Indian health bill bars therapist programs

A bill in the U.S. Congress would bar the Indian Health Services from expanding Alaska's dental health aide therapist program to other states.

The ADA has long opposed the therapist program and sued to stop its implementation in Alaska, arguing that it violated state laws that govern the licensing of dental professionals.

But the therapists practice under the auspices of the Indian Health Care Improvement Act, and in June 2007, Anchorage Superior Court ruled that the federal law trumps the state licensing regulations.

After losing that suit, the ADA fell back to preventing other states from implementing similar programs. It has threatened to oppose reauthorization of the Indian Health Care Improvement Act unless it includes a provision that bars it from funding dental therapist programs in any other state.

Similar objections from a variety of special interests have held up the reauthorization for 11 years. While Congress has extended the previous act from year to year, advocates say the program needs an overhaul.

The version of the reauthorization now in a subcommittee of the House of Representatives includes the clause requested by the ADA. According to a communiqué from the ADA, the organization is working to get similar language into a Senate version. The sponsors plan to include the bill in the larger healthcare reform bill now before Congress, the communiqué says.

The provision barring dental therapists outside Alaska frustrates some Indian organizations in other parts of the country that are having trouble getting dental care. But their primary voice in Washington, D.C., the National Indian Health Board, has agreed to the provision in hopes of finally getting the bill approved.

The therapists in Alaska undergo two years of training after high school, then qualify for a certificate that allows them to do simple extractions and restorations, as well as providing prevention, education, and cleaning.

Advocates say the therapists, who are drawn from small, remote, impoverished villages of Alaskan natives, are well-suited to bring basic oral health care to such communities, because they understand the local cultures and because they are willing to work for less money than dentists.

The ADA has argued that the villages would be better served by programs that bring in fully licensed dentists.