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.

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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.

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  • The significance of oral hygiene is as important as any serious health care protocol.

    Our overall health issues begin and end with our access to the dental profession. Our entire body, is a reflection on the way that we care for our oral health.

  • I am paying about $17 a month for dental ins. with Humana Medicare. I still can’t go to the dentist because I can’t afford the copayment. After paying my Bill’s each month I don’t have any money left over to pay to have my teeth fixed. I was told several years ago that I have gum disease and need extensive cleaning. I also have about 4 teeth that have the fillings fallen out of and I get toothaches all the time. My front tooth is a porcelain crown that has a crack in it. It hurts when I brush it and at other times. I hate my smile and it makes my self image worse. I already suffer from bipolar b and this doesn’t help. I have something wrong with my heart. I used to have to take antibiotics every time I had dental work but they changed the rules. I’m afraid the gum disease is going to give me a heart attack. I already had an abscess once from one of my bad teeth. I was able to get some amoxcillian at a Mexican drug store and the abscess went away. I wish Medicare would pay for dental. They don’t care if we die or not. Deborah Fuller
    P.S. I’m going to cancel my ins. because it is a joke the amount they pay.

    • I know exactly how you feel and it’s so disgusting to me that our government has let this go on for so long. Teeth are apart of our bodies and to exclude them from health insurance is the most asinine thing ever. How did this ever happen, who is the idiot that excluded teeth/dental from health insurance in the first place? What makes me so irate is the fact that people on Medicaid/Welfare have dental coverage for their children and probably for themselves too and some of these recipients have never worked a day in their lives! Even illegal immigrants get free dental care, hell they get free everything that’s why they keep coming over here in droves. I have paid into medicare for over 40 years and I don’t understand why I am paying 140./mo. for coverage? Yes, I too can’t even go to a damn doctor because I can’t afford the co-pays. These idiots that are in charge of Medicare don’t have a clue that 30.00 to 80.00 co-pays are out of the question when the only income you have is SS or SSD because that is just pocket change to them. I have suffered, for going on 10 years without the urgent dental care that I need. I’ve tweeted about this very issue too, many times, wondering why the hell teeth are not included in overall health insurance, they act like any dental work is all cosmetic or something. You can bet your bottom dollar that government employees have full dental coverage on top of voting to give themselves raises all the time while we suffer. I don’t want a separate dental ins. policy/rider or any damn discount plan, I want full dental coverage included right in my health insurance policy because teeth are apart of our bodies/health, enough of this nonsense. I pray to God this bill is passed and enacted ASAP!

  • I have for years been questioning what is the asinine sense of keeping dental separate from health care coverage! We don’t have to seek out separate coverage for our hearts, kidneys, or any other organ/body parts. Also, why is it that some states cover full dental coverage for Medicaid recipients who a lot of them have never worked a day in their lives for whatever reason that may be. Here, if you live in Ohio or some other state they get full dental coverage opposed to living in other states. The people who HAVE actually worked all of their lives and are on SS or SSD have NO dental coverage. NO one knows how seriously irate this makes me. Children of Medicaid recipients get full dental coverage, full orthodontic care – FREE braces on their teeth whereas I had to pay 10k for my child’s because I was a hard working responsible person who actually contributed to society and paid taxes in which paid for these people’s free dental care. Now here I am at 60 yrs old and disabled after working all my life and have to suffer every single day because I cannot afford to see a dentist to get the care that is needed, like NOW. Thank you so very much to the idiots who allow this to happen and keep happening.

  • Also, even the excellent VA health insurance, here in Socal, omits covering dental care. Why? My husband regularly visits the Jerry Pettis VA Hospital in Loma Linda. He’s had several surgeries and has regular check ups every 6 months with the same Dr. He also has NO TEETH! I order antibiotics online to fight infections. It makes no sense to me! Dental health is critical to overall health!

    • How shameful of our government to not even give our veterans dental insurance, my God, can it seriously get any more pathetic than this? These people who sacrificed so much for our freedom and put their lives on the line and we can’t even give them dental insurance? I swear this country is getting worse and worse, we take better care of illegal immigrants than we do our own veterans who served our country! We have some of our own citizens sleeping on the streets going hungry yet we can give illegal immigrants rent free homes/apts., food, and full dental and health care! Some of these people who are homeless work but they cannot afford to pay rent due to the lack of a living wage and lack of affordable housing. You want to know why we have such a shortage or affordable housing? Illegal immigrants. There needs to be some kind of uprising in our country and put our feet down because what is going on is absolutely disgusting and totally asinine. The damn liberals and the elite 1% talk of how inhumane it is to keep illegals out and all this other crap, because it does not affect them in the least. I am sick and tired of these idiots looking out for illegals but could care less about our own mentally ill homeless people going w/o everything! These people are draining us, draining our affordable housing, draining our social services/welfare systems, etc., whereas the money spent on them should be for our own citizens. This is why they keep coming here, because it’s all FREE for them and the money they earn from working gets sent back to where they came from to their other family members. I worked at a mfg. co. for years and there were a lot of Mexican men who worked there and they were married with children, the women were getting welfare, free health ins. and food stamps because they would tell the welfare that the husband ran off, they were living better than us.

  • I am on Medicare Disability which I received due to 3 County workers were drunk while driving and working. However I was in Sales and also working and was hit by these individuals. In 1999 that I finally got my Medicare Disability yet for the last 10 years I have been suffering with dental problems and infections and very I’ll and have no money to to get help. I have tried everything. Either you have to be dirt poor to get help, or have no insurance at all, or be on a 2 to 5 year waiting list, or if you make maybe $50.00 over the income limit you can’t get help. I will probably die of infection that will go to my heart and die. My whole month over the years is bad and I can’t hardly eat. Yet as the CDC regulates everything now we live in pain and they don’t want people to have to many antibiotics so pretty much they want people to die!! What’s wrong with Our Country and Government and all the Wealthy non caring people that have had something happen by no fault of their own???

    • Try Fish Mox. It’s amoxicillin. Affordable too. My daughter, years ago, worked at a pet store. She told me that several customers bought the antibiotics for themselves, not their pets. When my husband started having dental problems, I borrowed some amoxcillin from my daughter. I remembered her telling me about the amox for pets. I ordered some online from a pet med supplier, about $35, and imagine my surprise when the capsules were IDENTICAL to the pharmacy ones my daughter had given me! Please order some! I always have them on hand now for my husband. Seriously!!

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