With multiple “Medicare for All” proposals now circulating in Congress, opportunities arise to fix past mistakes that have segregated care for our mouths and teeth from the rest of our bodies. Polling shows that today’s universal coverage efforts are driven largely by public outcry that people can’t afford the health care they need to be happy, healthy, and successful. As this robust discussion continues, it’s time to include comprehensive dental care as a standard part of health coverage. No plan can fully address consumers’ concerns without it.
Regardless of income or insurer, people report more significant financial barriers to accessing dental care than any other aspect of health care — even though oral health is a crucial part of overall well-being. Untreated dental disease is linked to a variety of health issues. It can raise the risk for heart disease, make diabetes more difficult to manage, and may be linked to pregnancy complications such as premature birth. In childhood, tooth decay can harm healthy development and lead to lower grades, limiting students’ potential.
In adulthood, poor oral health can impede job prospects and earnings, particularly for women. Parents’ oral health and ability to access care affects their child’s health in other ways, too. If a mother has untreated dental disease, her child is three times more likely to suffer tooth decay. And when parents lose health coverage, it jeopardizes their child’s access to care. Ensuring that all Americans have the opportunity to achieve good oral health can help families stay healthy and boost prosperity for all.
Seizing the opportunity to break the silo between dental and medical coverage is not only good for kids and families, but it’s essential to reining in health care costs. The U.S. spends about $2 billion a year in dental-related visits to emergency rooms. Children in families without support to help them avoid tooth decay can end up on hospital operating tables, which can cost upwards of $15,000. Many of these expenses could be avoided by securing access to oral health coverage and preventive care for everyone in the family.
Despite this evidence, dental coverage for adults is not guaranteed by any federal health program. In Medicare, the basis for many universal coverage bills, seniors’ oral health care is conspicuously absent. There are efforts underway to remedy this barrier to care by adding comprehensive dental coverage to Medicare Part B. But several proposals to let younger adults buy into Medicare are based on its current set of as-yet-incomplete benefits.
In Medicaid, whether low-wage adults and pregnant women have oral health benefits varies by state: Tennessee’s Medicaid program does not offer any dental coverage for adults; in Arizona, it’s limited to emergency care; Ohio and North Carolina, in contrast, offer relatively robust care. Individuals’ health should not depend on where they live.
Some Medicare buy-in measures look to coverage standards set by the Affordable Care Act (ACA), but they also have limitations. Oral health for kids through age 18 is baked into the benefit structure of plans adhering to ACA rules as an essential health benefit. But that coverage is often sold separately from medical plans. There’s no requirement for marketplace plans to offer any dental benefits to adults. A public coverage option based on the ACA will likely fall short for families unless new policies compel major changes, such as integrating oral health into private health insurance and expanding the ACA’s 10 essential health benefits to include dental coverage for adults.
Policymakers have, over time, strengthened children’s oral health coverage in Medicaid, the Children’s Health Insurance Program, and private insurance. For the past two decades, kids’ coverage has steadily increased and rates of untreated tooth decay have declined. As of 2015, 9 in 10 children had comprehensive dental coverage. This is incredible progress.
At the same time, we have much to do to protect these gains and help all children stay cavity free: 2017 was the first time in 10 years that children’s access to health coverage lost ground. And harmful disparities in oral health exist based on race, income, geography, and other factors. Improving national policies around oral health coverage and care for the whole family could help address these challenges to support every child’s health and success.
Although it may be too early for one coverage expansion proposal to take root, every effort can steer the U.S. health system toward a plan that better meets the needs of all people. Especially with proposals that rely on a program as influential as Medicare, it’s essential to ensure that any universal coverage strategy doesn’t further entrench a flawed model — one that walls off one part of the body from another, or dices up coverage between children, parents, and other adults on whom kids count to help them learn and grow.
Rather than replicate today’s painful, costly, and piecemeal approaches to dental and medical coverage, we should build a better future by ensuring that oral health is an integral part of future health insurance plans.
Meg Booth is executive director at the Children’s Dental Health Project, a think tank based in Washington, D.C., that creates and advances policy solutions to protect children from tooth decay.