Dr. Brian Jeffrey Swann, who is on the board of directors for Remote Area Medical and practices dentistry in Tennessee, told a U.S. Senate committee about low-income people who drive from far distances to attend clinics where they can get their dental problems treated. (Screenshot from U.S. Senate webcast)
WASHINGTON — Dentists from throughout the country urged Congress to include dental coverage in Medicare during a hearing Thursday, saying that fewer than half of beneficiaries visit a dentist each year.
The panel of four dentists told the U.S. Senate Help, Education, Labor and Pensions Committee that other changes are needed as well to reduce the gap in consistent dental care for all Americans, including removing the barrier between health care and dentistry as well as bolstering affordable treatment for underserved communities.
The dentists also told senators that better outreach and education are needed to ensure people understand how missing regular checkups can have negative repercussions on their physical health.
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Dr. Lisa Simon, associate physician at Brigham and Women’s Hospital and a member of the faculty at Harvard Medical School, testified that “fewer than half of Medicare beneficiaries see a dentist each year. When they do, they spend more than $1,000 out of pocket on their care.”
She also told senators during the hearing that the dental coverage offered by many Medicare Advantage plans is insufficient. Such plans offered by private companies roll together Part A and Part B coverage and often include drug coverage.
“Dental plans are often a draw for beneficiaries that choose Medicare Advantage,” Simon said. “But my research has found that beneficiaries with Medicare Advantage have rates of dental access that are just as low and out-of-pocket costs that are just as high as traditional Medicare beneficiaries. Medicare Advantage is not the solution here.”
Dr. Myechia Minter-Jordan, president and CEO of CareQuest Institute for Oral Health in Boston, told the panel that traditional Medicare’s exclusion of dental benefits leaves about “half of Medicare enrollees, nearly 25 million older Americans and people with disabilities, without dental benefits.”
“There is currently no financial support for adults to purchase dental insurance through the Health Insurance Marketplace,” Minter-Jordan said. “And adult dental coverage is optional under state Medicaid programs, which means that coverage varies widely from extensive benefits to none at all.”
Dr. Brian Jeffrey Swann, who is on the board of directors for Remote Area Medical and practices dentistry in Tennessee, told the committee the nonprofit organization provides pop-up dental and vision clinics for underinsured and uninsured people.
“The people that come to RAM for assistance often drive across two or three state lines, sleeping in their cars, wrapped in blankets to stay warm. Many people come days before the clinic just to ensure that they get a ticket,” Swann said.
“Patients suffer from cavities and gum disease,” he added. “And this is concerning due to the interplay of gum disease and diabetes.”
Swann, who is also co-chair of Global Oral Health at the National Dental Association, said that organization has been calling for dental coverage to be included in Medicare for decades.
Sanders, Cassidy split on Medicare changes
The dentists’ recommendations revealed a chasm between the two top lawmakers on the panel.
“The lack of affordable dental care in America is a problem all over our country,” said HELP Committee Chairman Bernie Sanders, an independent from Vermont. “But it is especially acute for lower income Americans, pregnant women, people with disabilities, veterans, those who live in rural communities, and Black, Latino and Native Americans.”
Sanders said access to and affordability of dental care within the United States has “become so absurd” that Americans have begun traveling to “countries like Mexico, Costa Rica, India, Thailand and Hungary, where it is much less expensive to get the dental care they need.”
That is still out of reach for many people, leading to nearly 1 out of 5 senior citizens having lost their teeth, he said.
“And many of them cannot afford dentures, which can cost many thousands of dollars,” Sanders said, adding that “70% of older Americans have some sort of periodontal disease, which can lead to rheumatoid arthritis and cardiovascular disease.”
Sanders reiterated, as he has for years, that Medicare coverage should include dental and vision coverage.
Louisiana Republican Sen. Bill Cassidy, ranking member on the HELP Committee, said that about “88% of Americans have dental coverage,” though he noted the “pent-up demand for dental care is greater than the pent-up demand for medical care.”
Cassidy, a doctor, said that while traditional Medicare doesn’t cover dental procedures, about “98% of Medicare Advantage plans offer dental benefits and more than half of Medicare beneficiaries are enrolled in an MA plan.”
He appeared to reject the proposal to add dental coverage to Medicare in the immediate future, noting that the program is slated to hit a significant funding shortfall in about 10 years.
“With Medicare on track for insolvency in a little over a decade, we should also think about making that sustainable before adding programs to it,” he said.
Cassidy also criticized how Medicaid, a program that provides health insurance for low-income people, currently approaches dental care.
“The reimbursement rate under Medicaid is so lousy that frankly it’s the illusion of coverage without the power of access,” Cassidy said. “If you’re losing money on every patient you see who’s covered by Medicaid, you can’t make it up.”
Problems in rural America
Alaska Republican Sen. Lisa Murkowski raised the issue of access to dentists in rural areas, including her home state, during the hearing.
“I grew up in a part of the state where if you needed to go to the dentist, you got in an airplane or you got on a ferry and more often than not, you went to Seattle,” she said. “And that was not a cheap trip, but that was how we got our health care.”
“We have improved dramatically since then, but we still have far too many communities where access is an issue,” Murkowski added.
There are still many examples where “overall health outcomes have been impacted negatively, because it began with poor oral health care,” she said.
Dr. Gordon Roswell Isbell III, past trustee of the Academy of General Dentistry from Alabama, said that ensuring there are enough dentists and dental hygienists in rural areas is a challenge. He suggested developing programs that get dentists into rural areas.
“I know in our state that’s something we’ve worked hard at and we’re having some success,” Isbell said, adding that rural citizens “deserve” good dental care.
Swann testified that dental schools need more role models who can demonstrate to students the best ways to live and work in rural areas. He also suggested providing incentives and “innovative business models.”
Minter-Jordan said that one-third of rural residents do not have dental insurance and that 4 in 10 adults in rural areas haven’t seen a dentist in more than a year.
New Hampshire Democratic Sen. Maggie Hassan said during the hearing that while her home state expanded Medicaid coverage last year to include dental care, she’s hearing from a lot of people that it’s extremely challenging to find a dentist in rural areas who is accepting new patients and takes Medicaid.
Simon said that recruiting dentistry students from rural areas “can make a small dent in making these communities better served.”
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