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ADA, others ask Senate to prioritize oral health

June 12, 2017

By Jennifer Garvin

Washington — The ADA and 44 health organizations are urging U.S. Senate members to protect access to oral health coverage for all Americans as the legislators examine ways to reform the nation's health care delivery and financing systems.

"Our organizations are committed to ensuring that families have access to comprehensive, affordable health coverage, including oral health coverage," the  stakeholders wrote in a June 9 letter to Senate Finance Committee Chair Orrin Hatch, R-Utah, and Ranking Member Ron Wyden, D-Oregon, and Senate Budget Committee Chair Mike Enzi, R-Wyo., and Ranking Member Bernie Sanders, D-Vt.

"Medicaid, our nation's safety-net health insurance program, currently provides vital coverage to over 70 million Americans, including 37 million children," they said. "In addition, newly established standards for private dental plans and mechanisms to increase their affordability have improved the private dental insurance market for consumers.

"Poor oral health has long-term effects on an individual's life. Tooth decay remains the most chronic condition among children and adolescents, impacting school performance and attendance. Because it is a progressive, chronic condition, the oral health problems that impact children continue on into adulthood impacting employability, military readiness and overall health status."

Untreated dental disease has a "significant economic impact" on the nation's health care system, the stakeholders noted, citing a study by the American Journal of Public Health that found 4 million Americans visited hospital emergency rooms for dental-related problems between 2008 and 2010 which cost $2.7 billion. They also noted that the ADA Health Policy Institute found that in 2014 emergency room visits for dental conditions occurred every 14 seconds and cost approximately $863 per visit compared with an average dental office visit of $240.20.

The stakeholders stressed that "Medicaid program's importance to Americans' oral health cannot be overstated," pointing out that since 2000, the percentage of children without dental coverage has been cut in half and some 5.4 million adults have gained access to dental benefits as part of the Medicaid expansion, citing HPI research.

"As public insurance has reached greater numbers of children, the rate of untreated decay has fallen among low-income kids, and research shows emergency department visits for dental related issues decreased for the first time since the early 2000s between 2012 and 2013, with the largest declines among children and young adults," the stakeholders said. "And it is recent improvements to public and private oral health plans that have led to these improvements."

The establishment of Medicaid and Early Periodic, Screening, Diagnostic and Treatment programs has "ensured that poor children with public insurance have access to dental care that is comparable to the services available to more affluent children with private insurance," they said. "Dental care utilization among publicly insured children has steadily increased over the past decade even as increasing numbers of children enroll. To that end, we are concerned that proposed fundamental changes to Medicaid funding could put the nation's overall oral health at risk."

While it supports "state flexibility and innovation," the stakeholders said they believe states should "follow statutory guidelines when designing their Medicaid benefit programs because without such guidelines, care can and may be reduced or eliminated entirely," noting that historically, state legislatures have eliminated adult dental benefits in Medicaid when required to reduce their budgets.

"We believe that the coverage requirements and guidelines currently in place for states help ensure Medicaid provides necessary and appropriate care for children and would advocate for stronger guidance regarding coverage of adult dental services rather than increased flexibility that may chip away at the significant oral health progress that has been made among publicly insured individuals."

They also shared concerns that any changes to current legislation could affect the private dental market as well.

"We are concerned that proposed changes to private dental plan offerings and private health insurance financing could undo these improvements," the stakeholders said. "Proposals that waive benefit standards for private insurance packages will put at risk the availability of comprehensive oral health coverage currently offered to children, while significant changes to affordability mechanisms like tax credits and cost-sharing reductions will make it more difficult for families to purchase the coverage their children need.

"Additionally, all individuals, regardless of age, should be made better aware of what dental plan offerings are available and the affordability measures in place to help them purchase those plans."

In conclusion, the stakeholders urged Senate members to "resist the elimination" of oral health services for families enrolled in private insurance plans and "consider policies and guidance that would make dental services more accessible to all citizens, regardless of income or insurance type."

"Coverage impacts the ability of individuals to access care in the most appropriate, cost-effective setting, and our organizations believe that drastic funding cuts and structural changes to the oral health system will undermine the gains that families have made in accessing dental care and ultimately be detrimental to the entire healthcare system. We encourage you and your colleagues to utilize our organizations as resources and look forward to working with you to ensure that our nation's children and low-income, working families can continue to benefit from measurable improvements in oral health care and access to dental coverage."

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