Dental Care Considered Optional by Many States

With the campaign trail ablaze, Presidential hopeful, Mitt Romney and President Barak Obama are busy spelling out their differences and making their cases for the White House.  One of the most talked about topics has been the future of Medicare and Medicaid, as both sides of the fence believe that big changes are necessary, but they can’t seem to agree on how to go about making any.  They do agree, however, that states should not be permitted to make eligibility for Medicaid more difficult, causing many to cut back on optional benefits in order to save money.  One such “optional” benefit is dental care, which many states have significantly reduced or eliminated all together, leaving millions of Americans without access to coverage.  And the situation is not likely to improve with President Obama’s health care reform, as it only requires dental coverage for children; an extremely important demographic, but non-inclusive of all citizens.  The national cuts have recently been explored in the New York Times article, “Sharp Cuts in Dental Coverage for Adults on Medicaid,” leaving many concerned about the future of oral health in America.

A recent report from a national research group, Kaiser Commission on Medicaid and the Uninsured, claims that Medicare covers only pain relief and dental care emergencies in approximately half the states, and others cover preventive exams and cleanings but not necessary services, such as fillings and root canals.  And coverage is the least of concerns for many adult Medicaid participants.  Simply finding a dentist to visit has become an increasingly difficult challenge, with severe shortages in rural areas and few dentists even accepting Medicaid patients in other places.  Reimbursements from the federal health care program have been historically low and additional cuts are expected.  With access to dental care limited, emergency rooms across the country have become inundated with patients seeking relief from completely preventable oral conditions.  Shelly Gehshan, director of the Pew Children’s Dental Campaign, describes the situation as “penny-wise and pound-foolish,” because states are spending much more on emergency room visits than they would on preventative care.  Yet neither political party seems to have a plan that would resolve this growing problem.

Community health centers have been sprouting up around the nation as a measure to improve access to care in areas of great Medicaid need.  Lynn Community Health Center was established just outside of Boston and since its opening, demand has continued to increase.  While President Obama’s Affordable Care Act does not address the oral health of adults, it does provide $11 million to expand community clinics and construct new ones.  Many hope that these funds will be used to develop more dental care programs at these community centers.  Alaska and Minnesota are the only two states who are currently utilizing dental therapists to address the severe shortage of dentists in rural areas.  Dental therapists are considered midlevel providers who have more training than hygienists but less than dentists, and perform common procedures such as filling cavities and pulling teeth.  Several dental associations have not condoned the use of these providers, citing safety concerns, but Gehshan believes other states will soon embrace the idea.  Once the ACA is fully implemented, more than 5 million children will become eligible for dental coverage and there simply aren’t enough dentists to treat them.  There doesn’t seem to be a simple solution for this massive problem, causing a growing epidemic of preventable oral disease in our country.  With numerous recent studies showing just how intertwined oral health and general wellness are, one would hope that states would stop looking at dental care as “optional” and start making it possible for all Americans to have access to this very necessary and critical area of care.

Written by Mark Paulsort

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