Episode 3: NAVIGATING THE 2025 VIRGINIA LEGISLATIVE SESSION: INSIGHTS AND OUTCOMES FOR DENTISTRY

In this episode, Tripp Perrin discusses the outcomes and key themes from Virginia’s short 45-day 2025 legislative session, highlighting the political motivations and posturing influenced by upcoming elections. He highlights notable achievements for the dental community, including the passage of a crucial bill on insurance transaction fees and efforts to address the dental workforce shortage. Additionally, Tripp explores the session's impact on the budget, Medicaid concerns, and the importance of sustained legislative engagement by dental professionals.

Host: Paul Logan of the Virginia Dental Association. Paul focuses on member advocacy, developing resources for dental students and early career dentists, and working with a broad array of stakeholders to elevate and address Virginia’s dental workforce needs. Paul currently serves on the executive committee of the Coalition for Modernizing Dental Licensure and the College Board of J. Sargeant Reynolds Community College. Outside of work, he’s trying to keep up with his three- and six-year-old daughters.

Guest: Tripp Perrin, President of the Lindl Corporation and VDA Contract Lobbyist. Tripp began his career at Lindl in 1995 and eventually worked for two Virginia Governors. Tripp also has extensive private sector experience serving in a variety of senior-level management roles in the investment banking, management consulting, and healthcare fields. He holds an MBA from the College of William & Mary, a BA in Leadership Studies from the University of Richmond, and was a 1997 Fellow at the Sorenson Institute for Political Leadership

Note: In the time since this podcast was taped, Arkansas became the 11th state to join the Dentist and Dental Hygienist Compact. You can find the most up-to-date map of states with enabling or pending legislation at https://ddhcompact.org/compact-map/

SB925 Health insurance; carrier business practices, method of payment for claims

SB904 Medical malpractice; limitation on recovery; certain actions.

Contribute to the VDA Political Action Committee

Contact your legislators and share the talking points on the workforce crisis and other bills and budget items

VDA’s Dental Insurance Grievance Tracker - https://www.vadental.org/dental-insurance-grievance-tracker

Sign up for VDA text alerts by texting “VDA” to 52886.

Credits: 

• Host/Producer: Paul Logan
• Guest: Tripp Perrin
• Post-Production/Editor: Shannon Jacobs

Subscribe, share, and send your feedback and topic ideas to thefulcrumpodcast@vadental.org.

The information, opinions, and recommendations presented in this Podcast are for general information only, and any reliance on the information provided in this Podcast is done at your own risk. This Podcast should not be considered professional, medical, or legal advice.

Music in this episode from Epidemic Sound

Transcript

[00:00:00] Paul Logan: Today on The Fulcrum Podcast, we're joined by VDA contract lobbyist, Tripp Perrin to recap Virginia's General Assembly session and the legislation around workforce insurance rules and more that impacts dentists in Virginia and their patients.  

[00:00:30] Paul Logan: Tripp. Welcome. We had a short 45-day session that adjourned on time this year. Congratulations. Tripp, what were some of the themes you saw coming into the 2025 legislative session?   

[00:00:43] Tripp Perrin: I think you know, anytime you have a, a short session like this we have all a hundred members of the House of Delegates who are up for reelection in the Fall. And so that was certainly high motivation to get them in and outta here in a in a quick 45, 46 day session. So it was nice for them to come in and get their work done and get outta here. I think certainly there was some political posturing, obviously, as there always is in a session such as this, but particularly this one given the fact you've got a very narrowly divided house.

[00:01:15] Tripp Perrin: A lot at stake in the, in the elections come November. Uh, Along with the house, obviously you have members of the uh, you got the statewide elections as well to include Governor, Lieutenant Governor and Attorney General up for grabs. And so I think in a lot of respects nobody wanted to do too much to rock the boat.

[00:01:32] Tripp Perrin: There was a lot of sort of quote unquote brochure bills that probably was never gonna see the light of day, but just, just something that people could wave around uh, both on the 

[00:01:39] Paul Logan: Sure. 

