The roles and responsibilities of legislation are important to consider in policy implementation. Public policies derive from the ideas of concerned individuals, organizations, or members of the House of Representatives and Senate. Members of congress are then responsible in prioritizing policy agendas and solutions.
Once a legislative proposal is drafted, the bill may be introduced either in the House of Representatives or the Senate. Despite where the proposal originates from, a proposed bill must be vetted and passed by both legislative chambers before presenting to the executive branch (Longest, 2016). This legislative process for bill proposals is similar at both state and federal levels.
Legislative committees and subcommittees of the House of Representative and Senate are important institutions in moving proposals along the legislative process. Members of the Senate and House of Representative are actors who provide endorsement and sponsorship of bills that may be further designated into committees and subcommittees (Longest, 2016). These committees participate in extensive analysis of the proposal and have certain authority over respective committees.
In Arizona State legislation, Standing Committees participate in meetings to discuss potential bill proposals and amendments (Arizona State University Sandra Day O’Connor College of Law [ASU Law], 2019). These committees may hold public hearings to discuss perspectives and recommendations of stakeholders, organizations, and interest groups who are in support of a bill (Longest, 2016).
The Health and Human Services Committee of the Senate is responsible for holding hearings regarding proposed funding to expand dental coverage services to pregnant women through the state’s Medicaid program, Arizona Health Care Cost Containment System (AHCCCS). Arizona Senate Bill (SB) 1088, introduced in February 2019, was the 3rd attempt in legislation to pass dental coverage for pregnant women (Arizona State Legislature, 2020). Unfortunately, it did not receive the required votes to pass in the House of Representatives and was not enacted into law. This legislative proposal was originally proposed by Senator Heather Carter who continues to proactively press legislative action for comprehensive dental care coverage for pregnant women in AHCCS. This year, Senator Carter has recently endorsed SB 1170 in continuation of these efforts.
SB 1170 was proposed and first read in the senate on January 21, 2020 with a second read the following day. For a bill in Arizona to pass, three separate readings must occur before clearing from the chamber and sent to the Governor for consideration into law (ASU Law, 2019). It is the hope of bill supporters for SB 1170 that a fourth attempt in the legislative process will be successful. I encourage readers to view the Senate Health and Human Services Committee hearing from January 29th, 2020 (click video below). This hearing may help gain a thorough understanding of the legislative process and analysis of a bill discussed in a Standing Committee. Furthermore, you may find valuable information regarding the importance of comprehensive dental coverage for pregnant women.
References:
Arizona State Legislature. (2020, January). Senate Health and Human Services [Video]. Arizona State Legislature Bill Status Inquiry. http://azleg.granicus.com/MediaPlayer.php?view_id=13&clip_id=23578&meta_id=574433
Arizona State Legislature. (2020, February 13). Bill history for SB1170. Bill Status Inquiry. https://apps.azleg.gov/BillStatus/BillOverview/73234
Arizona State University Sandra Day O’Connor College of Law. (2019). The legislative process. Retrieved from http://libguides.law.asu.edu/ArizonaLaw/legislativeprocess
Congress.Gov. (n.d.). The legislative process: Overview [Infographic]. https://www.congress.gov/legislative-process
Longest, B.B. Jr. (2016). Health policymaking in the United States. (6th ed.). Chicago, IL: Health Administration Press.
