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ADA: Economic recovery offers access opportunity

Breaking Down Barriers to Oral Health for All Americans: The Role of Finance

April 30, 2012

By Craig Palmer, ADA News staff

Washington—Economic trends suggest reduced dental Medicaid funding, reimbursement cuts, benefit restrictions and a decline in public and private third-party financing for dental care “in the short term,” the Association said in the third of a series of statements on access to oral health.

“This paper examines why people from all walks of life are increasingly facing financial barriers to accessing dental care and offers solutions to reduce these barriers,” Dr. William R. Calnon, ADA president, said in a foreword to Breaking Down Barriers to Oral Health for All Americans: The Role of Finance.

“We realize that the ongoing economic crisis dramatically reduces the likelihood of significant reforms in the short term,” Dr. Calnon said. “But the economy will recover; Americans will return to work, and state and federal governments will be under less pressure to cut or underfund essential services. Economic recovery will present a terrific opportunity to bring tens of millions of dentally underserved - or unserved - Americans into a system of care that is capable of preventing most dental disease and intervening early when disease does occur.”

Offered to Association members by e-mail April 30, the ADA paper and media statement will be more widely distributed to media, policy makers and the public May 1. Future “breaking down barriers” papers will address such topics as disease prevention, oral health education and why patients do or do not utilize available services. Initial barriers papers on The Role of Workforce and Repairing the Tattered Safety Net were issued in 2011.

The Role of Finance paper offers eight recommendations toward eliminating unnecessary, costly, preventable dental disease over time.

• The government can use tax policy to encourage small employers and individuals to purchase dental benefit plans in the private sector or develop cooperative purchasing alliances—such as the state exchanges created by the Patient Protection and Affordable Care Act. Cost sharing (copayments) should be eliminated for diagnostic, preventive, and direct restorative procedures. Necessary care should not be subject to unreasonably low yearly maximums on coverage.

• Maximum plan benefit fees should be set in an open and transparent manner, with appropriate scrutiny from attorneys general, insurance commissioners and providers.

• Medicaid and CHIP (state Children’s Health Insurance Program) should reimburse for dental care minimally at rates that are acceptable to sufficient numbers of dentists practicing in the covered area to provide care to those eligible patients who seek it, as consistent with federal law. State programs should base these rates on the ADA Survey of Dental Fees or an equivalent database.

• Preventive care reduces the disease burden, thereby reducing the need for restorative care, thereby yielding improved health and cost savings. Dental plans should cover 100 percent of the cost for preventive services.

• State health exchanges should offer reasonably priced dental coverage to adults, especially the vulnerable elderly.

• States should implement administrative reforms to cut red tape that impedes dentists from delivering care and patients from receiving it. In many cases, this may involve “carving out” the dental portion of Medicaid and dedicating health department staff exclusively to running the dental portions of their Medicaid and CHIP programs.

• State Medicaid programs should be broadened gradually to include adults, beginning with coverage for urgent care that otherwise drives them to hospital emergency departments.

• Federal and state governments should expand programs that provide incentives for dentists to establish practices in underserved areas. Such programs are proven to work, and are especially attractive to new dental school graduates who carry an average debt load of $200,000 and increasingly are interested in loan forgiveness arrangements.

“Certainly, increased funding alone cannot 'fix’ a dental financing system that is rife with inefficiencies and shifting policies and overly tilted toward costly surgical intervention in disease that could have been prevented,” the ADA statement concludes.

“Healthy people of means would be better off self-funding their dental treatment than paying for insurance that has inadequate annual maximums and co-pays for major procedures. People of lesser means would be better off going to get their teeth checked periodically, even though the costs come out of pocket, rather than waiting until something hurts, which increases costs dramatically and can lead to lost teeth and cause or aggravate other health problems.”