To: Chuck Schumer
From: Punam Patel
Date: January 20, 2018
Re: Oral Health
Statement of Issue: Oral health is one of the issues that has gained a lot of traction since we realized the importance of it. Still, according to CDC, in 2011 to 2012 approximately 91% of adults from age 20 to 64 had dental caries, tooth decay classified as an oral health issue, in their permanent teeth. Out of this 91%, 27% of adults were untreated. As can be seen there is still an increased prevalence of oral health disorders which need to be addressed. According to American Dental Association, 95% of adults have stated that they value keeping their mouth healthy and 93% stated that regular visits to dentist keep them healthy. These statistics combined with the CDC statistics indicate that there may be several causes for this national oral health issue. One of which is the minimal to nonexistent dental coverage that insurances provide. American Dental Association continues to state that even under the Affordable Care Act dental health is not listed as essential leading insurance companies to provide minimal dental benefits. This points to the fact that even in this day and age more reform for oral health coverage is needed.
- Oral health diseases are linked to many other systemic disorders
It has been found that oral health conditions such as periodontitis can lead to conditions such as cardiovascular disease, bacterial pneumonia, diabetes mellitus, and low birth weight.
- People with chronic conditions require proper oral health care to prevent further deterioration of quality of life
People with diabetes are prone to oral health conditions such as tooth decay, periodontal disease, dry mouth, and infection. These oral conditions can then cause other associated systemic diseases as mentioned above. Even an increase in hormone levels, such as pregnant women are at a higher risk of developing inflamed gums which can go on to cause periodontal disease and lead to low birth weight.
- Poor oral health can lead to a lower quality of life
Presence of oral health conditions without proper access to care can leave the patient in pain and suffering which can also lead to difficulty in normal daily activities such as chewing, speaking, swallowing.
- Cost of advanced oral health treatment without any insurance coverage is very expensive for such as crucial aspect of our health
It has been found that having specialist dental treatment can cost patients around $1,624. Having a single procedure such as dental crown would cost around $1,000 to $1,500. A simple tooth extraction can cost around $300 to $ 1,500.
- Treating oral health diseases at a later point in time is more expensive than preventing the disease
It has been found that preventative dental care can help save money in the long-run, it is stated that for every $1 spent on preventative care you can save $8 to $50 in emergency treatment
Policy Options
- A possible policy option is to have a federal mandate that forces all insurance companies to provide basic preventative services for oral health. There would be certain coverages that every insurance plans should include such as annual dental cleaning and dental fillings.
- Advantages: This will help all people to be covered with basic benefits that can help them to gain annual preventative services. With these consistent preventative services, it would lead to lower incidence rates of oral heath disorders and possibly systemic diseases.
- Disadvantages: This would lead for increases in premiums, cost sharing, and lead to costlier plans. With the increase in prices for the plans many people would be reluctant to purchase the plan or even be unable to purchase the plan. Additionally, not everyone in the nation would need the coverage leading to services that are unused.
- Another possible policy is that basic dental health insurance is mandated for states to cover in their Medicaid plans and incentivize private insurances to include low cost basic dental coverages instead of mandating it. This would include preventative services and basic treatment coverages.
- Advantages: This would help the Medicaid patients that are in need of proper dental insurance since they lower incomes have been associated with poorer oral health. It also allows for the creation of some private coverage to be available for those that do not qualify for Medicaid. It would help cover the majority of patients that suffer from oral health disorders since patients that need coverage can either apply to Medicaid if they qualify or buy a private insurance that will provide some coverage.
- Disadvantages: This would increase the level of taxes that people pay in order to subsidize this new coverage. There would be an influx of people trying to apply to Medicaid in order to obtain these oral health benefits. There would be a more prevalent population of people that already have oral health diseases which would probably need advanced treatment to cover. Additionally, the number of dental providers that accept this insurance would remain low since Medicaid would try to pay lower amounts than other insurances.
- Possible policy that can be utilized is one that the federal/state government incentivizes employer-based insurances to provide basic dental coverage.
- Advantages: In this option it would help to cover many of the working-class people leading to majority of Americans that would gain coverage for oral health. Many of the working class would have a lower proportion of people with oral diseases allowing them to have greater impact on future prevalence and incidence of oral disease. Many of the providers would accept certain private insurances.
- Disadvantages: There would opposition from many businesses because it would raise the costs for them. In order to minimize costs then most businesses would try to cut cost by other means such as getting rid of lower paying jobs. Some employees would lose their jobs causing them to lose overall health care coverage. There would significant lobbying efforts and would be near impossible to have this type of mandate passed.
Policy Recommendation: After looking at how oral health affects health conditions and the type of population that it affects, it is critical to find a solution to this problem. The best policy recommendation that minimizes disadvantages and maximizes advantages would be to mandate the coverage of oral health in Medicaid. Even though this mandate has some drawbacks such as funding, I believe that it targets a larger amount of people that are more susceptible to oral health diseases, which is the low-income population. This policy also allows for consumers to decide if they need the coverage or not. This would also help to increase the awareness of preventative care in throughout the low-income population. This shows that this plan is feasible with proper political support and can be seen as the benefits of it off putting the costs.
Sources:
https://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/sgr/chap4.htm
https://www.cdc.gov/nchs/data/databriefs/db197.htm
http://www.ada.org/en/science-research/health-policy-institute/publications/research-briefs
https://dentistry.uic.edu/blog/value-preventive-oral-health-care
https://www.health.ny.gov/health_care/medicaid/#services
http://health.costhelper.com/dental-crown.html
https://www.growingfamilybenefits.com/cost-dental-implants/
http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0316_4.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610377/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88948/
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