WASHINGTON – Dentists from across the country urged Congress to include dental coverage in Medicare at a hearing Thursday, saying fewer than half of beneficiaries see a dentist each year.
The panel of four dentists told the Senate Aid, Education, Labor and Pensions Committee that additional changes are also needed to narrow the gap in consistent dental care for all Americans, including removing the barrier between health care and dentistry, as well as strengthening more affordable treatment for underserved communities.
The dentists also told senators that better outreach and education is needed to ensure people understand how missing regular checkups can negatively impact their physical health.
Dr. Lisa Simon, a physician assistant at Brigham and Women’s Hospital and a faculty member at Harvard Medical School, testified that “fewer than half of Medicare beneficiaries visit a dentist each year.” When they do, they spend more than $1,000 dollars out of pocket for her care.”
She also told senators during the Hear that the dental coverage that many Medicare Advantage plans provide is inadequate. Such plans offered by private companies bundle Part A and Part B coverage and often include drug insurance as well.
“Dental plans are often a draw for beneficiaries who choose Medicare Advantage,” Simon said. “But my research shows that dental access rates are just as low and out-of-pocket costs are just as high for Medicare Advantage beneficiaries as for traditional Medicare beneficiaries. Medicare Advantage is not the solution here.”
Dr. Myechia Minter-Jordan, president and CEO of the CareQuest Institute for Oral Health in Boston, told the panel that established Medicare’s exclusion of dental benefits results in about “half of those covered by Medicare, nearly 25 million older Americans and people with disabilities, not receiving dental services.” .”
“There is currently no financial assistance available for adults to purchase dental insurance through the Health Insurance Marketplace,” Minter-Jordan said. “And adult dental care is optional under state Medicaid programs, meaning coverage varies widely, from extensive services to none at all.”
Dr. Brian Jeffrey Swann, a board member of Remote Area Medical and a practicing dentist in Tennessee, told the committee that the nonprofit provides pop-up dental and vision clinics for the underinsured and uninsured.
“The people who come to RAM for help often drive across two or three state lines, sleeping in their cars and wrapped in blankets to stay warm. “A lot of people come days before the clinic just to make sure they get a ticket,” Swann said.
“Patients suffer from tooth decay and gum disease,” he added. “And that’s concerning because of the interaction between gum disease and diabetes.”
Swann, who is also co-chair of Global Oral Health at the National Dental Association, said the organization has been calling for dental insurance to be included in Medicare for decades.
Sanders and Cassidy split over Medicare changes
The dentists’ recommendations revealed a rift between the two top lawmakers on the panel.
“The lack of affordable dental care in America is a problem across the country,” said HELP Committee Chairman Bernie Sanders, an independent from Vermont. “But it is particularly acute for lower-income Americans, pregnant women, people with disabilities, veterans, people living in rural communities, and Black, Latino and Native Americans.”
Sanders said access to and affordability of dental care in the United States has “become so absurd” that Americans have begun traveling to “countries like Mexico, Costa Rica, India, Thailand and Hungary where it is much less expensive.” to receive dental care.” you need.”
That’s still out of reach for many people and has resulted in nearly one in five seniors losing their teeth, he said.
“And many of them cannot afford dentures, which can cost many thousands of dollars,” Sanders said, adding that “70% of older Americans suffer from periodontal disease, which can lead to rheumatoid arthritis and cardiovascular disease. “
Sanders reiterated, as he has for years, that Medicare coverage should include dental and vision coverage.
Louisiana Republican Senator Bill Cassidy, ranking member on the HELP Committee, said that about “88% of Americans have dental coverage,” although he noted that “the backlog of dental care is greater than the backlog of medical care .” .”
Cassidy, a physician, said that while established Medicare does not cover dental care, “98% of Medicare Advantage plans do provide dental benefits and more than half of Medicare enrollees are enrolled in an MA plan.”
He appeared to reject the proposal to add dental coverage to Medicare in the near future, noting that the program is expected to face a significant funding shortfall in about a decade.
“With Medicare on the path to insolvency in just over a decade, we should also think about making this sustainable before adding programs,” he said.
Cassidy also criticized how Medicaid, a health insurance program for low-income people, currently approaches dental care.
“The reimbursement rate under Medicaid is so abysmal that it is, quite frankly, an illusion of no-access health insurance,” Cassidy said. “If you lose money on every patient covered by Medicaid, you can’t recover that.”
Problems in Rural America
Alaska Republican Senator Lisa Murkowski raised the issue of access to dentists in rural areas, including her home state, during the hearing.
“I grew up in a part of the state where if you had to go to the dentist, you got on a plane or a ferry and usually went to Seattle,” she said. “And it wasn’t a cheap trip, but it was how we got our health care.”
“We have improved dramatically since then, but we still have far too many communities where access is an issue,” Murkowski added.
There are still many examples where “overall health outcomes have been negatively impacted because it all started with poor oral health care,” she said.
Dr. Gordon Roswell Isbell III, a former trustee of the Academy of General Dentistry of Alabama, said ensuring there are enough dentists and dental hygienists in rural areas is a challenge. He suggested developing programs that bring dentists to rural areas.
“I know we’ve worked hard on this in our state and are having some success,” Isbell said, adding that rural residents “deserve” good dental care.
Swann testified that dental schools need more role models who can show students how best to live and work in rural areas. He also suggested creating incentives and “innovative business models.”
Minter-Jordan said a third of rural residents do not have dental insurance and that four in 10 adults in rural areas have not seen a dentist in more than a year.
New Hampshire Democratic Sen. Maggie Hassan said during the hearing that although her home state expanded Medicaid coverage to include dental care last year, she has heard from many people that it is extremely arduous to get one in rural areas Finding a dentist who accepts up-to-date patients and takes Medicaid.
Simon said recruiting dental students from rural areas “can make a small contribution to better serving these communities.”
