Late last month as snow enveloped Olympia, Washington, state advocates braved the elements for hearings on two very important yet different issues - improving access to dental care and reproductive rights and contraception coverage. At one point a veteran advocate attending the same hearing for a bill on reproductive rights remarked to our partners at the Children’s Alliance, “When did access to dental care become more controversial than reproductive rights?”
While contraception coverage has been in the national spotlight recently, the debate over access to dental care continues to be just as heated in state capitals as community-driven efforts to add mid-level providers to the dental team are met with resistance from dental associations. Dental therapists, mid-level dental providers, are practicing in Minnesota, Alaska and more than 50 countries. In fact, WBUR explored how dental therapists offer a cost effective way to expand and preserve quality access to dental care for underserved populations during these difficult financial times. Most recently, proposals have been debated in Kansas and Washington. However, 15 other states including Vermont and New Hampshire are also exploring alternative workforce models as a way to extend care to underserved populations. Despite the fact that these new providers would be able to provide care in communities where there are not enough dentists and enhance the dentist-led team’s ability to provide routine and preventive care to vulnerable populations, community driven, multi-stakeholder and consumer efforts are still being met with opposition from dental groups.
This dynamic was on full display in Kansas last month at a House Health Care Committee Roundtable discussion that explored how adding a dental provider to the dental team will improve access to care. A broad coalition of community groups, children’s groups, supportive dentists, safety-net clinics and educators explained the clear need for better access to dental care, especially for children—27.6 percent of Kansas third graders have untreated tooth decay. This is due to the fact that 93 of the 105 counties in Kansas do not have enough dentists to serve their populations, 28 counties do not have a Medicaid dental provider, and only 25 percent of Kansas dentists accept Medicaid patients. Despite the broad-based support for a new way to deliver care, the dental association still opposed the measure.
Unfortunately, lawmakers continue to see the issue as a turf battle. As many know, scope of practice issues typically involve one trade association pitted against another trade association, which legislators do not like refereeing. But this issue is different because it is not about business or about dentists – it is about finding a way to treat untreated tooth decay and helping improve the oral health of underserved communities. As the issue evolves, it is critical to help policymakers and stakeholders elsewhere understand that limited access to dental care disrupts the lives of millions of kids throughout the country. In fact, according to the Pew Center on States state dental policies fail one in five children.
In Washington State, April Ritter’s daughter went without care. She was forced to endure pain and sleepless nights because Ritter could not find a dentist who accepted her Medicaid coverage. In addition to negatively impacting the health of children and adults, the lack of dentists in underserved communities or dentists who will only accept certain types of insurance is also leading to unnecessary costs. According to the Washington Hospital Association, severe toothaches are the number one reason people in Washington without insurance end up in the emergency room.
After taking a closer look at their analysis of ER visits for the time period of January 2008 - June 2009, which found the total number of dental-related ER visits was 54,000, with total charges of $35 million, the Washington Hospital Association joined a community driven coalition organized by the Children’s Alliance, Washington CAN, the American Indian Health Commission, Northwest Portland Area Indian Health Board, the Washington State Dental Hygienists Association, community health centers and supportive dentists who are working to add a dental therapist to the dental team as a way to improve access to care, preserve services and reduce costs – particularly costs incurred through unnecessary ER visits.
Recognizing the benefits of adding a new provider to the dental team would help improve access to care and help control costs, the Washington State Senate Committee on Health and Long Term Care supported the bill and passed it favorably out of their committee on February 2. Despite the bill advancing through the key committee and support from an energetic sponsor, Sen. David Frockt, other legislators did not seize the opportunity this year. However, a great deal of progress was made as lawmakers heard from children and adults in their districts who had unmet oral health needs who came out in support of the Washington Dental Access Campaign.
Last week, the debate regarding access to dental care unfolded in New Hampshire in much the same way – children’s advocates supporting efforts to increase access to care were met with opposition from dentists.
Vermont may be the next state to examine access to dental care. Hopefully, policymakers understand the effort is about the estimated 24,000 children in Vermont enrolled in Medicaid who failed to get the dental care they urgently needed in 2009 or the 10,000 Vermont seniors and 62,000 adults under age 65 who went without care that year, rather than the interests of a trade association. The best solutions begin with listening to the people who need access to care not the businesses and groups who claim they speak for them.
-- David Jordan, Dental Access Project Director