[00:01:40] Tripp Perrin: Progressive side as well as on the conservative side um, so that people could use that as they go out and, and, and get to get the campaigning.

[00:01:47] Tripp Perrin: But I have to say overall. All these things are fast and furious, but uh, as far as sort of process and how things went I think it went very well. I think there was a lot of concern that uh, we may not have a budget. , but certainly the House and Senate in terms of their negotiating and being able to get to a place where they both agree, which is not always easy, even though they're both, both houses are controlled by Democrats. They were able to pretty easily send a budget to the governor that they can agree on. And now the governor's gotta decide ultimately what to do with that budget. 

[00:02:19] Paul Logan: Sure. And. Even with a short session we did see a few significant wins for dentistry.  

[00:02:26] Paul Logan: And for those listening, whether you were there in person or not, you were represented by the hundreds of dentists and dental students who showed up for VDA Dental Days at the Capitol, along with our lobbying team, our Director of Government Affairs, Laura Givens, who, keeps it all organized. 

[00:02:40] Tripp Perrin: She makes it all happen

[00:02:41] Paul Logan: In the right direction and, and yeah.

[00:02:45] Paul Logan: So, um, starting with insurance transaction fees, this is one of the big issues that we hear about from our members, something we've seen in the VDA's Dental Insurance Grievance Tracker. Can you talk about the process for that? That bill and what it means for our member dentists. 

[00:03:01] Tripp Perrin: Sure. It was a bill that got introduced. We did not actually have, actually as an association have it introduced some other associations did. I think the hospital association was involved as well as the medical society, but we quickly flagged the bill as soon as it dropped. And basically what the bill does, it requires a health insurance carrier to notify a provider i.e. a dentist if the carrier or entity completing the transaction on behalf of the carrier uses a payment method that imposes a transaction fee or processing fee or something similar there too.  

[00:03:33] Tripp Perrin: So it requires notification, number one and then number two, and probably most importantly, it also requires that that carrier uh, also provide an alternative means of payment that does not have a fee associated with it. So, So good win there. You know, uh, certainly, Certainly a good win. You know, Obviously costs continue to go up and our costs and our member's costs continue to go up. So a good way to keep keep those and check it in line.   

[00:03:56] Paul Logan: And those are things you think about. It might be a small fee on each transaction, but over the course of a year of transactions you're talking about, it could be hundreds, thousands of dollars for a practice. 

[00:04:06] Tripp Perrin: Visa and MasterCard are very uh,, very well-healed, publicly traded companies for a reason. They just get a small piece of a lot of, lot of pies.   

[00:04:15] Paul Logan: Workforce is on the mind of all of our member dentists. We did a lot of education with the General Assembly this year on the dynamics of Virginia's allied dental workforce shortage ahead of a major budget year, coming up next year. We also had an important bill from Senator Todd Pillion, , that directs the Board of Dentistry to study and make recommendations on expedited pathways to licensure by endorsement for dentists and dental hygienists.

[00:04:42] Paul Logan: The other piece of his bill is that it directs the group to make recommendations on a pathway for qualified, internationally trained dentists to practice dental hygiene under the supervision of a licensed dentist. Obviously this passed with strong support from the VDA. Can you talk a little , bit about what it means going forward and the next steps members can expect? So now we have this bill setting up a work group. 

[00:05:05] Tripp Perrin: Yeah, it's uh, it's definitely, it is, it's a you know, certainly as far as I think consequential piece of legislation, it'll certainly be know next to the credit card deal. Very important uh, to keep the issue you know, this, the workforce issue front and center directly with the Board of Dentistry and with other stakeholders, including yourselves.

[00:05:22] Tripp Perrin: Including the hygiene association is something that's near and dear to Senator Pillion's heart who obviously is a pediatric dentist, i n Abingdon the dental Association could not have a better advocate up in Richmond. As I've said before, he is somebody that's very well regarded on both sides of the aisle.

