New GAO report reveals trends in coverage, use of dental services

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

In 2011, 4 million children did not obtain needed dental care because their families could not afford it, according to a new Government Accountability Office report. In 2008, more than 40 percent of adults with tooth or mouth problems did not see a dentist because they lacked dental coverage or the money to pay for care. Roughly 62 percent of Americans carry private or public dental coverage, a rate that is about the same as it was in 1996, according to the report, “Dental Services: Information on Coverage, Payments, and Fee Variation.”

“Unfortunately … not much has changed in this arena,” said Kathleen Iritani, explaining the findings in an interview on the GAO’s Watchdog report.

Most people know that they need to go to the dentist often. Having dental coverage is strongly associated with the use of dental services. Americans often say that the cost of dental care and the lack of dental coverage are reasons they don’t get needed dental care,” Irritani said.

The GAO report revealed a shift away from private coverage and toward public coverage when 1996 and 2010 rates were compared. The percentage of Americans with private dental coverage decreased from 53 percent to 50 percent, while coverage through Medicaid or the State Children’s Health Insurance Program (SCHIP) increased from 9 percent to 13 percent.

Individuals with no dental coverage decreased from 28 percent to 25 percent, and coverage for 10 percent to 12 percent of the population was unknown, according to the study.

The use of dental services – the percentage of individuals who had at least one dental visit – also remained relatively unchanged. Medicaid and CHIP beneficiaries, children in particular, showed increased access to care, with their use of dental services up from 28 percent to 37 percent. But publicly insured children still got to the dentist far less often than their privately insured peers: 58 percent of kids with private insurance got dental visits in 2010, the report found.

Americans are paying more for dental care, the GAO analysis found, with the total amount paid out of pocket by individuals and by other payers increasing 26 percent, inflation-adjusted, from $520 in 1996 to $653 in 2010.

The report, which also looked at the fees charged by dentists and health centers, found wide variations. In one example, in Miami, Fla., the upper-end fee of $150 for a periodic oral examination was more than twice the midpoint dental fee of $62. Dental fees also varied between local dentists billing private insurers and health centers serving residents of the same community, the report found. In general, the analysis concluded, most health centers offered a 100 percent discount – resulting in no fee – to the lowest-income patients for many, but not all, dental services.

The study was prepared for Sen. Bernie, I-Vt., who chairs the Senate’s subcommittee on primary health and aging. At a Sept 12 hearing called by Sanders, witnesses testified about the lack of care for suffering children, the high cost of dental services and low Medicaid reimbursement rates.

“We are paying for an inefficient, unjust system,” said Sanders, who is pushing for sweeping legislation aimed at expanding dental coverage and delivery of care and adding new care providers to the dental workforce.

Here is a short report on the Sept. 12 hearing filed by Pat Bradley of North Country Radio, as well as a five-minute highlights video from the hearing and witness testimony and the full video from the hearing.

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