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Dental Plans Have Data For Health Reformers To Chew On

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Dental plan trade groups are hoping statistics concerning the importance of dental care and dental benefits will help improve their position in the health reform debate.

The National Association of Dental Plans, Dallas, recently released results from a survey that compares U.S. residents who have dental benefits to the 143 million U.S. residents who have none.

The Delta Dental Plans Association, Oak Brook, Ill., which represents a group of nonprofit dental carriers, has posted a collection of position papers and fact sheets at, to make the case that addressing oral health in federal health care reform legislation is important–and that federal policymakers should remember that “the dental delivery system itself remains vastly different from medical in many key respects.”

Some dentists have criticized the plans’ efforts to influence the views of policymakers, contending that the plans themselves drive up costs and hurt the quality of care by weakening the bonds between dentists and patients.

Groups representing dentists are mobilizing their own information lobbying efforts.

The Academy of General Dentistry, Chicago, has posted a position paper on access that briefly objects to the idea of health insurers pushing patients to choose cheaper, possibly lower-quality care.

In March, the American Dental Association, Chicago, convened a summit on improving access to dental care. One conclusion was that advocacy groups need to find “better ways to define and measure the access issue,” the group says.

Dental plan association representatives say they already have statistics that suggest that access to dental benefits has a strong correlation with indicators of oral health and overall physical health.

U.S. residents without dental benefits tend to be poorer, less educated and less health conscious in general than residents with dental benefits, and that complicates efforts to separate causes from effects.

But the NADP, which reached 6,000 consumers through the Web, found that consumers without dental benefits were less likely to take even routine, low-cost steps to tend to their own dental health. Only 53% of the survey participants without dental benefits said they brush their teeth two or more times per day, compared with 63% of the participants with dental benefits, and only 60% of the participants without benefits said they floss at least once per week, compared with 70% of the participants with benefits.

About 15% of the participants without dental benefits described their overall health as fair or poor, and 21% said they had had a tooth extracted within the previous 2 years.

Only 9% of the insured participants described their overall health as fair or poor, and only 16% had had a tooth extracted within the previous 2 years.

“The choice is to have dental benefits now and to focus on prevention and to get people to the dentist, or to pay for the complications of dental disease later on,” says Evelyn Ireland, NADP executive director.

Ireland cites the flurry of recent formal studies that appear to show that improving dental care can improve overall medical care. One shows that providing extra dental care for patients with gum disease and diabetes correlates with a 19% reduction in the cost of treating the patients’ diabetes, Ireland says.

“Dental is really an essential part of a benefits package,” Ireland says.

DDPA reports that U.S. employers lose 164 million work hours to dental disease and other oral health problems each year, and U.S. adults are 3 times likelier to lack dental insurance than medical insurance.

One concern the NADP and DDPA share is the possibility that members of Congress will lump dental insurance together with medical insurance.

“What are the key differences between dental and medical benefits plans?” DDPA asks in a discussion of its principles. “Medical plans focus on treating disease and illness, while dental plans emphasize routine preventive care–before problems become serious and expensive to treat. As a result, dental coverage is far less expensive.”

Dental premiums are only about 10% as high as medical premiums, and, over the past 6 years, the average annual increase for dental premiums has been only half as high as the rate of increase for medical premiums, the association says.

Congress did include dental insurance in the provision of the American Reinvestment and Recovery Act that created a temporary 65% government premium subsidy for laid-off workers who accept COBRA health coverage continuation benefits. Eligible workers can use the subsidy program to continue dental benefits, Ireland says.

So far, the COBRA subsidy is so new that no information is available about dental COBRA subsidy take-up rates, Ireland says.

The Obama administration and members of Congress have not talked much about dental benefits in connection with the ongoing health reform efforts.

“Although congressional staff is engaged in nuts and bolts discussions about health care reform, so far those discussions do not include dental care,” ADA staff members write on recent legislative developments.

The NADP was glad to see Congress update the State Children’s Health Insurance Program to give more children access to free or subsidized dental coverage, Ireland says.

The federal government does not require state Medicaid programs to offer dental benefits to adults, and adding a Medicaid dental benefits mandate could be another good way to expand access, Ireland says.

If the government sets up some kind of government-run health coverage supermarket, then the NADP would like to see a dental insurance option be available. But the coverage sold should be full-blown dental insurance, not simply a package of preventive care benefits, Ireland says.

Otherwise, she asks, “what do people do when they need treatment?

DDPA says “positive attributes of a reformed health care model” would build upon the “success of existing private programs,” expand the dental workforce, and spur more dentists to practice in underserved areas.

“Negative attributes” would include “any system that erodes existing, comprehensive dental benefit programs already in place in the group benefits market” and “any system that eliminates the role of third-party administrators by establishing a single-payer, government-sponsored program.”