[00:05:39] Tripp Perrin: He's a budget conferee, meaning, meaning he's in the room with the when the pie gets cut. And , that's obviously very important uh, for lots of, lots of different reasons, but particularly as it relates to dentistry. And so what the, what will happen next , once we get through reconvene session, which is April the second the Board of Dentistry will start to put together these work groups and probably my guess is probably have three or four different sessions to figure out, what can we do to expedite licensure, both for dentist, but as but probably on our end, most importantly for hygienists. What are the things that we can do to increase the hygienists that that practice here in Virginia? And certainly loosening some of the, some of the restrictions that we can that may be a pathway as well as I know we've had lots of discussion about having foreign trained dentist be able to do hygiene here in Virginia. That's certainly something we're gonna take a very, very hard look at. I think as needed, I think Senator Pion will be happy to to weigh in and give his opinion and his thoughts to make sure that we have a meaningful piece of legislation or pieces of legislation next year going into 2026 session.  

[00:06:48] Paul Logan: And when you're talking about that licensure by, by endorsement across state lines that's a big chunk of our licensed workforce. When you look in the last five years, it's 43% of hygienists licensed were educated out of state. So having those clear pathways is important for them to have just confidence as they're coming in that they're going to be able to get to work, get licensed and begin practicing. 

[00:07:14] Tripp Perrin: Absolutely, and I think the genesis of this whole Bill was the um, medical society, the Board of Medicine came out with some regs. The governor actually approved them back in December. Previously it was, I think medicine was either four or five in the last six years, somebody had to practice in order to be able to come into Virginia by endorsement. With dentist. It was, it's also five or six years thought is to take it and mirror what is now the board of medicine, which is only two years. And I think that'll be one of the things that we'll talk about about here with the work group, whether it's two years or three years or some something different. But that'll definitely be a topic of conversation. And it was really sort of the genesis to, to get this whole thing started uh, with Senator Pillion.  

[00:07:55] Paul Logan: And while we're on that topic, this is a bill that didn't pass this year, but the previous year Virginia became the fifth state to enter the dentist and dental hygienist compact. That compact commission actually met for the third time. And they are setting up the framework for that and something that we expect, hopefully that they'll be able to begin issuing compact privileges later this year. They're now ten states that have passed enabling legislation or part of the compact. 16 more states have pending legislation including Maryland. We're also moving forward on that front. And hopefully as Virginia has representation on that compact commission, we'll be able to move forward with with rules that will make it much easier, or at least give people confidence as they're coming in from out of state or looking to practice in a different state that that they'll be able to have a smooth transition to do that.

[00:08:56] Tripp Perrin: Sure. It's always you know, and we, we've talked about it forever since I've been working with you guys for. 16, 17 years now, I think you've gotta balance obviously what's in the best interest of the patient, first and foremost. Right? But also as the world has changed and you have more and more frankly younger legislators who were sort of used to the sort of being mobile and, definitely are more inclined to want to to, to loosen some of these restrictions again, as long as it stays within the realm of keeping, keeping the patient safe. So I think we're gonna continue to see a move to that as long as we are we're in the meetings to, to make sure we get it the way we want it we'll be in good shape. 

[00:09:37] Paul Logan: Switching to a different topic. We saw a different flavor of some of the legislation that's been introduced a number of times by Senator Bill Stanley come back this year.

[00:09:47] Paul Logan: Can you talk about the medical malpractice cap legislation that ultimately was passed by indefinitely and what we should expect going forward for that then? 

[00:09:58] Tripp Perrin: Sure, definitely. It's so, it's the primary uh, folks , who should be concerned about this uh, you know, , or oral surgeons. Those in the association actually take health insurance 'cause that's where the Med Mal Cap lies. And I think ultimately the legislation did not pass. As you note, it has been introduced at least three of the last four, if not four of the last five, or if not five of the last six sessions. But there was an agreement back in, I believe it was 2011, between the medical society and the trial lawyers and a much different political environment. That basically said, we're gonna, we're gonna keep the med mal cap at a certain amount. I don't know the exact amount, but some, somewhere around 2 million, -2.5 million, something around that. And it goes up each year a little bit each year and said, look, we've got a 20 year agreement on this thing.  

