# data[].attributes.body
The American Dental Association (ADA) has played an active role in advocating for legislation to improve and expand private dental care and oral health for Americans.

1. Because the use of dental services is closely tied to income, the favorable tax treatment of employer-provided health insurance premiums has been a significant factor in the industry's expansion.

2. With legislative initiatives like Medicaid expansion and the inclusion of dental coverage in the Affordable Care Act, the ADA has been promoting greater access to dental care. The American Dental Association (ADA) has collaborated with state and federal lawmakers to enact laws requiring insurance companies to pay for dental services and raising payment rates for dentists who treat marginalized groups.

3. The ADA has pushed legislation to alleviate the lack of dentists in underprivileged communities. The ADA collaborated with state and federal lawmakers to develop laws that offer dental students who agree to practice in underprivileged areas loan payback plans and scholarships.

# data[].attributes.body
Legislation to decrease the availability and/or increase the price of substitutes is a limiting mechanism deployed by health associations to decrease competition. Decreasing the supply will increase demand for their respective member's services. The three approaches utilized to achieve this is: declaring the substitute illegal shifting demand away from the substitute, excluding substitute services from receiving payment through third parties raising the price of the substitute, and raising the cost of substitutes causing them to pass that cost on to the consumer of the service.

# data[].attributes.body
Legislation to reduce the price and/or increase the quantity of complements focuses on keeping the physician the primary provider of healthcare services. A substitute increases competition, while complements increase productivity without having to sacrifice more income. The determination of whether an input is a substitute or a complement is dictated by who receives the payment. For example, if a nurse provides services under the supervision of a physician and the physician bills the patient, the nurse is a complement. If a nurse practitioner provides services and bills the patient, they are a substitute. For the purpose of standardizing, the state practice acts is suppose to lay out certain tasks that each health profession is able to perform and under whose guidance they must comply with.

# data[].attributes.body
American Nurses Association

By working with the government in ways to limit the increased supply of nurses.(How to place a cap on more nurses' output)-- Goal is to decrease the number of nurses coming out

1. Nursing education is only offered to colleges that offer a BS degree in nursing

2. To be deemed  a professional nurse you must graduates from a four-year program or else you are a technical nurse

3. Increases the nursing educational requirements

1. Put them through the ringer

# data[].attributes.body
Limits to legislation increase to supply

The limits to what the legislation can do to increase the supply of a particular good or item in three ways.

1. Government financing institutions and places that create the supply

2. Policies and tax exemptions for companies to continue to provide these services and pay lower interest rates or lower or no taxes to the government

3. Regulations to who and what can be sold to the consumers and provide aid on how  to enter the marketplace (when you are new)

# data[].attributes.body
- There was concern during the 1980s that there was too many dentist practitioners. that the number was increasing as well as other health professions.

- Instead of waiting for the market to put a cap of the number of dentist. The ADA solution was to reduce the number of dental school spaces.

- The ADA response was "a surplus of dentists does exist to meet the current demand for dental services".

- ADA encourage constituent socieities in preparing some form of legislation that could be use to petition the current policies to adjust enrollment in dental schools.

- ADA has imposed requirements on new dental entrants that could be potiential barriers.

- Example: foreign medical and dental graduates had to be U.S citizens before they were able to start practice in many states.

- Other requirements could be a 1 year residency requirement in order to practice in when moving to a new states. No matter how well trained and experience they had prior to moving.

# data[].attributes.body
Dental Societies serve the needs of the public in oral health through membership. They promote overall health, which is related to general health.

Dental Societies Practice the “any willing provider” practice, based on 1982 legislation, which states that people are free to make their own choices as it relates to choosing their providers.

The providers that are used are PPOs and HMOs. The difference is that HMOs are a closed provider panel, where prices are set, and PPOs are able to discount their fees for more patients.

# data[].attributes.body
Before there was medical insurance, providers were able to price-discriminate, and once insurance was effective, physicians tried to maintain this practice.

Blue Shield, a medical insurance, paid the physicians fee in full for patients who fell in lower income, while for patients with a higher income, physicians were able to “balance-bill” (charge patients an additional amount after Blue cross payment)

Blue cross income limits were later removed

This conflicted with physicians decision to participate with medical insurance. Many contemplated what pathway would benefit them the most payment-wise

Once Medicare was introduced, physicians decided if they wanted to participate in the program.

If physicians did no participate, patients would have to pay for everything, possibly more.

