To: Brian Kavanagh of the 26^th Senate District

From: Heba Fakir

Date: 7/17/21

Re: Federal and Local Mandate for Affordable and Accessible Dental Coverage by Insurance Providers

Statement of Issue

74 million American families do not have dental insurance, and many are unable to afford the full cost of basic dental care. Instead, many would prefer to forgo dental care. High dental costs are a considerable challenge to Americans, especially for those from low socioeconomic backgrounds. What federal and local policies can be implemented to make dental coverage more affordable and accessible?

Background

Oral healthcare is often considered a separate entity from other chronic medical conditions, however, oral healthcare is intertwined with chronic medical conditions like Diabetes or Heart Disease. Despite that, there is a lack of access to dental care. Studies report 80% of residents in major metropolitan areas, have inadequate access to affordable dental care. New York is ranked 30 out of the 50 states in terms of dental wellness. It is recommended that dental cleaning be done twice yearly, however, this can cost between $75 and $200 per person. About 2/3 of people who have dental insurance get it through their employers as a separate add-on to health coverage. And for those without employer-provided plans, it can be impossible to pay for dental care out of pocket. In addition, Medicaid coverage of adult dental services varies state by state and doesn’t include all forms of dental care. Also, the consequence of poor dental health does not end at affecting health, it can also affect employment and school attendance.

Landscape: Key Stakeholders

American Dental Association, Health Insurance Industry, Federal Government, State Government, Democratic and Republic Politicians, Labor Unions, Workers Associations, American Medical Association, American Nurse Association, American Academy of PAs

Policy Options

• Have a federal mandate that backs inclusion of universal dental coverage with health insurance, this would include coverage for preventive and restorative dental services regardless of age or medical illness. Preventive dental care includes regular oral exams, teeth cleaning and routine x-rays. Restorative dental care includes dental fillings, dental crowns, dental bridges, dental implants, and root canals.
  • Advantages: This will make it easier for clinicians to coordinate care with dentists since dental programs will be in the same provider network. Dental coverage and access will increase for patients leading to a healthier population. This will also help reduce the financial costs for medical illnesses associated with dental care.
  • Disadvantages: Insurance companies can regulate dental procedures and decide on dental reimbursement rates. If the fees are insufficient for dentists, this may lead to dentists being unwilling to participate. In addition, there will be longer wait times for dental care because of declining dentist to population ratio. This will not cover cosmetic dentistry. Insurance rates may increase.
• Have state and local mandates that focuses on preventative care by creating interdisciplinary partnership between dentists and healthcare providers. This can occur by providing dental services at medical offices or hospitals. Also, increasing access to dental therapists and hygienist will help promote preventative dental care.
  • Advantages: This is less costly than the federal mandate and this will lead to better quality of care by making it easier for clinicians to coordinate care with dentist. It also helps address dental health disparities by expanding access to dental care. The more dental therapists and hygienists available will allow for decreased waiting periods.
  • Disadvantages: There will be an increase demand for dental providers, amongst the already a declining dentist to population ratio.There may be an over-referral of patients. Healthcare providers and dental providers may be unwilling to participate. This will not address dental care affordability challenges.
• Have optional work mandates that allow employees a paid dental leave 1-3 days per year.
  • Advantages: This will significantly reduce patients’ out of pocket preventative dental care expenses.
  • Disadvantages: This a limited policy that would only cover the working population. It would not be able to cover long term dental procedures like restorative dental work Employers may regulate what preventative dental procedures are allowed.

Policy Recommendations:

With dental care becoming more unaffordable and inaccessible, many Americans are choosing to forego seeing a dentist. Hence, the importance of having dental care reform. I believe enacting the federal mandate, which includes dental coverage into health insurance, will quickly make dental care more accessible. This option will allow for coordinate care between healthcare providers and dentists, leading to better quality of care and reducing medical problems related to poor oral care. It’ll also help expand access to dental care.

However, this option can allow insurance companies to increase insurance rate, and to regulate dental procedures including reimbursement rates. There’s also the drawback of longer wait times for dental care because of declining dentist to population ratio.

I suggest to combat this, that the federal government mandates a standardization of dental procedures and reimbursement rates. As for the increasing insurance rate, the federal and local government must find a way re-allocate funds, like from the military to the healthcare service. And to counter the low supply of dentists, I suggest that there be incentives like grants for students in dental schools.

Sources:

Bertolami C. N. (2011). Access to dental care: is there a problem?. American journal of public health, 101(10), 1817. https://doi.org/10.2105/AJPH.2011.300271

Biordi, D. L., Heitzer, M., Mundy, E., DiMarco, M., Thacker, S., Taylor, E., Huff, M., Marino, D., & Fitzgerald, K. (2015). Improving access and provision of preventive oral health care for very young, poor, and low-income children through a new interdisciplinary partnership. American journal of public health, 105 Suppl 2(Suppl 2), e23–e29. https://doi.org/10.2105/AJPH.2014.302486

Kanzigg, L. A., & Hunt, L. (2016). Oral Health and Hospital-Acquired Pneumonia in Elderly Patients: A Review of the Literature. Journal of dental hygiene : JDH, 90 Suppl 1, 15–21.

Naughton D. K. (2014). Expanding oral care opportunities: direct access care provided by dental hygienists in the United States. The journal of evidence-based dental practice, 14 Suppl, 171–82.e1. https://doi.org/10.1016/j.jebdp.2014.04.003

The Many Costs (Financial and Well-Being) of Poor Oral Health | College of Dentistry | University of Illinois Chicago. (2019, August 6). The Many Costs (Financial and Well-Being) of Poor Oral Health | College of Dentistry | University of Illinois Chicago; dentistry.uic.edu. https://dentistry.uic.edu/news-stories/the-many-costs-financial-and-well-being-of-poor-oral-health/

Vujicic, M., & Fosse, C. (2022). Time for Dental Care to Be Considered Essential in US Health Care Policy. Journal of Ethics | American Medical Association. Retrieved 17 July 2022, from https://journalofethics.ama-assn.org/article/time-dental-care-be-considered-essential-us-health-care-policy/2022-01.