[00:10:47] Tripp Perrin: We agreed not, we're not gonna come back to lower it. We're not gonna come back to increase in the trial lawyer's case. Obviously 14 years, is a very long time. And people's memories have gotten a lot shorter. And there's more and more pressure on the trial lawyers to abandon that agreement.  

[00:11:02] Tripp Perrin: To their credit, they have not done that yet. Obviously what happens is you get folks up there who've been through a horrific accident and their damages are limited and obviously that, that tugs the heartstrings of a lot of legislators and understandably so. While at the same time, on the flip side of that if, if you increase that med mal cap and you don't do it in the right way, ultimately what will happen is, you won't be able to get insured here. Dentist, oral surgeons will not be able to get insured. OBGYNs will not be able to get insured. And so it's striking that balance. And there was a work group last year. There will be a work group this summer I'm sure as well. That takes a look at sort of the economics of that. Given where we are right now politically, typically Democrats ultimately are a little more with the trial lawyers than a Republican regime would be.  

[00:11:50] Tripp Perrin: Right now, I'd say that it looks pretty good that the Democrats could keep control of both chambers, potentially the governorship as well. And so I think there's a thought this year that you know, the medical community needs to get together and really figure out a solution here , assuming that the other side the trial lawyer types are willing to do it.  

[00:12:09] Tripp Perrin: Bill Stanley's a great guy from Martinsville and, and uh, but he's, he's a trial lawyer. And then you have a speaker of the house and is also a trial lawyer, but also who's, whose wife is a dentist. And uh, and so, uh, you know, we'll kind of see how things uh, shake out over the next uh, year. But it's gonna be important to be engaged in that issue as we move forward.   

[00:12:28] Paul Logan: Moving to the budget. Uh, as, As we mentioned earlier, this wasn't a big budget year. But uh, what were the big issues , at play and where do you see things going into the next year?   

[00:12:39] Tripp Perrin: I think as January started there's a lot of talk about tax, there's some tax relief in there. The Governor has insisted upon tax relief. There's a lot of tax relief in his budget, which he unveiled in December. The Democrats disposed of that and did their own thing. It's one sort of one time rebates and that sort of thing, so that it's not an ongoing revenue hit to the, to the uh, to the budget.

[00:13:02] Tripp Perrin: Like you said, in Virginia, we have a two year budget. And so technically we don't need a new budget. We had one last year that's been approved, but we also have, there was also certainly because Virginia has a balanced budget requirement in its constitution we've very well managed state fiscally uh, we had a surplus and so they were able to do some things uh, relative to rebates, increase some spending, particularly in K-12 uh, was, was a big area of, of increased spending.

[00:13:30] Tripp Perrin: We did not get an increase this year, but certainly we're not hit with any decrease in our rates. Of course, we had 30% two years ago and 3% last year. On the Medicaid front, very few, and I'm trying to remember if any providers, actually this year, they, HHR, Health and Human Resources was not was not something that the, either the house or neither the house nor the Senate really focused on.  

[00:13:52] Tripp Perrin: I think right now, the thing you're gonna need to watch is there's been a special committee formed by the speaker to take a look at the impact of the federal cuts that are happening. Virginia is, I believe the state that is most reliant upon federal workers.  

[00:14:08] Tripp Perrin: And so the layoffs and the uncertainty couldn't have a tremendous impact on our ultimate budget number, revenue number to, to project. And so they will be coming back here even if it's not in a formal session, although there may be one of those to take a look at Medicaid, there's some concern about Medicaid cuts both from a reimbursement perspective, but also in terms of just the sheer numbers of people that are on Medicaid. We have some triggers in our Medicaid language here in Virginia. They could be problematic. And so there's a lot of uncertainty and I think that from a political standpoint that Democrats want to use, they're gonna want to use that in the fall to to beat up on the Republicans.

[00:14:50] Tripp Perrin: And um, so you've got the political play of it also, but I think there's a, real play in terms of what could potentially be the impact uh, of, of the budget moving forward? 

