Biden’s plan to add dental coverage to Medicare faces a setback: Shots

Like many seniors, William Stork of Cedar Hill, Missouri, does not have dental insurance and does not want to pay $ 1,000 for a tooth extraction he needs. Health advocates see President Biden’s Build Back Better program as a unique opportunity to provide dental coverage to people like Stork who are on Medicare. An unlikely opponent: the American Dental Association.

Joe Martinez for Kaiser Health News


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Joe Martinez for Kaiser Health News


Like many seniors, William Stork of Cedar Hill, Missouri, does not have dental insurance and does not want to pay $ 1,000 for a tooth extraction he needs. Health advocates see President Biden’s Build Back Better program as a unique opportunity to provide dental coverage to people like Stork who are on Medicare. An unlikely opponent: the American Dental Association.

Joe Martinez for Kaiser Health News

William Stork needs a tooth. That’s what the 71-year-old retired truck driver’s dentist told him during a recent check-up.

This type of extraction requires an oral surgeon, which could cost him around $ 1,000 because, like most seniors, Stork does not have dental insurance and Medicare will not cover his dental bills. Between Social Security and his Teamsters Union pension, Stork says he can live comfortably in Cedar Hill, Missouri, about 30 miles southwest of St. Louis.

But the cost of $ 1,000 was significant enough that he decided to wait until the tooth absolutely had to come out.

Stork’s predicament is at the heart of a long-simmering rift in the dental profession that has reemerged as a battle over how to add dental coverage to Medicare, the public insurance program for people of 65 and over – if a benefit can pass at all.

A unique opportunity in a generation

Health equity advocates see President Biden’s Build Back Better program as a unique opportunity to provide dental coverage to those on Medicare, near half of which did not visit a dentist in 2018 – long before the pandemic interrupted dental appointments for many. Rates were even higher for black (68%), Hispanic (61%) and low-income (73%) seniors.

Coverage was excluded from a new cadre announced by Biden on Thursday, but supporters are still hoping they can get the cover in a final deal. To complicate their push, there is a debate over how many of the country’s more than 60 million Medicare beneficiaries should receive it.

Advocates of dental coverage for everyone on Medicare find themselves facing an unlikely opponent: the American Dental Association, which supports an alternative plan that would offer dental benefits only to low-income Medicare beneficiaries.

Medicare has excluded dental coverage (and visual and hearing coverage) since its inception in 1965. This exclusion was intentional: the dental profession has long fought stay away from the traditional medical system in order to preserve the autonomy of the domain.

Dental care and health are inextricably linked

More recently, however, dentists have emphasized the link between oral health and overall health. The most infamous, the 2007 deaths of a 12-year-old boy who could have been avoided with an $ 80 tooth extraction guest changes to the Maryland version of Medicaid, the state’s federal public insurance program for low-income people. But researchers have also, for example, linked dental care to reduction in healthcare costs in patients with type 2 diabetes.

When the World Health Organization suggested delaying elective oral health visits last year to prevent the spread of COVID-19, the American Dental Association repulsed, with Dr. Chad Gehani, then president of the organization, saying, “Oral health is integral to overall health. Dentistry is essential health care.

The ADA-backed Medicare proposal would only cover seniors who earn up to three times the poverty level. This currently translates to $ 38,640 per year for one person and the number of potential beneficiaries of over 60 million people to rabout half this number.

Medicare has never required means tests, but in a world where Congress seeks to cut social spending from $ 3.5 trillion over 10 years to $ 1.85 trillion, the ADA present its alternative as a way to save money while covering those who need dental insurance the most. A congressional budget office To analyse estimated that the plan to provide dental coverage to all Medicare beneficiaries would cost $ 238 billion over 10 years.

