When it comes to access to routine dental care – a major determinant of oral health – the Affordable Care Act (ACA) falls well short in its goals of lowering costs, increasing access and improving health outcomes, according to new analysis by the American Dental Association. But in a series of three new research briefs, the association's Health Policy Resources Center (HPRC) also reports that state governments have the ability to pick up where the ACA left off, by employing critical policy levers at their disposal.
"The ACA is a missed opportunity, and we have a long way to go in ensuring access to oral health for all Americans," writes Dr. Marko Vujicic , managing vice president of the HPRC and co-author of the briefs. "This is especially true for adults, who have experienced greater financial barriers to dental care in recent years. Unfortunately, the ACA does little to break down financial and other critical barriers to dental care, and states will need to pick up the slack if we're going to address the oral health challenges facing America."
According to the HPRC reports, under the ACA about 8.7 million children are expected to gain some form of dental benefit from the program, which will reduce by approximately 55 percent the number of children without dental benefits.
But for adults it's a different story. Only an estimated 5.3 million adults are expected to gain extensive oral health coverage as a result of the ACA, almost all due to Medicaid expansion in the few states that provide extensive dental benefits. This will reduce the number of adults without dental benefits by about 5 percent, a negligible impact. Further, Medicaid-eligible adults may see few improvements in their ability to receive dental care, the HPRC analysis suggests.
The HPRC also warns there is likely to be significant pressure on Medicaid providers under the ACA changes, because the law fails to address such critical factors as administrative inefficiencies and low provider reimbursement rates. "As a result, poor adults could increasingly resort to other options, including visiting emergency rooms for dental care," writes Dr. Vujicic.
Taken together, the briefs reinforce previous HPRC analyses that show barriers to dental care for children have declined in the past 10 years, while barriers for adults have risen. The HPRC review shows more children had dental benefits in 2010 than in 2001, due primarily to Medicaid and SCHIP which mandate dental benefits for children. By contrast, more adults went without dental benefits in 2010 than they did in 2001. Although more adults had Medicaid over that period, adult dental benefits within Medicaid programs eroded during the 2000s.
Despite the troubling outlook for adults, HPRC analysis does suggest opportunities to reverse the recent trend. First, state governments have the chance to pick up where the ACA left off. Most state Medicaid programs currently provide no or very limited dental benefits for adults, giving states the ability to expand coverage in conjunction with reforms that would help shore up their Medicaid systems.
Accountable care organizations also present a critical opportunity to help bridge the gap between oral and whole body health. They are meant to improve the coordination of various types of care, improve the patient experience and help reduce overall health care costs by breaking down "silos" of care, the HPRC noted.
"Through their analyses, the HPRC has made a compelling case on the need to act now to address the oral health care crisis facing tens of millions of Americans," said ADA President Dr. Robert A Faiella. "We are committed to creating and sustaining actionable solutions that provide care now to people in need, prevent disease from occurring or recurring, and provide people with the knowledge that empowers them to be good stewards of their own oral health."
Dr. Faiella added that the ADA will launch a major campaign next week aimed at achieving those goals.
American Dental Association