Hillary Clinton bills herself a progressive who gets things done. And the Democrats’ nominee for president has pledged to keep the Affordable Care Act intact in office, shielding it from Republican repeal attempts and building on its foundation.
When it comes to building on the Affordable Care Act, one of Clinton’s first priorities should be expanding access to dental care.
A person’s dental health is inextricably linked with overall health, so it’s illogical that medical and dental insurance evolved as separate products throughout the 20th century and that the Affordable Care Act largely perpetuated the dichotomy. There’s no reason medical care should apply to every region of the body but the mouth.
The Affordable Care Act designates preventive dental care a required benefit for health insurance plans sold on the law’s online marketplaces, but only for children. The federal law also requires that state Medicaid plans cover pediatric, preventive dental care — but no such requirement extends to coverage for adults.
That leaves adult dental coverage options inconsistent and dependent on a mix of state policy decisions and state-by-state insurer offerings. According to the Kaiser Family Foundation, only 15 states offer extensive adult dental coverage through Medicaid (Maine isn’t one of them). And state health insurance exchanges offer a patchwork of dental coverage options, often through stand-alone insurance plans that adults must purchase apart from their medical plans and without the help of the federal subsidies that defray the cost of health insurance.
The result? The U.S. Health Resources and Services Administration estimates 108 million Americans lack dental insurance, compared with 35.7 million people who live without health insurance.
In Maine, adults with Medicaid can receive coverage only for dental emergencies, such as tooth extractions, which are generally needed only after manageable dental problems have developed into major — and expensive — health issues.
The medical consequences of a lack of dental care are clear. A 2010 study of emergency room use by the Muskie School of Public Service at the University of Southern Maine revealed that dental disease was the top reason for someone age 15 to 44 with MaineCare or without insurance to seek emergency room care.
Dental problems can have medical roots, and medical problems can have dental origins. Diabetes can contribute to gum disease, for example. Gum disease, in turn, can exacerbate diabetes. Gum disease also is associated with increased risk of stroke. Pregnant women with poor dental health — such as untreated tooth decay and gum disease — are more likely than other mothers to have low birth-weight or premature babies. And at a most basic level, poor dental health can make it difficult for someone to eat a nutritious diet, Dr. Charles Norman, then president of the American Dental Association, told the website MarketWatch in 2014.
Researchers have found that adequate, preventive dental care is linked with fewer hospital admissions and substantially lower medical costs during pregnancy and to treat type 2 diabetes, coronary artery disease and cerebrovascular disease. Preventive dental care, once integrated into the health insurance system, is a benefit that can go a long way toward paying for itself.
Clinton so far has pledged to build on the Affordable Care Act as a way to make access to health care universal. She’s pledged to pursue a public insurance plan as an option on the Affordable Care Act’s exchanges. And she’s proposed allowing people 55 and older to buy into Medicare — which, by the way, doesn’t offer comprehensive dental care as a core benefit.
In focusing on new mechanisms to make insurance more widely available, she can’t afford to lose sight of a critical benefit that insurance should cover.
