Public dental-care option sought
Democrats seek to add it to Medicare after 1965 denial
Tens of millions of older Americans who cannot afford dental care — with severe consequences for their overall health, what they eat and even when they smile — may soon get help as Democrats maneuver to add dental benefits to Medicare for the first time in its history.
The proposal, part of the large budget bill moving through Congress, would be among the largest changes to Medicare since its creation in 1965 but would require overcoming resistance from dentists themselves, who are worried that it would pay them too little.
The impact could be enormous for people such as Natalie Hayes, 69.
Hayes worked in restaurants, raised a son and managed her health as best she could within her limited means. As she lost her teeth — most of them many years ago and her remaining front ones last fall — she simply lived with it.
“I had a lot of pneumonia,” she said, at a recent visit to the Northern Counties Dental Center in Hardwick, Vt. “Not a lot of good dental care.”
For Hayes, the top set of dentures she was there to get will mean the difference between smiling and not smiling — and a wider choice of food. But financially, this would never be an option if her two sisters had not pooled funds to help her. Although Medicare, the federal program primarily for people 65 and older, helped pay for her pneumonia hospitalizations and recent shoulder surgery, it does not cover dental care.
Nearly half of Americans 65 and over didn’t visit a dentist in the last year, and nearly 1 in 5 have lost all their natural teeth, according to the Centers for Disease Control and Prevention. There’s growing evidence that dental problems can worsen other health conditions that Medicare does cover.
Sen. Bernie Sanders, I-Vt., chair of the Senate Budget Committee, has played a crucial role in advancing the measure. He recalled living in Vermont, 5 miles from the clinic where Hayes received her care, and learning that many residents lacked access to dentists. “A child who lived nearby, his teeth were literally rotting in his mouth,” he said.
Since then, the situation in Vermont has improved. Community health centers serve about a quarter of the state’s population. The state’s Medicaid program pays for preventive care and for up to $1,000 a year in other treatment for children and poor adults.
But it does not pay for dentures, which can run into the thousands of dollars.
With so many uninsured older patients, dentists such as Dr. Adrienne Rulon, who treated Hayes, practice triage. Certain teeth are more important to save. Filling a cavity in one tooth is less expensive than a root canal in another.
Sometimes, patients will come in for an exam, learn about expensive problems, then disappear for months while they save money for the procedure. “People are having to pick and choose,” she said. “It’s a huge untreated population.”
Poor adults in other states have even fewer resources. Medicaid is not required to cover adult dental services, and many states do not pay for any services at all, while others cover only emergency treatments, including tooth extractions. Vermont’s program is among the most generous in the nation.
On Capitol Hill, the proposal to add a Medicare dental benefit has near-universal support among Democrats, and many health industry and consumer groups back it, too. The main opposition comes from dentists.
The American Dental Association, which fought to keep dental care out of the original Medicare program in 1965, supports a limited government benefit for older Americans.
The association, whose leaders say they want Congress to concentrate scarce resources patients who struggle the most, wants Medicare dental benefits to be offered only to poorer patients, to be offered by private insurers and to be included in its own special part of Medicare.
Medicare would most likely pay lower prices than older patients who can now afford to pay for care themselves, a potential hit to dental income. It’s possible some providers would refuse to accept Medicare.
Groups that have been pushing for the provision describe this as a rare opportunity to advance a popular policy.
In one recent poll, 84% of Americans, including more than three-quarters of Republicans, supported adding dental, vision and hearing to Medicare.
With the $3.5 trillion package, lawmakers hope to add not just dental benefits to Medicare, but vision and hearing coverage as well.
The provision still faces challenges. So far, no Republicans have signed onto the plan, and negotiations are still underway among Democratic lawmakers about its size and contours.
Among the various health care priorities, the dental benefit is relatively expensive — the cost estimate for a version passed by the House in 2019 was $238 billion over five years.
But Melissa Burroughs, an associate director at the consumer group Families USA, says she has been struck by how every lawmaker she talks to wants dental coverage in the package.
“It’s highly unusual,” she said. “We’ve gotten from ‘Oh, this would be good’ to ‘Oh, this is important, and let’s take action now.’”
Nearly half of Americans 65 and over didn’t visit a dentist in the last year, and nearly 1 in 5 have lost all their natural teeth, according to the Centers for Disease Control and Prevention.