Obamacare Leaves Gaping Cavity in Adults' Dental Health

By: Nancy Smith | Posted: February 10, 2014 3:55 AM
Dental work

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 you’re 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 don’t 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 isn’t 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 isn’t just about preventing cavities or bad breath. The mouth is a gateway into your body’s 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 Won’t (or Can’t) 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 patient’s 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.

Comments (9)

12:16PM APR 1ST 2014
Dentistry is the gateway to health, so it is important to continue to help educate the population on good dental healthcare, however, preventive care is not expensive and does not need to be included in an insurance plan!
If the ADA can educate/ spend more time on educating the public to spend 2 visits per year on dental health maintenance, this alone can help save the public from more extensive problems...Get rid of the fear that is propagated by Insurance carriers on the need for major dental care needs! ..the idea of getting rid of amalgam alone would help alleviate many future major problems...People can learn and place a higher importance on the care of their teeth...and it is just a part of normal hygiene!
...with all of the strides the dental community has made in the last 20 years, being forced into the ACA will be a terrible regression!
Outsiders should not become the wedge between Dr/Patient care and They are not in the best position to decide on cost limitations for care. We are the ones who are paying an unlimited amount of technology expenses in our overhead...how can they limit the cost, when you are the one paying the overhead? Dentistry will be forced to merge with medicine and the network system and then we will travel down the same path as medicine has which has led us to this current MESS. You should not rush dental care, just as you should not rush medical care and we all need to get back to a system where there is less focus on the money making and more focus on the patient need!
People/ Patients themselves need to take simple responsibility... it's not expensive...and small investments in themselves can reap great rewards and can help to balance out the overall healthcare mess! We have done a good job improving overall wellness and we must continue to do so... but educating the public to simple prevention is not costly for the middle class...and for those in real poverty there are outreaches and government programs to provide assistance already.
FIROZ Mullar
4:09PM FEB 14TH 2014
We didn't need health care reform, we need insurance reform, which we didn't get. Insurance companies are all crooks. Obamacare only allowed the crooks to continue to steal. How many of you out there paid auto insurance for years and years with no accident...then one day you get in a fender bender and surprise....insurance canceled or worse yet....premiums go through the roof? How many of you have suffered with homeowner premiums for years and years and have never claimed dime one on your homeowners insurance.... along comes Katrina, Wilma, or some other storm and now the fat cat insurance companies are crying the poverty blues and looking for any loophole they can find to not pay up...or the offer you $4,000 to repair a room that they know needs a whole new roof to the tune of $10,000. Not health care reform....INSURANCE REFORM!
Christopher Go
10:33PM FEB 11TH 2014
Do all of you really believe that millions and millions of people who were once insured under private insurance will now really go without dental insurance? Wow. If any of you want dental insurance, that is certainly an option if you choose it to be an option with your healthcare provider. Sure you will have to pay more for dental coverage but someone explain to me how that is different than what you do at work now? If you want dental insurance you pay a higher premium. If you don't, dental expenses are paid in cash. How do I know this? First of all, my family is on Obamacare (as of January 1st) and we have the dental option and the vision option. Secondly, I'm a dentist - my office sees lots of patients each day that have new ACA mandated insurance and have new dental insurance. The dentists that are quoted in this article are either lying or ignorant. These scare tactics are embarrassing. STOP IT.
Fran k
2:17PM FEB 10TH 2014
Now really, are you that surprised? The only fix is to repeal Obamacare. Otherwise we all will sink into socialistic demise.

There is no fixing this. Another stupid idea forced upon the Majority by that loser of a party called the Democrats. As a group, they are soooo

9:02PM FEB 10TH 2014
And just to make this clear . . . these continuing, similar SSN fan club troll want-to-be pseudonyms are not only not me, but as pointed out below by Michael, they're clearly . . .

Pathetic . . . .
2:54PM FEB 10TH 2014
Nancy Smith's article is fancy concern trolling. Your remak is PATHETIC CONCERN TROLLING. Fact is PPACA/Obamacare is working well and would be working better if the Republican Party was a responsible political party and not the modern party of secession and sedition. As to dental insurance, my experience has been and continues to be that dental insurance is provided separate from the vast majority of health insurance policies generally by dedicated dental insurance only companies. Plus most dentists in my experience do not accept dental insurance but let the patients do the submissions to get reimbursed directly. They do this to not have the additional overhead of having to process and deal with differering forms and requirements of the insurance companies.
David Lane
2:11PM FEB 10TH 2014
We have many difficulties in terms of healthcare in this country for everyone. Dental insurance is really limited and dental health is important for your gneral health as well. You can die if your teeth go bad and thousands of people have. We have medicare plus a supplement to help us with what is not covered and also dental rider coverage. There is always more to pay. It looks to me that we need a full national health program covering everything. I'm sure the doctors and hospitals and ther providers wouldn't like this idea. We have tons of duplication of services and expensive equipment that drives up the costs. Its time to look at all this, pay the doctors a living wage, expand the hours of service. When insurance came on the scene we saw a proliferation of doctor millionnaires. Tits there in plain sight.
12:46PM FEB 10TH 2014
My answer to this Q:
"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. "

Let's start with ending subsidies for corporations... even as Republicans say they are for lowering the Deficit, they took away 9 Billion in the Farm Bill earmarked for SNAP/Food Stamps only to give a $15B additional subsidies to big Agra!

Let's close tax loopholes that allow hedge fund managers to pay 15% on their earnings instead of the average paid by any other citizen.

End subsidies to any business larger than say $10M in annual revenue. A TOO BIG TO BAIL law.

Take some funding our of the Pentagon budget. The military maintains 267 golf courses around the world for its brass. its time they stop such nonsense. Hole in one, or Hole in gum? Prioritize oral hygiene over extravagant military niceties. Let them play at municipal or private courses on their own dimes!
12:37PM FEB 10TH 2014
Perhaps the House of Boehner can focus on improving this aspect of #ACA. In stead Boehner's House focuses on repetitive repeal votes that are symbolic, and cost the treasury millions in Congressional salaries and time.

I ask my fellow citizens ... what good is the Republican party able to do, if they focus soley on doing nothing, or the opposite of the President.

Lest we remember, ACA is the brainchild of the Republicans. Liberal / progressives were angry that the president didn't push for Single Payer.

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