Time to fill the gaps in dental care coverage

The road ahead to improve oral health for all

In 5000 BC, ancient Sumerians believed tooth worms caused dental decay. During the Middle Ages, tooth extractions were performed by barbers instead of dentists. We have come a long way since then. Besides knowing what causes decayed teeth and gum disease, we now know for certain that your mouth is connected to the rest of your body, affecting overall health and wellness.

Poor oral health is directly connected to other health issues like heart disease, stroke, Alzheimer’s disease and mental health, and there are massive disparities in oral health outcomes and access to care. Yet without coverage, dental care is far too expensive and out of reach for millions of people in America. Even worse, the people who arguably need oral health coverage the most — including people of color, older adults, people with disabilities and others — are most often shut out of the system.

I can never forget when I worked in the Senate, meeting for years with health care experts in New Mexico (the state the Senator I worked for represented). The healthcare professionals we spoke to stressed how the oral health of vulnerable New Mexicans — both children and adults — was creating devastating pain, systemic disease, and even barriers to education and employment. These experts emphasized that one of the greatest unmet health needs in these Native American and Latin communities was untreated oral disease.

For too long, our elected officials have consistently put the reality of oral health need on the back burner while countless people have suffered. In 2022, we cannot let policymakers pass up opportunities for progress. It is long past time for action and Families USA is committed to keeping this topic at the forefront of health policy conversations until everyone has access to dental care.

The good news is that the tide is turning. Just last year, Congress developed a version of Build Back Better legislation that would have dramatically improved Medicare coverage for oral health. While that policy does not look likely to make it into a final bill, it served an important purpose by intensifying conversations in Washington DC and around the country. This effort showed that federal policy change on this issue is possible, is popular, and that vast majorities of the American people and many policymakers are fired up about getting it done.

The work of making significant and lasting changes to our health system can be frustratingly slow. I remember about 15 years ago leading staff work on the Senate Finance and HELP Committees to develop a comprehensive set of oral health care reforms, many of which ended up in the Affordable Care Act, a couple of years later. Families USA has been leading the Oral Health for All campaign for seven years, focused on improving oral health coverage in Medicare and Medicaid — it took that whole time plus decades of work from others to get as far as we did in 2021. It is a big deal that the discussion over how to build a stronger country coming out of the pandemic put Medicare dental coverage front and center, and included considerable discussion about Medicaid dental coverage too. Now we must ensure that we have changed the dynamic of the conversation forever — oral health cannot sit in the back seat any longer.

Luckily, the events of the past year gave us a lot to work with in our quest to keep the attention on oral health coverage:

o The original Build Back Better proposal included Medicare dental coverage, and lawmakers fought for both Medicare and Medicaid dental coverage to be included in every iteration of the bill that has been drafted thus far.

o For voters, Medicare dental coverage was the most popular policy included in the original Build Back Better package.

o National and local media recognized what a pressing issue oral health is, including the need for Medicare coverage, putting the topic front and center for legislators and the public. It even landed a front-page article in The New York Times!

o Grassroots and coalition-based efforts grew considerably in both their size and power, including large scale collective actions from the Medicare Oral Health Coalition and the Oral Health Progress and Equity Network to directly engage policy makers and the public.

This is huge progress for an issue that had been long ignored and overlooked. Policymakers now know that this issue is extremely important to their constituents, and the topic is making headline news. We must seize the next opportunity to pass big legislation AND work to get some smaller, important wins as soon as this year.

For instance, the Biden administration can take immediate action to authorize coverage of “medically necessary” dental care in Medicare without waiting on Congress to act. This policy change would ensure that Medicare enrollees who have oral health needs directly tied to their medical needs can get the necessary care to advance their treatment (e.g. if you need a kidney transplant and cannot get it until your gum infection is treated, your gum treatment will be covered). While this is just one modest step forward, it’s one that could help thousands of older adults and those with disabilities who need care the most.

Not all progress needs to come from the federal government. State level action is the key to advancing oral health coverage in Medicaid. Thanks to strong advocates and elected officials, many states are already working to expand and improve oral health coverage for adults who rely upon Medicaid for their health insurance. This progress may not always be permanent — states often cut Medicaid oral health coverage at the first sign of budget trouble. However, the more states that take action the clearer it is that oral health really matters — to voters and to policymakers. This helps keep the pressure on Congress to enact more comprehensive and permanent solutions that improve Medicaid and Medicare dental coverage.

So, what does this all mean for our work today? It means we have more to do to get the small wins that can make a real difference. It means we must harness all of the power we built in the last year to keep the momentum going and keep oral health coverage in the spotlight. Oral health is not an option for families; it is a necessity to protect our overall health. Our health should not depend on our wealth, where we live, or the color of our skin. This goal is only achievable when programs and policies make oral health more affordable and accessible for all.