Legislation to allow Kansas dental hygienists with advanced training to provide a broader range of services isn’t likely to survive approaching deadlines that restrict the number of bills lawmakers can consider during the remainder of their session.
Because they are non-budget bills that haven’t advanced in either legislative chamber, the bills authorizing the licensing of registered dental practitioners (RDPs) likely will be set aside for the remainder of the session.
It’s happened before. Advocates have introduced RDP bills every year since 2011 in Kansas only to have them shelved by lawmakers, usually without a hearing.
This year is different in only one respect: The chairpersons of the House and Senate committees with jurisdiction over health issues said they didn’t intend to “work” the RDP bills — Senate Bill 49 and House Bill 2079 — but agreed to have hearings on them this week.
Determined to make the most of their face time with the committees, advocates structured their testimony to showcase the broad nature of their coalition. They brought in the dean of the University of Minnesota Dental School and officials from Wichita State University and Fort Hays State University to testify along with the CEOs of two Kansas health foundations.
And they emphasized that the RDP bills had the support of Americans for Prosperity – Kansas, the free-market advocacy group backed by the Koch brothers that is especially influential with the conservative Republicans who control both houses of the Legislature.
Rodger Woods, deputy director of AFP – Kansas, told members of the House Health and Human Services Committee that licensing RDPs — also known as dental therapists — would help expand access to dental services in underserved areas of the state.
“There is far more demand than supply for oral health services (in Kansas),” Woods said, noting that 95 of the state’s 105 counties have a shortage of dental providers.
He praised the Kansas Dental Association for sponsoring the Mission of Mercy program that once a year provides charity care to large numbers of Kansans in desperate need of dental services. But he said, “From my perspective, it’s more like what we do in Third World countries.”
Woods added: “I think we need to address the issues beyond providing free care once a year. We need a dental workforce in this state just as willing to see a Medicaid or uninsured patient as they are someone with private insurance.”
Representatives of the Kansas Dental Association said creating a new kind of dental provider isn’t the way to address the state’s access problems. Kevin Robertson, KDA’s director, said various initiatives are increasing the number of dentists in Kansas and the number practicing in rural and underserved areas. He said allowing hygienists with advanced training to fill cavities, pull teeth and do restorative work that now only dentists can do would jeopardize the safety of patients.
“Kansas has made great progress in improving access to quality dental services throughout Kansas, and we will continue to work with our partners and the Legislature to develop additional strategies,” Robertson said in his written testimony to the House committee. “This is a complex issue that does not have a simple one-size-fits-all solution.”
Daniel Minnis, a Pittsburg dentist who has broken ranks with his KDA colleagues, countered the association’s safety concerns.
“Your decision on this legislation should be made on facts and not emotions,” Minnis told members of the House committee.
And the facts, he said, are that RDPs receive more intensive training than dentists do on the limited number of procedures the bills would allow them to perform. In addition, he said, thousands of studies have been done on patient safety.
“And they all show the same thing,” Minnis said. “The mid-level provider is safe.”
Minnis urged lawmakers to ask the opponents for “one piece of factual evidence” to support their claims that RDPs would endanger patients.
Rep. John Wilson, a Lawrence Democrat, complied, asking the KDA’s Robertson if he “could provide evidence” of harm.
Robertson said he couldn’t point to specific research.
“There is not a study, so to speak,” he said.
Even so, he said, dentists believe the Kansas bills would allow RDPs to do more complicated procedures than supporters are suggesting.
“I think they (dentists) believe very strongly that there would be health consequences,” he said.
The debate over this year’s RDP bills may be over. But the debate on the issue isn’t. Supporters say they will continue to press their case next year and beyond with help from national groups backing similar efforts in other states.
And Robertson said the KDA, with help from the American Dental Association, will continue its opposition.
Jim McLean is executive editor of KHI News Service in Topeka, a partner in the Heartland Health Monitor team.