The University of Arizona. (2020). The legislative process [Infographic]. http://libguides.library.arizona.edu/c.php?g=847161&p=6057216
Oral Health Care Screening in Pregnancy 
Thank you for describing the legislative process in parallel with a bill that is actively being considered. As a Neonatal Nurse Practitioner, I found your post particularly interesting. On a daily basis, I work with premature and low birthweight infants admitted to the NICU for anywhere from days to over a year depending on the infant’s gestational age and comorbidities. I noted in the recording of the Arizona Senate Health and Human Services Committee hearing, that the primary objections, concerns, and questions related to SB1170 were financial in nature. Moreover, in investigating the parallel Arizona House of Representatives bill, HB2727, I noted that the current amendments to the bill are similarly financial. Given the Arizona Congress’ fixation on the financial burden of providing comprehensive dental care to pregnant AHCCCS members, I feel it is important to note the financial burden of prematurity on society in comparison. The Institute of Medicine issued a report in 2007 that quantified the annual cost associated with preterm birth in the United States. The total cost was $26.2 billion per year (Institute of Medicine Committee on Understanding Premature Birth and Assuring Healthy Outcomes, 2007). A recent systematic review estimated that 5-38% of preterm births are attributable to periodontal disease (Daalderop et al., 2018). If we extrapolate this, $1.31 billion – $9.96 billion per year in costs related to prematurity might be prevented with preventive dental care. In its current state, SB1170 appropriates $460,100 from the state General Fund and $478,000 from the federal Medicaid authority in 2021 to provide the aforementioned services (2020). I am certainly not an economist, but a basic cost/benefit analysis seems to indicate long term cost savings through enactment of SB1170 / HB2727.
ReferencesDaalderop, L.A., Wieland, B.V., Tomsin, K., Reyes, L., Kramer, B.W., Vanterpool, S.F., & Been, J.V. (2018). Periodontal disease and pregnancy outcomes: Overview of systematic reviews. JDR Clinical and Translational Research, 3(1). https://doi.org/10.1177/2380084417731097
Institute of Medicine Committee on Understanding Premature Birth and Assuring Healthy Outcomes. (2007). Preterm birth causes, consequences, and prevention. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK11362/
S.B. 1170, 54th Legislature. (2020).
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Kendra,
Thank you for your informative blog regarding oral health in pregnancy. I had the opportunity to attend the March of Dimes Lobby Day on February 11, 2020, and one of the bills that was being supported/presented was SB 1170 and its companion bill 2727 which would add a comprehensive dental benefit for pregnant women on AHCCCS and appropriate $4 million dollars to cover additional costs (March of Dimes, 2020). I was surprised to hear that this was the third year that a form of this bill had been presented and had yet to be approved. The link between periodontal disease and adverse pregnancy outcomes including preterm labor is well documented (ACOG, 2019). Screening and counseling about oral health during pregnancy has been demonstrated to increase cleanings. Women are at increased risk of periodontal disease if they have a low socioeconomic status. Increasing education as well as improving access to preventive oral care would go a long way to begin to impact long term oral health of women.
References
American College of Obstetricians and Gynecologists. (2013). Committee opinion No. 569: Oral healthcare during pregnancy and through the lifespan, Reaffirmed 2019. Retrieved from https://www.acog.org/-/media/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/co569.pdf
March of Dimes. (2020). Taking care of Arizona moms and babies: 2020 bill package to improve pregnancy outcomes and maternal and infant health. March of Dimes.org
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It was hard for me to comprehend that it actually took multiple versions of this bill to assist pregnant women on AHCCCS to get adequate dental care. I checked on the progress of the bill on Request to Speak and it looks like it unanimously was voted through both the Health and Human Services and Appropriations committees. Here is to the hope that this third version of the bill is the charm as the Rules committee decides when it will move to the floor. Thank you for bringing attention to this bill, I will definitely be keeping an eye on it.
This had me wondering what is covered in other states and whether Arizona was ahead or behind on this issue. According to a report conducted in 2016, 46 states plus Washington D.C. cover some type of dental services during pregnancy, however the range of services varies. Only 16 states offer extensive coverage, 17 and D.C cover limited services, such as cleaning, and 13 cover only emergency care, like trauma and uncontrolled bleeding. The states that have extensive dental benefits offer diagnostic, preventive, and restorative procedures with a higher benefit limit (Skinner, 2016). It would be amazing for Arizona to move into this category.
Reference
Skinner, E. (2016). Oral health care and coverage during pregnancy. National Conference of State Legislators, 24(48).
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