HMO’s limited price- discrimination, physicians were not able to receive hospital privileges when joining a plan

AMA opposed for medicare participants to joins HMO’s

# data[].attributes.body
- The AMA favors internship and residency programs in hospitals, but residents are complements not substitutes for the physician because the physician is paid for the service.
- The main concern of the AMA is that interns, residents, foreign medical graduates, etc do not become substitutes for the physician.
- The purpose of interns and residents is to take care of the physician's patients, allowing the physician to be relieved from working in the emergency room or being on call. This also gives interns and residents the opportunity to gain experience in the healthcare field.
- Since residents are complements, not substitutes, the AMA is in favor of using foreign medical graduates to serve as interns and residents. However, after graduating, foreign medical graduates substitute existing practitioners. Therefore, the AMA advocated that there be a time limit on how long foreign medical graduates can stay in the United States after graduating.

# data[].attributes.headline
American Medical Association (AMA) -Decreases availability/decreases price of substitute (Elizabeth)

# data[].attributes.subject
American Medical Association (AMA) -Decreases availability/decreases price of substitute (Elizabeth)

# data[].attributes.body
Substitutes are goods that can be used in place of one another. The price and demand for substitutes are directly related. One of the major legislative goals of health associations is to raise the price of goods and services that are substitutes for what the members of the association produces. Also, the association attempts to decrease the availability of the substitute. Associations achieves their goals by:

·      Declaring the substitute illegal- demand will shift away from the substitute

·      Refusing payment services- the price of the substance will rise

·      attempting to raise the price of the substance-they must raise the price to stay in market

Examples of legislation made by the American Medical Association (AMA).

·      Claim that osteopaths are unethical- physicians do not teach them •

·      Deny osteopaths hospital privileges- not a good substitute •

·      Deny osteopath licenses

·      Medicare excludes non-physician substitutes- chiropractors, optimists

·      Substitute services are more expensive than physician services.

# data[].attributes.body
- Nurse Training Act: AHA lobbied for passage of this act and believed federal educational subsidies would increase RN supply to hospitals
- Opposed legislation that would increase cost of inputs to hospitals --> min. wage extension legislation, called for moratorium (prohibition of activity) on license separation of health professionals
--> License separation: limits hospital's ability to substitute different health professionals, demanded by each health professional association to ↑ demand for services by restricting tasks others professions can perform
- Hill-Burton program: provides capital subsidies to modernize hospitals --> AHA was strong proponent of this program

# data[].attributes.body
- The AMA has adopted demand increasing legislation through an employer mandate by requiring employers to cover their employees through employee-sponsored health plans. This increases the demand for physician services because those that are working but are not receiving health insurance through their employer are required to have private coverage. This ultimately is a way for physicians to make as much money as possible
- The AMA is also in favor of adopting demand increasing legislation through a system of tax credits, which incentivizes consumers to purchase private health insurance, thereby increasing how much money they take home

# data[].attributes.body
- legislation that enables health associations to achieve a goal that cannot be achieved through a competitive market (i.e. making as much money as possible for the members of a given health association by increasing the demand for services)
- demand-increasing legislation is essentially legislation that increases the demand for health services ?

# data[].attributes.headline
The American Nurses Association (Fatima)

# data[].attributes.subject
The American Nurses Association (Fatima)

# data[].attributes.body
- is in favor of permitting advanced nurses to bill a fee-for-service
- Nurses are trying to become independent practitioners though AMA is not with them on this
- they want to do this because it is the best way for them to increase their income (just how physicians or nurse practitioners do it)

# data[].attributes.headline
Securing the highest method of reimbursement -Fatima

# data[].attributes.subject
Securing the highest method of reimbursement -Fatima

# data[].attributes.body
-The method used by the provider (doctors) to charge for their services
-providers utilize 2 methods to obtain the highest method of reimbursement
- 1st: eliminate price competition,
- this can be crucial for new practitioners or firms trying to put themselves out there to notify the people they are available to provide services therefore advertising their services.
- advertising medical services has been deemed “unethical behavior”
- penalties like getting your medical license revoked exist for engaging in such practices.
- the AMA is trying to fight congress to allow physicians to establish what is like a cartel to be able to set their own prices if they’d wish to do so.
-2end: engage in price discrimination
-it is to charge different patients a different price even if it was the same service as the other patient who received the same treatment
- they do this depending on the patients(or their insurance) ability to pay