William Stork needs a tooth out. This is what the 71-year-old retired dentist told him during an examination.
This type of extraction requires an oral surgeon, which could cost him around $ 1,000 since, like most seniors, Stork doesn’t have dental insurance and Medicare doesn’t cover their dental bills. Between social security and his Teamsters pension, he lives comfortably in Cedar Hill, Missouri, about 30 miles southwest of St. Louis. But this cost is so high that he decided to wait until the tooth absolutely needs to come out.
Stork’s predicament is at the heart of a long-smoldering chasm within the dental profession that has re-ignited as a struggle to get dental insurance included in Medicare, the public insurance program for people 65 and older – if a benefit can be provided at all.
Health justice advocates see President Joe Biden’s Build Back Better agenda as a unique opportunity to provide dental care to Medicare patients half of it did not see a dentist in 2018 long before the pandemic paused for many dentist appointments. The rates were even higher for black (68%), Hispanic (61%), and low-income (73%) seniors.
The coverage has been exempted from a new framework announced Thursday by President Joe Biden, but proponents still hope they can get the coverage in a final agreement. Complicating their advance is a debate about how many of the country’s more than 60 million Medicare beneficiaries should get it.
Champions covering everyone on Medicare face an unlikely adversary: the American Dental Association, which supports an alternative plan to provide dental benefits only to low-income Medicare recipients.
Medicare has excluded dental (and eye and hearing protection) since its inception in 1965. This exclusion was by design: the dentist profession did long fought to separate from the traditional medical system.
More recently, however, dentists have emphasized the relationship between oral and general health. Most notorious is that 2007 death of a 12-year-old boy who could have been prevented by a $ 80 tooth extraction asked Changes to Maryland’s version of Medicaid, the state’s state insurance program for low-income people. But researchers also have dental care with them, for example reduced health care spending in patients with type 2 diabetes. When the World Health Organization suggested postponing non-urgent oral health visits Last year, to prevent the spread of Covid-19, the American Dental Association Repelled, with the then President Dr. Chad Gehani said, “Oral health is an essential part of overall health. Dentistry is indispensable health care. “
The Medicare proposal, backed by the ADA, would only cover seniors earning up to three times the poverty line. That’s currently the equivalent of $ 38,640 per year for one person, which reduces the number of potential recipients from over 60 million people to about halfway this number. Medicare never required a means test, but in a world where Congress is trying to cut its social spending package from $ 3.5 trillion over 10 years to $ 1.85 trillion over 10 years, the ADA the gifts its alternative to save money while covering those who need dental care most urgently. A budget office of the Congress analysis estimated the plan to provide dental care to all Medicare beneficiaries would cost $ 238 billion over 10 years.
In contrast to the ADA, the National Dental Association is pushing for universal dental benefits from Medicare. The group “Promotes Equal Oral Health Opportunities Among Colored People” was founded in 1913, in part because the ADA did not remove discriminatory membership rules for its member organizations until 1965. Dr. Nathan Fletcher, chairman of the NDA’s board of trustees, said he wasn’t surprised his organization is at odds with the ADA on this issue of Medicare coverage.
“The face and demographics of the ADA is a white man, 65 years old. Understand that those who make decisions for the ADA are usually those who have been in the field for 25-30 years, are doing well, and are ready to retire, ”Fletcher said. “It doesn’t look like that [patients] who we’re talking about. “
Research from the ADA’s Health Policy Institute found Cost as an obstacle to dental care “regardless of age, income level or type of insurance”, but older, low-income adults were more likely to identify this as an obstacle.
“It would be tragic if we didn’t do something for these low-income seniors,” said Michael Graham, ADA senior vice president of government and public affairs.
Graham is critical of the design of the proposals in Congress for a universal dental benefit of Medicare and notes that one includes a 20% co-payment for preventive services that could prevent low-income patients from receiving the care they are likely to receive.
“Something is better than nothing, but the something [with a copay] is almost nothing for many seniors, ”said Graham.
Graham said the ADA covers 100% preventive services for Medicare low-income beneficiaries.
Of course, if you only cover low-income seniors, the biggest question is: will dentists even accept Medicare if they don’t have to? Low-income patients often seek treatment in safety net clinics that plan months in advance. Some dentists fear that Medicare benefit limited to older, low-income adults would be easier to avoid, pushing even more newly insured Americans into an already strained dental safety net.
Less than the half of dentists overall accept Medicaid, but more than 60% of NDA members do, according to Fletcher. The ADA Care for the reimbursement rates and bureaucratic paperwork for a Medicare benefit will be similarly unattractive.
However, Fletcher, dentist director for a Medicaid insurance company in Washington, DC, said participating in Medicaid varies greatly States – and as with Medicaid, participation in any new Medicare dental program would depend largely on the design of the benefit.
If reimbursement rates are high enough for Medicare benefits, it could be very lucrative for dentists to cover millions of seniors, Fletcher said. Ultimately, dentists should have a choice of whether to accept Medicare patients, and all Medicare patients should be eligible for dental benefits as they have paid into the program.
Dr. Nathan Suter, William Stork’s dentist, feels it is right to add a dental benefit to all seniors.
As a self-proclaimed “proud ADA member”, Suter is at odds with the organization that showered him with awards. He was named Dentist of the year from the affiliated Missouri Dental Association in 2019 and received one of the ADA awards for young dentists in 2020.
“As an ADA member, I think they should sit at the table for me to make sure it’s as good as possible for all of my seniors,” said Suter, who valued at least 50% of patients at his House Springs. Missouri, practices are older adults.
But instead of pushing for a universal benefit, the ADAs are well-funded lobbying is push against The plan proposed by Congressional Democrats to add dental care to all Medicare beneficiaries. The organization has asked its members to contact their congressional representatives on this matter. Graham said more than 60,000 emails have been sent to Capitol Hill to date.
Suter sees the fight over whom to cover as a generation break. As an aspiring dentist, he prefers to add full dental coverage now so that he can adapt his business model sooner. And the more seniors receive dental services, the larger their potential customer base becomes. Dentists like him, who are still building their practices, have less time to get involved in ADA’s policy-making process, he said.
Embroiled in this are patients like Stork, who said the possibility of dental insurance with Medicare is one reason he withholds the extraction, knowing that benefit, if any, is unlikely for years.
Stork also knows that benefit may not cover a middle class person like him, even if approved. Still, it would be nice to have if his tooth couldn’t wait any longer to come out.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health topics. Along with Policy Analysis and Polling, KHN is one of the three main operational programs at KFF (Kaiser Family Foundation). KFF is a non-profit foundation that provides the country with information on health issues.
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