The Senate health-care bill: What’s at stake for dental practices and the dental industry?
By reducing the number of people with dental insurance coverage, the Senate's health-care bill would have a negative impact on dentists, dental practices, and the dental industry. Learn more in this opinion piece by Meg Booth of the Children’s Dental Health Project (CDHP) and Kevin Thomas of Elevate Oral Care, who look at the progress made by the Affordable Care Act (ACA) and the projected consequences of the Better Care Reconciliation Act (BCRA).
Industry | Opinion
News stories about the health-care debate have shared dozens of numbers and statistics, leaving many Americans feeling numb, confused, or both. By now, you may know that Senate’s health-care bill has been projected to raise the number of uninsured kids and adults by 22 million. (1) Yet there are other numbers that reveal how the bill (if it becomes law) would affect dental professionals and those who work in the dental trades.
The Senate’s bill is called the Better Care Reconciliation Act (BCRA), but there is nothing “better” about BCRA. This bill would undermine the oral health of millions of children and adults. Both the dental professionals who deliver care and those who produce dental supplies would take a significant hit.
Figure 1: Effect of the Senate's proposed health-care law on the dental industry | Open in new window
Effect on dental practices
Let’s start with the dental profession. BCRA makes deep cuts in Medicaid and imposes caps that are unlikely to keep up with the future costs of dental care. This resulting gap could force many states to freeze or cut Medicaid reimbursement rates for dental providers—or prompt states to adopt tougher eligibility rules that restrict coverage.
In addition to the 37 million children with public dental coverage, roughly 5 million new adults gained dental coverage after state Medicaid expansions following the passage of the Affordable Care Act (ACA). (2,3) BCRA would unravel the expansions by phasing out the federal contribution for these newly covered adults. This would put a huge squeeze on state budgets. As experience shows, adult Medicaid dental benefits are among the first areas that are cut or eliminated altogether when a state faces a budget shortfall.
For middle-income adults, BCRA does little to make coverage more affordable. And affordability truly matters. According to a recent study, adults are more likely to cite cost as the reason they didn’t obtain dental services than they are to cite cost as an obstacle for getting medical care, prescription drugs, or mental health services. (4)
For dentists and their staffs, a major drop in coverage means patient visits would be highly likely to decline. And it means many thousands of people wouldn’t receive the preventive and restorative services they need for optimal oral health. A recent national survey of parents confirms this connection between coverage and care, showing that uninsured children were nearly three times as likely (26%) to go without care than kids who were dentally insured (9%). (5)
Effect on the dental industry
A big drop in coverage would also hurt the dental trades industry. The Children’s Dental Health Project (CDHP) conducted an analysis to gauge this impact. After consulting with the American Dental Association’s Health Policy Institute, CDHP estimates that for every 1,000 people who lose dental coverage, an estimated $10,837 less is spent on dental supplies and equipment (figure 1).
The ACA and Medicaid are not perfect programs. There are many ways they could be improved through bipartisan negotiations. However, the Senate bill takes all of us—families, dental providers, and the industry—in the wrong direction. BCRA would allow states to waive pediatric dental or any of the other “essential health benefits” that were established by the ACA. Instead of downgrading children’s oral health, we should work to ensure that both children’s and adult’s oral health services are viewed as essential.
From 1997 to 2014, the number of children without dental coverage dropped by 58%, thanks mostly to Medicaid and the Children’s Health Insurance Program (CHIP). (6) CDHP fought to make dental coverage a guaranteed part of CHIP. Senators should build on this progress, instead of passing a bill that could reverse them.
If you’re as disturbed by BCRA as we are, please call your Senators’ office in Washington. CDHP has created a one-pager that makes it simple to find Senators’ phone numbers and consider what you want to say when a staff person answers. Remember: Democracy is not a spectator sport.
1. H.R. 1628, Better Care Reconciliation Act of 2017 cost estimate. Congressional Budget Office website. https://www.cbo.gov/publication/52849. Published June 26, 2017. Accessed July 15, 2017.
2. The Children's Health Insurance Program. Georgetown University Health Policy Institute Center for Children and Families website. https://ccf.georgetown.edu/2017/02/06/about-chip/. Published February 6, 2017. Accessed July 15, 2017.
3. Medicaid expansion and dental benefits coverage. American Dental Association website. website. http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIgraphic_1116_1.pdf?la=en. Accessed July 15, 2017.
4. Vujicic M, Buchmueller T, Klein R. Dental care presents the highest level of financial barriers, compared to other types of health care services. Health Aff. 2016;35(12):2176-2182. http://content.healthaffairs.org/content/35/12/2176.full. Accessed July 15, 2017.
5. Jacob M. Survey offers more proof that dental coverage counts. Childrens Dental Health Project website. https://www.cdhp.org/blog/454-survey-offers-more-proof-that-dental-coverage-counts. Published April 4, 2017. Accessed July 15, 2017.
6. JADA study shows impact of dental benefits on meeting children’s dental needs. American Dental Association Website. http://www.ada.org/en/press-room/news-releases/2017-archives/february/jada-study-shows-impact-of-dental-benefits-on-meeting-childrens-dental-needs. Published February 6, 2017. Accessed July 15, 2017.
Meg Booth is the executive director of the Children’s Dental Health Project (CDHP), a nonprofit policy organization based in Washington DC.
Kevin Thomas is a managing partner at Elevate Oral Care. He serves on the CDHP Board and the Dean’s Council for the University of California–San Francisco School of Dentistry.
Editor's note: This article first appeared in the Apex360 newsletter. Subscribe here.