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Nancy Smith

Obamacare Leaves Gaping Cavity in Adults' Dental Health

February 9, 2014 - 6:00pm

In the Obamacare conversation, dental health care flies under the radar -- a scary reality, say many dentists, who fear the new federal law will trigger an oral health crisis.

They say Obamacare looks good for children, but disastrous for adults -- particularly middle class adults, because it provides nothing for them.

Those who currently have dental health insurance through their employers will lose it when they are forced into an Affordable Care Act (ACA), or Obamacare, exchange plan.

That's a significant number of now-insured employees. A study conducted in 2010 by researchers at the University of Maryland Dental School in Baltimore and the federal Agency for Healthcare Research and Quality, concluded that 63 percent of employers offering health insurance also offer dental insurance.

How many of those people are likely to have the money or the inclination to find a private dental plan is uncertain, but some dental professionals think the percentage is likely to be low.

Under the health care law, dental insurance is treated differently for adults and children 18 and under.

The law treats dental coverage for children as an essential health benefit. This means if youre getting coverage for someone 18 or younger, dental coverage must be available as part of a health plan or as a stand-alone plan.

This is not the case for adults. Insurers dont have to offer adult dental coverage and adults don't have to buy it. In fact, they don't have to buy it even for children to avoid paying the penalty.

Dentists say fewer healthy adults will opt for this coverage because they face higher premiums through the mandated ACA coverage. Therefore, because adults who require more extensive and costly treatment make up a greater fraction of the pool, dental premiums will rise. This will result in fewer people with private insurance plans that include extensive dental coverage.

Under Obamacare, early estimates were that up to 8.5 million additional children would receive dental coverage by 2018 through private or government insurance. Perhaps up to 4.5 million adults would qualify for dental coverage through added Medicaid rolls and 800,000 through health insurance exchanges under the ACA. But most states have reduced adult dental coverage under Medicaid due to soaring costs. So those numbers may be nowhere near reality.

"This is terrible," retired Fort Pierce orthodontist John Naismith told Sunshine State News. "Without affordable dental care many adults will forego seeing a dentist because they can't afford to. Others will lose their savings to pay off their dentist. ... Once again, those running this country have really screwed up. If Obama believes we all deserve affordable health care, then why isnt dental care part of the Affordable Care Act?"

Miami dentist Julian Cruz agrees. He quotes the American Dental Association: Taking care of your teeth and gums isnt just about preventing cavities or bad breath. The mouth is a gateway into your bodys overall health. And since gum disease and other health problems may be linked, brushing and flossing are more important than ever. See your dentist regularly to keep your smile, and yourself, healthy.

Linked with poor oral hygiene are cardiovascular disease, dementia, respiratory infections, and diabetic complications, among others.

Evan Levine, a proactive cardiologist in Ridgefield, Conn. and author of What Your Doctor Wont (or Cant) Tell You: The Failures of American Medicine and How to Avoid Becoming A Statistic, is trying to educate officials on the seriousness of the impending dental health crisis.

"My colleagues and I are now seeing patients with rotting teeth, with infectious endocarditis caused by poor dentition, and people in chronic pain from old caries," he says.

"Heart surgeons are doing careful dental exams because they are concerned that patients have smoldering gum and tooth infections and that could compromise a newly inserted valve. Therefore, many patients having heart surgery are first having a number of teeth urgently removed."

But under Obamacare, Levine says, "the patients surgery will be covered, the heart surgeon will be paid about $2,300 for his work -- that includes all his postoperative care and visits -- and the patient will likely be billed thousands of dollars, by the dentist.

"Under ACA, patients having life-saving heart surgery will have more out-of-pocket expense for that dental bill than for the heart surgery."

Says Beth Truett, president and CEO of Oral Health America, "Until we have an expansion of this kind of (i.e., dental) coverage, and until we have people really recognizing what this means for their overall health, I do believe we have an unimaginable tragedy on our hands."

The Florida Dental Association was unavailable to answer questions late last week.

Incidentally, Obamacare has increased taxes, which will be counterproductive. These include a medical device excise tax of 2.3 percent. Even government analysts admit this tax will increase the cost of national dental care by an estimated $160 million annually.

There is a bill in Congress that would widen the ACA, Medicare, Medicaid and veterans benefits to include dental health. But that legislation is a long way off from discussion, and according to Washington budget analysts, nobody has any idea how to pay for it.



Reach Nancy Smith at nsmith@sunshinestatenews.com or at 228-282-2423.

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