House committee considers DOC Access Act
ADA shares support for bill in health subcommittee hearing
The ADA is making its voice heard on Capitol Hill. Ahead of a Sept. 15 hearing for the House Energy and Commerce Committee’s Health Subcommittee, the ADA submitted a statement for the record expressing strong support for H.R. 1521, the bipartisan Dental and Optometric Care Access Act, or the DOC Access Act. The bill was among 17 legislative proposals discussed during the committee's hearing on “Examining Legislative Proposals to Reform Medicare Provider Payment and Bolster Health Care Cybersecurity.”
The ADA is pressing Congress to address insurer control over fees for dental services that insurance plans do not cover.
In the statement, ADA President Richard Rosato, D.M.D., and Executive Director Nader Nadershahi, D.D.S., Ed.D., M.B.A., expressed strong support for the bipartisan DOC Access Act, saying it would limit contractual arrangements that allow insurers to set fees for services they do not cover.
More than 40 states have enacted laws limiting insurer involvement in fees for services that dental plans do not cover. But the ADA noted that self-funded plans governed by the Employee Retirement Income Security Act, or ERISA, can claim an exemption from those state protections without federal action.
“It is unreasonable for dental plans to set fees for services in which the plans have no financial liability,” Drs. Rosato and Nadershahi wrote.
The issue comes as a new Government Accountability Office report highlights concentration in the dental insurance market. In 2024, the three largest dental insurers in each state held a median of 66.8% of the group-market enrollment, with their combined share ranging from about 38% to 98%. In 11 states, the three largest insurers controlled at least 80% of the market.
The ADA said that allowing these carriers to continue to fix prices on services they don’t cover only increases their leverage in the market, further concentrates their power, and shifts costs to patients who pay out of pocket, instead of decreasing the cost of care.
Rep. Yvette Clarke, D-N.Y., who introduced the legislation with Rep. Buddy Carter, R-Ga., said the bill “seeks to lower prices and puts control back into the hands of patients and their doctors.”
“It is clear patients deserve lower costs, greater transparency, accountability, and the freedom to choose their care, which is why we've introduced bipartisan legislation, a commonsense step toward addressing anticompetitive conduct and strengthening protections for patients,” Rep. Clarke said.
Rep. Carter also raised concerns about consolidation in healthcare during the hearing.
“I've often said that at the end of the day, whether you're Republican or a Democrat or an Independent, we all want the same thing when it comes to healthcare. We want affordable, accessible quality healthcare. And accessibility is being impacted by consolidation,” he said.
Drs. Rosato and Nadershahi concluded the letter by calling on the committee to take further action on H.R. 1521. The next step in the legislative process would be a formal subcommittee markup of the bill if lawmakers decide to proceed on the bill.
“Passage of H.R. 1521 would balance the scales and bring equity to carrier-provider contracting at the federal level,” they wrote. “We respectfully urge the Committee to markup H.R. 1521 and look forward to working with you to advance the bill.”
