Patients delay dental care due to cost more than any other health care service, according to testimony Thursday at a hearing of the Senate Health, Education, Labor, and Pensions (HELP) Committee to explore how to make dental care more affordable and more available to Americans.
HELP Committee Chair Sen. Bernie Sanders (I-Vt.) said at the hearing that dental care is often ignored in health care discussions, yet millions of Americans are unable to afford or access the dental care they need.
Indeed, he said, today nearly 70 million adults and eight million children have no dental insurance and half of Americans that do have insurance skip their appointments because they can’t afford to pay for dental procedures. One out of five seniors have lost their natural teeth and can’t afford a full set of dentures and 70 percent of older Americans suffer from periodontal disease. More than 40 percent of children in America have tooth decay by the time they reach kindergarten.
“It’s absurd that every year hundreds of thousands leave the United States to go to countries like Mexico to get the dental care they need,” Sanders said, noting that the price of a dental implant is $5,500 in America and $850 in Mexico for the same treatment.
The other problem is there is a lack of dentists and dental hygienists, especially in rural areas. And of the dentists in America, only a third provide care to people on Medicaid. “We’ve got to expand high-quality dental insurance in America,” he said, noting many seniors don’t have comprehensive coverage because traditional Medicare doesn’t cover most dental procedures.
Lisa Simon, M.D., DMD, associate physician, Brigham and Women’s Hospital, and a member of the faculty, Harvard Medical School, urged the committee to support legislation that would make adult dental coverage a mandatory Medicaid and Medicare benefit. While children with Medicaid or CHIP have dental coverage, the benefit disappears the moment they become adults, she said. “If dental care is an essential benefit for low-income children and the privately insured, low-income adults must have the same right to health care,” she said.
Medicare hasn’t provided a dental benefit since 1965, she said. Fewer than half of Medicare beneficiaries see a dentist each year and when they do, they spend more than $1,000 out-of-pocket on their care. Indeed, she said, patients delay dental care due to cost more than any other health care service. Although Medicare covers some limited dental benefits for Medicare beneficiaries with specific diagnoses, it’s not comprehensive care and will likely impact fewer than 10 percent of all beneficiaries.
Dr. Simon noted that dental coverage is a popular supplemental benefit of Medicare Advantage plans. However, her research has shown that beneficiaries have low rates of dental access and equally high out-of-pocket costs. “Medicare Advantage is not the solution,” she said. “The evolution of dental care delivery must be a national priority. “
Myechia Minter-Jordan, M.D, MBA, president and CEO of CareQuest Institute for Oral Health, agreed.
“If we want to truly improve overall health, we need to prevent oral health disease before it takes hold,” Dr. Minter-Jordan testified, noting that access to dental care will keep other health conditions from worsening. “Poor oral health has a direct link to a person’s overall health, including greater risk of diabetes, hypertension, obesity, dementia, mental health issues, and adverse birth outcomes Given that there are persistent health inequities associated with many, if not all, of these conditions, preventing oral disease may also be key to tackling disparities that exist throughout our health care system.”
Brian Jeffrey Swann, DMD, MPH, board of directors of Remote Area and co-chair of global oral health outreach at the National Dental Association; and Gordon Roswell Isbell, III, DMD, MAGD, past trustee of the Academy of General Dentistry also testified at the hearing.