Letting Medicaid, Medicare and other health insurance programs exclude coverage for teeth is as foolish as letting the programs exclude coverage for arms, legs or other body parts, Dr. Burton Edelstein testified today in Washington.
Edelstein, a professor of dentistry and health policy at Columbia University, appeared at a hearing on the state of U.S. dental care that was organized by the primary health and aging subcommittee at the Senate Health, Education, Labor and Pensions (HELP) Committee.
Subcommittee members reviewed the work of researchers from the Pew Center on the States, Washington, who reported earlier this week that patients with dental problems are flooding into emergency rooms, and that about 20% of emergency room visits in Minnesota are the result of dental problems.
Edelstein, the founding president of the Children's Dental Health Project, Washington, and a commissioner on the Medicaid and Children's Health Insurance Program Access Commission, said U.S. residents' inability to get timely dental care is a hidden epidemic.
One obstacle to helping low-income people get dental coverage and dental care is that "Congress, in its decisions about coverage, has only very recently recognized that dental services are essential to basic, primary, health care – and then only for children," Edelstein said, according to a written version of his remarks posted by the HELP Committee.
Congress has treated dental coverage as an optional Medicaid benefit for adults, and dental coverage is absent from the Medicare program, Edelstein said.
"As a result of the Medicare exclusion of dental coverage, millions of baby boomers will be moving out of employer-sponsored dental coverage that they have enjoyed for decades and into no dental coverage at all," Edelstein said. "Unlike many of their predecessors, they have benefited from dental care and have retained their teeth. They will need ongoing and regular basic primary dental care which is increasingly priced out of reach for the uninsured."
Now, as states are implementing programs related to the Patient Protection and Affordable Care Act of 2010 (PPACA), they are finding that Congress has required them only to cover pediatric dental care, Edelstein said.
"This consistent record of exclusion is equivalent to arbitrarily excluding a limb, an organ, or an essential biological function from health coverage," Edelstein said. "It inherently suggests that dental care is not primary care, not essential care, and something that people can do without."
In some cases, Edelstein said, the result is that patients with medical insurance but no dental insurance seek dental care in the emergency room simply because they know the medical insurance will cover the emergency room visit -- even though emergency rooms care is about 10 times more expensive than ordinary dental care and emergency rooms generally can provide only painkillers and antibiotics, not treatments for the underlying causes of pain and infections, Edelstein said.
The country does now requires all states to offer dental benefits to children enrolled in Medicaid and and the Children's Health Insurance Program (CHIP), and states are now planning to provide dental coverage for children throughthe new PPACA health insurance exchange system, Edelstein said.
One simple step Congress could take would be to invest $5 million in dental health literacy efforts in fiscal year 2013, which starts Oct. 1, and another step would be for Congress to provide $8 million in funding to support pilot programs that seek to prevent tooth decay in very young children, Edelstein said.
Congress also needs to make sure that pediatric dental care programs focus on the children to appear at the highest risk of suffering from tooth decay, Edelstein said.