The Unseen Dental Crisis of Seniors

The American Dental Association (ADA) – the largest association of dental professionals in the country – are fighting against the proposal to add dental benefits to Medicare. We talk about the politics of ADA opposition to healthcare, and also hear from seniors themselves about what it’s like to go without needed dental care.

Podcast: Play in new window | Download

Subscribe: More

---

Dental care is not part of health insurance for most Americans, and the proposal to include dental benefits (as well as hearing and vision) in Medicare is running into opposition from…dentists. Today Ben and Stephanie dive into the crisis of American seniors without dental care, and the opposition from the American Dental Association.

Last week we emailed our list of Medicare for All supporters, asking if any seniors with challenges getting the dental care they need would be willing to share their story with us. We weren’t prepared for the flood of 150 stories that came in, or how heartbreaking they would be.

• Sandy in Turtle Creek, Pennsylvania: “I’m a 64yr old woman who [is] shut in my apartment. Instead of having friends, going places, doing things, I don’t leave my home because I have no teeth. After a horrific divorce, I lost my teeth, and cannot afford dentures. It has caused a deep depression, and loneliness. I’m 64, which I don’t feel like should be the end. I should be going to church, having friends, going places, but can’t. Due to the embarrassment and shame of not having teeth. I’m never going to be able to afford nice dentures, so this has become my life.” [Impact on mental health, social life.]
• Mary in Devine, Texas: “My husband and I both have dental problems. I had my bottom teeth pulled out in hope of getting affordable dentures. I went to see about them and the price is always three to six thousand dollars. It is outrageous… I don’t have insurance. My husband has Medicare but it doesn’t cover dental… We both can’t eat nuts, dried fruit or even salads.  We would like to eat healthy. We are unable to have protein foods. I have [even] choked. I mostly eat very soft foods and make smoothies. It is quite painful. It saddens me because of [the] lack of concern and our quality of life is affected.” [Impact on broader health – ability to eat healthy.]
• Janus in Champaign, IL (edited down): “I am a 66-year-old woman who worked for the University of Illinois.. for 25 years. During that time, I had good dental coverage and saw the dentist every year to have my teeth cleaned. In 2000, I started my own business, and could only get healthcare coverage by joining the local farm bureau. That policy did not include dental care… [and] I had to go in debt just to keep insurance coverage until the Affordable Care Act was finally enacted… And then I turned 65. I was forced off of the ACA policy and into Medicare… I have not had a dental cleaning for 15 years and see no future in which I will be able to get that kind of care for myself… Now that I am a senior, I expect a safety net to catch me in times of, oh say a pandemic!  My business is caring for clients’ homes and pets when they travel. No one is traveling. I made $4,000 last year… It’s not looking any better for 2021…”

The Medicare for All movement has been fighting to expand Medicare, including finally adding comprehensive vision, hearing, and dental benefits. Because of our pressure, this demand has actually been taken up in Congress, despite the fact that President Biden’s proposal for this bill didn’t include any Medicare expansions. But as Medicare expansion works its way through the committee process, the proposed benefits are shockingly poor for dental coverage.

Today, Medicare Part B doesn’t cover any routine cleanings, regular care, teeth replacement, etc. Basically, no preventative care, only emergency care as it relates to other medical treatment (https://www.healthmarkets.com/content/medicare-part-b-dental-coverage)

On the plus side, the House proposal would cover routine care, a full or partial set of dentures once every five years (or more based on dental professional recommendation), which are big wins. Unfortunately it does not cover the dental procedures that tend to be the biggest expenses for seniors. And these limited benefits are not proposed to start until 2028.

Also on the negative side, this proposal would require cost-sharing that would effectively make the benefit out of reach for low-income seniors. Medicare would only cover 10% of major dental treatments the first year – 2028!! – and would only eventually cover 50% of major dental treatments, increasing by 10% every year until 2032.

The reason these proposals are so weak is directly related to the lobbying of dentists.

