No simple solution for gaps in oral health care

The lack of oral health coverage that affects more than 100 million Americans is a problem that will only be partially addressed by health care reform, organizers of a recent forum on Capitol Hill acknowledged.

The Patient Protection and Affordable Care Act (PPACA) ensures dental benefits for children in the “essential health benefits” package.

But PPACA has far less to say about adult dental coverage.

It’s the same with other federal health care programs: Medicaid entitles children to dental benefits, but not adults. And Medicare does not cover routine dental care for elders.

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The continuing gap between the provision of oral health services and other types of health care services will remain an immense challenge with no simple solution, agreed speakers at the Aug. 17 event, “Oral Health: Putting Teeth into the Health Care System.”

An increasing number of uninsured people are turning to emergency rooms for relief of dental pain and infection, said panelist Julie Stitzel of the Pew Center on the States. A PDF of her presentation is available online.

In a study, Pew concluded that preventable dental conditions were the primary diagnosis in 830,590 visits to emergency rooms in 2009, a 16 percent increase from 2006. Besides being a costly burden to the states, the visits often do not address the patients’ needs.

“It is the wrong care at the wrong place at the wrong time for desperate patients,” Stitzel said.

Yet poor adults often find themselves with few places to turn when they need care.

While poor children are entitled to dental services under Medicaid, adults are not. The dental care they may be able to obtain varies from state to state and the benefits are often meager. In addition, they regularly end up on the chopping block when states are going through rough times.

“Obviously we are still concerned that in an underserved area a child has dental services until 21 and then we just cut them loose,” said panelist Lynn Douglas Mouden, D.D.S., the chief dental officer for the Centers for Medicare and Medicaid Services.

“That doesn’t mean their dental problems or need for dental care has gone away. We are still in a position where it’s up to the states to decide whether or not they are going to provide adult dental services under Medicaid. And with competing state priorities, it is still going to be a concern.”

Mouden acknowleged his continuing concern about the lack of dental care for seniors under Medicare.

“When people turn 65 in this country, we apparently no longer care about their oral health,” he said. Acknowledging that he is approaching that age, he added “I hope that Medicare will catch up by the time I get there.” Mouden’s presentation is available online.

The forum was sponsored by the nonpartisan Alliance for Health Reform, which organizes many health-related briefings and events, including an annual bipartisan health care retreat for members of Congress, and the Robert Wood Johnson Foundation, a major health care philanthropy.

More materials and resources, including presentations by additional speakers, were provided at the event.

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