authorization of Appropriations.--To carry out this 
section, there is authorized to be appropriated $750,000 for 
each of fiscal years 2022 through 2026.

           *       *       *       *       *       *       *


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