A Real Kick in the Teeth
Now is the time to fill Medicare’s oral health cavities
You know the old aphorism that if you take care of your teeth, they’ll take care of you? Given what we now know about the connection between oral health and wellness throughout the rest of your body, it’s more true than you might realize.
And that makes one of the real holes in Medicare even more confusing: We have made a national commitment to take care of the health of the most elderly in America — but left the mouth completely unprotected? It’s time for Congress to truly support older adults’ and people with disabilities’ health by adding dental coverage to Medicare Part B. This incredible step forward for our nation is being debated in Congress right now, as part of the Build Back Better budget bill and its fate will be decided in a matter of weeks.
Medicare doesn’t cover oral health because the law explicitly excludes it, except in very limited, hospitalization-related circumstances. This has been called “perhaps [Medicare’s] biggest failing” — and with good reason. What explains it? Dentistry has traditionally been viewed as separate from medicine (the first dentists were barbers — seriously) and dental insurance was a relatively new concept when Medicare was enacted.
But we now know how dangerously misconceived the dental-medical schism was. “Oral health has been linked to heart disease and infection as well as pneumonia. Dental problems can signal larger health issues, such as diabetes, HIV/AIDS, osteoporosis and Alzheimer’s disease. The oral cavity is a gateway to your body,” as one endodontist has put it. “Your dentist can be your first line of defense.”
And yet nearly two-thirds of Medicare enrollees — 37 million people — do not have any dental coverage, according to the Kaiser Family Foundation, which reports that nearly half of all beneficiaries forego dental care altogether. This is often because of the cost: 52 percent of voters aged 65 years and older told YouGov in July that they avoided necessary dental procedures because of the cost. And, as Illinois Democratic Rep. Robin Kelly recently pointed out during a Families USA conversation on this issue, there is a racial equity component to this as well: 71 percent of Black and 65 percent of Hispanic Medicare beneficiaries went without a dental visit during the last year. Medicare’s exclusion of dental coverage is a prescription for a deteriorating quality of life for our seniors, not to mention even more expensive medical problems down the road. Like all health coverage — oral health care coverage has to include the services that people need and has to be affordable, so that people have real financial security when they seek care.
I recently heard the story of Paul Gibbs, a Utah-based independent filmmaker and health care advocate whose case is all too typical. Medicare covered his kidney transplant several years ago, but he couldn’t afford necessary oral care. When he finally got dental coverage years later, his neglected problems cost him thousands of dollars, part of his jaw and all of his teeth on his right side. “I’ve been put thousands of dollars into debt over it, a lot of pain [because] in this country our health care system seems to view health care and dental care as two different things,” Gibbs said. “They’re not. They’re deeply connected. The human body is a miracle made of all these different systems that work together as a cohesive whole.”
It’s no wonder that the same YouGov poll from earlier this summer shows overwhelming, bipartisan support (almost 80 percent of likely voters) for adding oral health coverage to Medicare. Voters in states with hotly contested 2022 Senate races feel even more strongly about the idea, with over 80 percent supporting it. This isn’t a partisan issue: overwhelming majorities across the ideological spectrum like the idea (94 percent of liberals, 77 percent of moderates and 65 percent of conservatives). An incredible 93 percent of people in America say that oral health is a necessary part of overall health care (they’re right) and 55 percent say that they will hold their member of Congress responsible if the dental care problem is not fixed (they’re right on that too).
President Joe Biden included Medicare oral health coverage in his budget, and both chambers of Congress are working through the details in hopes of passing something later this year. They’re on the verge of potentially doing something big. But it has to be real, meaing it has to be a true oral health care benefit — providing both preventative benefits and covering services that are needed to restore oral health, It also has to ensure the care is affordable, with reasonable cost sharing and deductibles, like the other benefits in Medicare Part B..
Despite its popularity, securing a new oral health care benefit in Medicare is going to be a hard fight and decided in just a few weeks. At the end of the day we all know that no one’s health should depend on their wealth. But the older adults and people with disabilities who rely on Medicare face impossible choices because of this glaring cavity in the system. Congress should fill it.
