COVID-19 has wreaked havoc on our state’s budget. Once again, dental care for poor adults is on the chopping block. Eliminating dental benefits for adults using Medicaid will not solve our budget problems — and will lead to more unnecessary suffering.
Good oral health is essential to our health and well-being. It helps us to contribute to society. Imagine trying to find a job with dark cavities in your front teeth. Or having to care for young children while nursing a toothache that’s kept you awake the past week.
Medicaid is our country’s safety net health insurance program. We are only one of 19 states that provides full dental benefits to adults in Medicaid.
But this was not always the case.
In 2011, our state eliminated dental benefits for poor adults. We went from having one of the most generous Medicaid programs in the country to one in which only emergency dental care was covered. This sent a message to our state’s most vulnerable citizens that oral health does not matter. Dentists abandoned the program, and many did not rejoin when benefits were restored three years later. The cuts put additional strain on community health centers — the very places low-income patients depend on for essential health care.
Contrary to accounting logic, dental cuts may actually increase overall spending.
During the Great Recession, other states like California, Massachusetts and Oregon also eliminated adult dental benefits. Since then, studies have shown that care-seeking shifts to emergency rooms — the most expensive place to go with a toothache. We saw similar patterns in Washington.
Worst of all, for patients, emergency rooms are not equipped to provide definitive care.
Our team’s research has shown that what most patients get, after spending hours in crowded waiting rooms, is a narcotic — adding fuel to the opioid epidemic — and advice to see a dentist for treatment the patient cannot afford.
Vulnerable individuals get caught in a vicious cycle that is frustrating, unproductive and inhumane.
Moving forward, how do we protect the oral health of low-income adults?
Lawmakers in Olympia need to keep Medicaid dental benefits intact. An investment of $13.3 million in fiscal year 2021 — or roughly $60 for each of the 200,000 adult Medicaid enrollees in Washington — would allow low-income adults in our state to continue getting dental care. Good oral health care is essential to our state’s post-pandemic economic recovery.
Next, comes benefit reform. Medicaid should pay for care that matters. Contrary to popular belief, some patients may need to see a dentist only once a year. A task force should be established to review the evidence on dental care with the charge of updating the benefit list with evidence-based services. This is sure to be a contentious process, but would help to control dental spending and reduce waste.
Broader steps are needed to improve the value of dental care. Value is a function of costs and quality. We can reduce costs by focusing on evidence-based care. Steps are needed to boost quality. No longer can we ignore the root causes of dental diseases: too much sugar and not enough fluoride. We need to continue stepping up to Big Sugar like we did in King County with the sweetened beverage tax. We need to invest in programs that encourage healthy behaviors and continue promoting water fluoridation.
COVID-19 is a reminder of our responsibility to care for those less fortunate, which includes protecting the oral health of low-income adults. Our elected officials need to show us that they learned from the 2011 Medicaid cuts.