The American Dental Association (ADA) has been mobilizing dentists all over America to lobby – hard – for dental coverage NOT to be included in Medicare, particularly for coverage of procedures and surgery.

• As per usual, it all comes down to the money. Dentists are worried that Medicare won’t pay out enough for their services. 
• The American Dental Association has been fighting since 1965 — the original enactment of Medicare — to keep dental services out of federal hands. 
• The ADA claims that it wants the government to focus on patients “with the most need” instead of seniors at large — which to them means poorer patients (up to 300% of the federal poverty level), a.k.a. those just not going to the dentist at all (which is a sizable amount of the population – nearly half of Americans 65 and up didn’t seek dental services last year because they couldn’t afford it).
• Additionally, they do not want dental benefits included under Medicare Part B, which covers physician care.
• What’s most interesting about this is that while experts agree dental care IS medical care (as many bodily health issues can begin in the mouth), dentists have managed to strategically weasel their way out of taking part in any federally funding programs for decades — unlike their medical counterparts.
• The reasons the ADA provide for not wanting to be lumped into these programs like medical are vague and frankly bizarre. They claim the paperwork and coding isn’t the same as their medical counterparts, the reimbursement is “unknown”. These are all obviously things that would be figured out with the passage of the bill and building of the program – so it should be a non-issue. 
• Even today, while dentists can accept Medicaid, many don’t. According to the ADA, only 43% of dentists accept Medicaid or Children’s Health Insurance Program (CHIP).

Dentists are able to charge heavily through private insurance, ensuring that they only see “desirable” patients that are guaranteed to pay co-pays in full, on-time. 

Unsurprisingly, most dentists lean conservative. 63% of dentists’ donations go to Republicans, 37% to Democrats. There are 4 dentists in the House of Representatives, all are Republicans 

In 2018, the American Dental Association outspent the American Hospital Association in lobbying.

As a result, dental care experiences even bigger service disparities than medical care in this country.

Dr. Ibraheem Samirah, a Representative in the Virginia House of Delegates, did recently publish an op-ed in Richmond Times-Dispatch titled “Medicare dental coverage will benefit millions of Americans”. He tells the story of a patient of his on Medicare who is being treated for cancer, learning that she could not afford the $5,000 needed to repair her front teeth, and she would likely have to lose them. As Dr. Samirah writes: “America does not treat the mouth, the most voluntarily used part of a human, as a part that needs to be kept healthy for life.”

While dental services only account for 4% of national healthcare services, dentists still wield a lot of donation and lobbying power, with some legislators comparing the power of the ADA to the NRA in terms of tenacity.

What does dental care look like in other countries that do have single payer healthcare? A 2020 journal article from Health Policy tells us the following: Overall most jurisdictions offer public dental coverage for basic services (exams, x-rays, simple fillings) within four general types of coverage models:

1. Deep public coverage for a subset of the older adult population based on strict eligibility criteria: Canada (Alberta), Australia (New South Wales) and Italy; 
2. Universal but shallow coverage of the older adult population: England, France, Sweden; Denmark: children under age 18 free, subsidized after that. Dental check up is about $50 out of pocket. Cavity is about $85-$140.
3. Universal, and predominantly deep coverage for older adults: Germany; and 
4. Shallow coverage available only to some subgroups of older adults in the United States.

So in short: there really isn’t a country anywhere — even single payer healthcare systems — that are comprehensively covering dental. Even today, England and Canada are fighting their own battles to increase coverage.

We are hearing that the Senate is preparing better language for dental benefits, with efforts led by Senator Bernie Sanders. But the Senate too will experience intense lobbying from the ADA. So we have to push our Senators to make dental coverage as strong as possible.

CALL TO ACTION: Use National Nurses United’s Senate hotline to urge the Senate to pass strong dental benefits. 202-509-9128. And call your dentist too! They need to feel the pressure from their patients.

Follow & Support the Pod!

You can listen to Medicare for All on Apple Podcasts, Google Podcasts, or visit our website here.

Please donate to the Healthcare-NOW Education Fund to support the podcast!