Nothing to Smile About: The Affordable Care Act’s Cavity Problem

Nothing to Smile About: The Affordable Care Act’s Cavity Problem

Nothing to Smile About: The Affordable Care Act’s Cavity Problem

Last week, in Washington, a rare thing occurred: A U.S. Senator actually addressed the shameful state of dental care in the country. At a hearing on the Affordable Care Act, which is only months away from beginning its nationwide enrollment period, Sen. Ben Cardin of Maryland showed his teeth. Speaking to the baffling decision to list pediatric oral care under the Essential Health Benefit Packages (EHBPS) – essentially meaning kiddie dental must be ‘offered’ by providers, but it’s not ‘required’ to be covered in full – Cardin says, “There is no guarantee or requirement that families have pediatric dental coverage, and the coverage could be provided in a stand-alone plan with a separate deductible, so that a family with two children might have to pay as much as $1,400 in out-of-pocket costs for dental coverage.”

With dental costs often too rich for many Americans’ blood – more than 100 million Americans don’t go to the dentist due to the price – and the lack of clear solutions has led to a health crisis. As I recently tweeted, half the state of Kentucky, for example, is without any form of dental insurance, leading to what’s formally considered a “dental desert,” state especially in need of coverage. (The ACA does take additional measures for these crisis areas.) The idea that kids should be tended to in terms of dental care and not their parents makes little to no sense for the overall health of our nation.

As it currently stands, adults must purchase separate dental and vision plans, and the ACA continues this ludicrous practice. Starting in October, individuals purchasing individual or small-coverage plans, either within or outside a health-care marketplace exchange, may have to change dentists if theirs won’t accept it. Worse, even participating dentists services have zero limitations placed on out-of-pocket expenses for the patient.

Sound familiar? If so, that’s because this is the current, utterly broken system of handling dental costs and ensuring people get covered. Which is to say, they don’t. As points out, even the covered pediatric plans don’t ensure the patients won’t get bilked:

“A medical plan offering dental coverage may seem cheaper (one premium), but it likely has a large combined deductible, and non-preventive dental expenses may not be covered until the medical deductible is satisfied. The high out-of-pocket maximum for medical must be reached before covered pediatric dental or vision would be paid in full.”

How has it come to this point? For one, we’re only now getting the scientific research that shows dental care is directly tied to overall body health, so there’s a lengthy history of considering dental care ‘secondary’ to so-called general care. For another, 91% of dentists are small-business owners, according to Salon, which means they bear all the risks and costs involved in a practice. This fear of operational cost losses has lead dentists to refuse patients with Medicaid.

That the Affordable Care Act does little to address this logistical quagmire is more than shocking – it’s depressing. Kudos to Sen. Cardin for saying something; if only we had 49 other Sen. Cardins speaking on our behalf.


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