[00:14:58] Paul Logan: That's right. I think Virginia is one of, I believe, nine states that have that trigger law and.  

[00:15:04] Paul Logan: If anything is cut , that does put us in a position where we may need to make some hard decisions. 

[00:15:09] Tripp Perrin: Yeah. Basically, for those listening, in Virginia they baked a 90/10 rule , into the Virginia law, which basically says if the, if the federal government reimburses anything less than 90% of it gets below, gets below 90% Virginia's footing the bill for more than 10% of it, of the Medicaid expansion cost. Then automatically a significant hundreds of thousands of people get kicked off the Medicaid rolls. Right. So, uh, There's a lot, a lot of concern about that and what would happen and, and how do you, how do you go about fixing that?  

[00:15:38] Paul Logan: We touched on lobby day, but can you talk about how important it is right now to reach out to legislators, thank them for where they have helped engage, build relationships with them in the sort of off season, outside of the general assembly session. 

[00:15:55] Tripp Perrin: Yeah. Well, it, it's a great, It's a great point and Laura's done a great job through the years of making sure all of our legislators in the House and the Senate have a dentist that they're somehow connected to. Hopefully in most cases it's actually their their provider. I always laugh and tell people, you've got a lot of leverage when you've got a sharp object in somebody's mouth but seriously, I think it's it's very important that we continue to do that and really double down to make sure, particularly new folks that have not been in the legislature for a while or folks that for some reason we don't have a contact dentist for that we spend some time and I've told my team we're gonna spend some time making sure that we fill any of those gaps and 'cause look, you can't beat home cooking. My job is to figure out what the legislative process is and what the best path to winning ultimately is. But at the end of the day, you can't beat home cooking in this business. You can't beat somebody from home walking through the door in a friendly face and sitting down.

[00:16:52] Tripp Perrin: And obviously somebody that's truly an expert in the field. I'm not an expert in the field. The team's not an expert in the field, but the membership here are the experts. They're ones in the white coat that will sit down and actually explain the issue in a very non-partisan way. So it can't express how powerful that is over time.  

[00:17:10] Paul Logan: Laura, who's actually in this room she does an amazing job of keeping our member dentist informed on all of the things that relate directly to oral healthcare, but just as you're talking about like how do you get involved with your local delegate, local state senator, getting on their mailing list, their constituent list, making sure you hear what they're focused on, finding opportunities to go to events, fundraisers with them, engaging in the VDA PAC, which helps to build relationships with those legislators and make sure that those legislators have those, all of those things can have an impact, and 

[00:17:44] Tripp Perrin: Especially the PAC, 

[00:17:46] Paul Logan: Especially the PAC the, 

[00:17:47] Tripp Perrin: Especially participating in the PAC. 

[00:17:49] Paul Logan: But it all, so much of it comes down to relationships, having trust and that takes time.

[00:17:57] Tripp Perrin: It does. It's, It's a great point. I always tell people, lobbyists, particularly, they're breaking, trying to break into this business. I said, you can't force relationships. If you do, everybody sees it, it's very transparent and you know, you can't, it takes years to build, but once you do , and you've, you've been credible, you've told the truth you've, giving folks the information that they've asked for. I always tell people when we go in on an issue, we give 'em both sides. We try very hard to do that. Say, look here's what we're telling you. Yeah. Here's what the other side's gonna tell you. And just being dead honest with them so that they can make a good decision for themselves for their constituents and for the state. And hopefully you know, eight times outta ten anyway they're, they're on our side and not on the others.   

[00:18:37] Paul Logan: Alright Tripp, thank you so much for taking the time this afternoon to provide this update for our members. If you'd like to stay up to date on the latest action alerts, what's going on at the VDA, please text "VDA" to 5 2 8 8 6.

[00:18:53] Paul Logan: That's "VDA" to 5 2 8 8 6. 

[00:18:56] Paul Logan: Thank you for joining us for this episode of The Fulcrum Podcast. Please send your comments and ideas to thefulcrumpodcast@vadental.org. See today's show notes for links to the legislation we discussed and the VDA's advocacy resources. Thank you.