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ADA, AAPD urge Senate to prioritize oral health care in ACA reform

September 18, 2017

By Jennifer Garvin

Washington — The ADA and American Academy of Pediatric Dentistry 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.

In a Sept. 18 letter to Majority Leader Mitch McConnell, R-Ky., Minority Leader Charles Schumer, D-N.Y., and Finance Chair Orrin Hatch, R-Utah, and Ranking Member Ron Wyden, D-Ore, the two associations said they believe that believe that some of the provisions in proposed legislation by Senators Lindsay Graham, R-S.C., and Bill Cassidy, R-La., would be "detrimental to Medicaid programs and the vulnerable Americans who rely on them for health care and coverage."

"Medicaid, our nation's safety-net health insurance program, currently provides vital coverage to over 70 million Americans, including 37 million children," wrote ADA President Gary L. Roberts and AAPD President James D. Nickman.  "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 can have long-term effects on an individual's life, wrote Drs. Roberts and Nickman, noting that tooth decay remains the most chronic condition among children and adolescents.

"The Medicaid program's importance to Americans' oral health cannot be overstated," they wrote.

The two associations noted that dental services are an essential part of the Early Periodic, Screening, Diagnostic and Treatment program and that states develop dental periodicity schedules for their programs to ensure poor children with public insurance have access to dental care that is comparable to the services available to children with private insurance.

The ADA and AAPD also highlighted the economic impact of untreated dental disease, citing ADA Health Policy Institute research that found in 2014 emergency room visits for a dental condition occurred every 14 seconds in the United States, costing approximately $863 a visit compared with an average dental office visit cost of $240.

The two associations said that while they support state flexibility and innovation, states should follow statutory guidelines when designing their Medicaid benefit programs because "without such guidelines, care can and may be reduced or eliminated entirely. This was clear under the Children's Health Insurance Program prior to the enactment of the Children's Health Insurance Program Reauthorization Act of 2009, when states had the ability to limit or eliminate dental benefits for enrolled children and great variation existed across states."

Finally, ADA and AAPD reminded the senators that state legislatures have "historically eliminated adult dental benefits in Medicaid" when required to reduce their budgets because adult dental benefits is often seen as an "optional benefit" for states to provide.

"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," Drs. Roberts and Nickman wrote.

The letter concluded with ADA and AAPD urging the Senate to "reject the proposed changes to Medicaid funding and seek alternatives that will ensure continuity of coverage and continued access to oral health services for the most vulnerable Americans."  

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