Health advocates worry Calif. children won’t access dental care in exchanges

The advocates who fought hard for the inclusion of pediatric dental benefits under the Affordable Care Act have been closely watching as states set up their insurance exchanges, also known as marketplaces.

Their first look at the details of dental coverage to be offered on California’s state exchange, Covered California, got them worried, the Sacramento Bee’s Jim Sanders reports.

“Filling cavities in children’s teeth is designated by law as one of 10 ‘essential benefits’ in next year’s federal health care overhaul. But children’s advocates say that the fine print shows that it’s not all that essential after all,” wrote Sanders on July 10 in “Children’s Advocates Say New Dental Plans Not That Filling After All.”

 “Unlike other key medical services, California families considering the purchase of pediatric dental insurance next year:

  • Will not be fined for failing to acquire it.
  • Will not be eligible for federal subsidies to ease costs to low-income households.
  • Will not find an insurance policy on California’s new health care exchange that combines kids’ dentistry with coverage for the nine other essential health benefits, including hospitalization and prescription drugs.

“The bottom line is that low-income families buying pediatric dental insurance through the state’s online exchange, Covered California, will pay an extra monthly premium and potentially more out-of-pocket expenses.”

The fact that dental insurance is nearly always sold separately from medical insurance is complicating the challenge of including affordable dental benefits into the coverage sold on the exchanges.

As Sanders reports, the California advocates have begun pushing the state exchange “to switch gears and embed medical care and kids’ dental care into a single policy, with premiums cut by charging the same price to families with children and without.”

Kathleen Hamilton of the Children’s Partnership, a coalition of advocacy groups, told Sanders that pediatric dental care should be no different than other essential health services that not every age group or gender uses – such as mammographies or prostate tests – but whose costs are blended into premiums charged to all.

“That’s what drives affordability,” Hamilton said.

But Sanders talked with a state legislator who had a very different view.

Assemblyman Dan Logue, R-Marysville, told the reporter that many older people with no children have a hard enough time paying for their own health care, much less subsidizing pediatric dental care.

“If we continue to ask people to pay for health care for everybody, I think you’re going to see the system collapse,” Logue told Sanders.

In another good story on the topic, “Calif. Insurance Exchange Unveils Pediatric Dental Plans” Donna Domino, of the offered additional details.

The Patient Protection and Affordable Care Act “gave the states flexibility to offer pediatric dental care in three ways: as embedded, bundled, or standalone plans,” Domino wrote. But while the exchange provides federal subsidies on a sliding scale to Californians with annual incomes ranging up to $45,960 for an individual and $94,200 for a family of four who buy medical insurance on the exchange, no subsidies are available for stand-alone or bundled pediatric dental coverage, Domino noted.

Covered California spokeswoman Anne Gonzales told her the exchange chose to forego an embedded plan because embedded plans include pediatric dental coverage as part of the overall health plan and require everyone to pay the same premium whether they have children or not.

Another concern, according to Gonzales, was keeping the uniformity of health insurance plans in order to make it easier for consumers to know what they are buying.

“We wanted people to be able to buy insurance online and quickly see prices and the provider network, and they don’t have to look at all the benefits because all the benefits are standard,” she told “But if we start embedding certain benefits into plans, like the pediatric dental benefit, it could be confusing for consumers.”

Gonzales also pointed out the law requires only that pediatric dental insurance be available, not that parents must buy it for their children, added Domino.

But Domino also got an earful from critics, including California Insurance Commissioner Dave Jones and the Children’s Partnership advocacy group, who predicted that excluding embedded dental coverage will drive up the costs and ultimately hurt kids.

Leave a Reply