When the Affordable Care Act goes into effect next year, millions of Americans who have been without access to affordable medical care will be covered under Obama’s planned insurance overhaul. However, those hoping for dental work will be out of luck.
The health plans that American consumers will be required to purchase will cover a variety of services, including hospitalization, preventive and wellness services, and psychological services. And while the coverage is fairly vast, dental coverage is notably absent.
“The ACA really falls short on adult coverage in dentistry,” said Robert Faiella, the American Dental Association president. “The dental side is not really addressed.”
According to the ADA, dental coverage has been on the decline for the last decade, despite the rise in children receiving benefits. The percentage of adults who go to the dentist has dropped from 41 percent in 2003 to 37 percent in 2010. As a result, emergency room visits for dental problems rose to 2 million in 2010 — more than twice the number of emergency room visits for dental problems in 2000.
Faiella sees the lack of dental care in The Affordable Care Act as a huge oversight. “We’re concerned about it because the law does not draw attention to the fact that oral health is very critically involved in overall health,” he explained.
Presently, the law only has a few provisions for children’s dental services as an essential health benefit, but it has no additional coverage mandates for adults. A big problem is that ACA-certified pediatric dental coverage could see adults getting cost hikes of nearly 57 percent — from $35 to $55 — in order to insure their children.
The Association of Dental Plans believes that this will cause adults to drop coverage on themselves. NADP executive director Evelyn Ireland explained that while millions of children might receive coverage under the ACA, millions more adults might lose coverage “for a net loss of coverage in the overall population.”
Other notable omissions from the Health Department’s final list of children’s preventive benefits that insurers must cover at no cost to patients include routine cleanings and sealants, although fluoride supplements are covered if prescribed from a pediatrician.
It is also expected that federal subsidies for exchange-based health plans will not factor into the inclusion of dental plans, meaning those who have to buy it separately will have no extra money to do so. “It is a really odd kind of situation where they’re going to be oversubsidizing some consumers and undersubsidizing others,” Ireland says.
While the government is not providing subsidies, the insurance exchanges will provide dental plans for adults, and consumer health advocates are hoping that Americans will purchase them. The sticking point will end up being whether the plans or more or less expensive than what’s already on the market.