Research Finds Cost Is A Barrier To Dental Care

Unlike the ADA, the National Dental Association is pushing for a universal dental benefit of Medicare. The group, which “promotes equity in oral health among people of color”, was formed in 1913, in part because the ADA only eliminated discriminatory membership rules for its affiliates. ‘in 1965. Dr. Nathan Fletcher, chairman of the board of directors of the NDA, said he was not surprised to find his organization in conflict with the ADA over Medicare coverage.

“The face and demographics of ADA is a 65 year old white male. retirement, ”said Fletcher. said. “It doesn’t look like the [patients] we’re talking about. “

ADA Health Policy Institute Research find cost as a barrier to dental care “regardless of age, income level or type of insurance”, but low-income seniors were more likely to report it as a barrier.

Why Some Oppose a Universal Dental Medicare Benefit

“It would be tragic if we didn’t do something for these low-income seniors,” said Michael Graham, senior vice president of government and public affairs for the ADA.

Graham criticizes the design of Congressional proposals for a universal dental benefit of Medicare, noting that a includes a 20% co-payment for preventive services that could prevent low-income patients from accessing care they would otherwise get.

“Something is better than nothing, but the something [with a copay] means next to nothing for a lot of seniors, ”says Graham.

The ADA supports 100% preventative services for low-income Medicare beneficiaries, he says.

Would Most Dentists Take Medicare Patients?

Of course, only covering low-income seniors has its own questions, the most important of which is: will dentists even accept Medicare if they don’t have to? Low-income patients often seek dental care at safety clinics that plan months in advance. Some dentists fear that a limited Medicare benefit to low-income seniors will be easier to avoid, pushing even more newly insured Americans into an already overburdened dental safety net.

Overall, less than half of American dentists accept Medicaid, although more than 60% of NDA members do, according to Fletcher. ADA worries the reimbursement rates and red tape for a Medicare benefit will also be unattractive to many of its members.

But Fletcher, who is dental director of a Medicaid insurance company in Washington, DC, says he participated in Medicaid. varies considerably across the states – and, as with Medicaid, participation in any new Medicare dental program would largely depend on the design of the benefit.

If reimbursement rates for a Medicare benefit are high enough, Fletcher says, providing coverage to tens of millions of seniors could be very lucrative for dentists. Ultimately, he says, dentists should have the choice of whether or not to accept Medicare patients, and all Medicare patients should be entitled to dental services, since they have paid into the program.

A generational divide in the profession

William Stork’s dentist Dr. Nathan Suter sees adding dental insurance for all seniors to be the right thing to do.

Describing himself as a “proud member of the ADA,” Suter finds himself at odds with the organization, which has showered him with accolades. He was nominated Dentist of the Year by the Missouri Affiliate Dental Association in 2019 and received one of the ADA Awards for Young Dentists in 2020.

“As a member of the ADA, I think they should be at the table for me, making sure it is as beneficial as possible for all of my seniors,” says Suter, who estimates that at least 50 % of patients in his practice in House Springs, Missouri, are seniors.

But rather than pushing for a universal benefit, the ADA well-funded lobbying operation is push against The plan proposed by the Congressional Democrats to add dental coverage for all Medicare beneficiaries. The organization has asked its members to send an email to representatives of Congress on the subject; over 60,000 emails have been sent so far, Graham says.

Suter sees the battle over who to cover as a generational divide. As an early-career dentist, he prefers to add full dental coverage now so he can adapt his business model sooner. And the more seniors there are with dental coverage, the more its potential clientele grows. Dentists like him, who continue to grow their practice, are less likely to have the time to get involved in the ADA’s policy-making process, he says.

Patients like Stork, who say the possibility of dental coverage in Medicare is one of the reasons he’s withholding the tooth extraction he needs, even though he knows he’s unlikely a benefit is implemented before years, if at all.

Stork also knows that the benefit might not cover a middle-class person like himself, even if it is approved. Still, a blanket would certainly be nice to have when your tooth can’t wait to come out.

Kaiser Santé news is a national, editorially independent program of the Kaiser Family Foundation and is not affiliated with Kaiser Permanente.


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