Photo credit: Children's Alliance (Seattle, WA)
For 12 years, Congress has been blocking funding to an Affordable Care Act (ACA) program that could increase access to dental care and improve health equity at the behest of an influential special interest group. Last week Community Catalyst, along with 91 other organizations, sent a letter to Congress urging them to not continue including this workforce prohibition in FY23 spending bills and instead finally fund the program to get more dental providers into communities.
The ACA created the alternative dental health provider demonstration program to drive innovation in approaches to dental workforce and hasten the rollout of newer provider models like dental therapists. The program would award 15 grants of at least $4 million to colleges, health systems, tribal organizations or clinics to establish programs to train or to employ these providers. However, these grants have never been awarded because language has been repeatedly inserted into appropriations bill prohibiting the program from being funded. While Congress has never given a reason for including the prohibition, the American Dental Association has taken credit for the funding ban in the past.
Dental therapists are licensed providers that work under the supervision of a dentist to provide routine dental care like exams and fillings. Dental therapists can work in a variety of settings, but they are specifically trained to extend routine care into chronic shortage areas. Working under the off-site supervision of a dentist and collaborating via telehealth, dental therapists can bring care to people where they are, whether that’s schools, nursing homes or rural communities.
Dental therapists have worked around the world for a century but the first U.S. dental therapy program was created almost twenty years ago by Alaska Native leaders who wanted to address chronic dental care shortages in their communities. By creating an accessible education pathway and recruiting students directly from communities without good access to care, community leaders built a representative pool of healthcare providers that live and work in the community. The result is better oral health outcomes at the population level. Put plainly, more people are getting care and keeping their teeth. Today, dental therapists are now working or authorized in at least some settings in 12 states but that progress has been hard won as the American Dental Association and its state affiliates have tried to stop dental therapy every step of the way.
Across the states, support for dental therapy has been bipartisan and diverse. President Biden endorsed the expansion of dental therapists in his campaign platform and the Trump administration promoted them as well. In its recent follow-up to the 2000 Surgeon General’s report on oral health, the National Institute of Dental and Craniofacial Research named dental therapy as the “most important change in the dental workforce since the 2000 report.”
Building on all this support, we were thrilled last year to see both the FY22 House and Senate Labor-HHS appropriations bills pass without the prohibition and instead with report language stating the importance of dental therapists. As such, we were very disappointed to see the recent omnibus spending bill pass with prohibition language included.
The evidence is clear: dental therapists work. That’s why Community Catalyst and 91 other organizations are calling for Congress to support states and Tribes seeking to expand their dental workforce. As it undertakes FY23 appropriations, Congress needs to decide to whose voices it’s going to listen.