On March 27, the House Energy and Commerce Subcommittee on Health held a hearing entitled, “Insuring Bright Futures: Improving Access to Dental Care and Providing a Healthy Start for Children.” The hearing examined coverage for and access to children’s dental health services under Medicaid and the State Children’s Health Insurance program (SCHIP).
In his opening statement, Chair Frank Pallone (D-NJ) said, “Today’s hearing was brought about after a12-year old Maryland boy lost his life because he was unable to access the dental care he needed to treat an abscessed tooth. What started out as a simple toothache quickly developed into a far worse problem that cut this boy’s life far too short.” Chair Pallone outlined the problems associated with delayed dental care, noting that they were more acute for children from un- or underinsured families: “Poor children are more than twice as likely to have cavities than children who come from wealthier households. Medicaid is able to provide comprehensive dental care to many low-income children through its early periodic screening diagnosis and treatment benefit…But there are many children who are not eligible for public health insurance programs who are unable to also receive proper dental care. When I am home in New Jersey, and I am visiting a community health center or a hospital clinic, I see first hand how difficult it is for low-income families to obtain primary dental care. The community health centers that I talk to describe the difficulty they have in securing dentists to provide care to their patients.”
Ranking Member Nathan Deal (R-GA) said, “I’m sure our witnesses will tell us there are a number of barriers to proper oral health care despite the fact that all states must provide dental services as part of their Medicaid programs. Every state with an SCHIP program provides dental coverage as well. It seems that the impediment to coverage in public programs exists not necessarily because the benefit does not exist. For instance, many dentists choose not to participate in the programs. In 2000, only about a quarter of dentists participated in the Medicaid program. Also, in my conversations with dentists, many cite the overwhelming administrative burden of providing services through public programs. I believe it is shortsighted to point only to reimbursement rates when dentists will choose to provide their services on a pro bono basis rather than participate in the public programs.” Rep. Deal urged the subcommittee not to require dental coverage, saying, “I’m afraid that many [on] our committee have an interest in creating mandates within SCHIP like the dental benefit in Medicaid which makes it more difficult for states to provide health coverage that is appropriate for the needs and individual conditions of each state…I fear that if we remove the flexibility of SCHIP we will seriously hamper the ability of states to design innovative health care proposals to cover their uninsured.”
Dr. Kathleen Roth, president of the American Dental Association, began her testimony by detailing the disparities in access to dental health care. She cited a report by former Surgeon General David Satcher; the report found that “about 80 percent of the tooth decay occurs in only about 25 percent of the children children who are overrepresented in the lower socioeconomic strata.” Dr. Roth said poor children also were more likely to face geographic barriers to accessing care since their communities often lack a sufficient number of dental health providers. She lauded the Children’s Dental Health Improvement Act 2007 (as-yet-unnumbered), sponsored by Reps. John Dingell (D-MI) and Mike Simpson (R-ID), saying that the legislation “will do a great deal to improve delivery of dental care in Medicaid and SCHIP and ensure a chief dental officer presence in key federal agencies, among other initiatives.” Dr. Roth made several recommendations for increasing accessing to dental care, including raising Medicaid reimbursement rates, offering a tax credit for professionals who open an office in an underserved area, increasing community outreach, water fluoridation, and reducing administrative requirements for dentists participating in public health programs.
“Just as the mouth is integral to the body, so too must dental care be legislated as an integral component of well baby and well child care,” said Burton L. Edelstein, founding director of the Children’s Dental Health Project. Dr. Edelstein said that despite the relatively low cost of preventative dental care, “many children insured through Medicaid seek relief of toothaches in the emergency rooms of our community hospitals because of difficulty accessing dental care in private and safety-net offices. One Texas study reported that the cost to Medicaid is three times greater for emergency room care care that doesn’t solve the underlying dental problem than the total cost of preventive care would have been to assure oral health in the first place.” He said that only 25 percent of children covered by Medicaid had a preventive dental visit in the preceding year, less than half the rate for children with private insurance coverage. In closing, Dr. Edelstein urged the subcommittee “to ensure that dental care is never again considered optional in SCHIP.” Additional witnesses included: Dr. Raymond C. Scheppach, executive director of the National Governors Association; Ms. Christine Farrell, Medicaid policy specialist at the Michigan Department of Community Health; Dr. Stephen B. Corbin, senior vice president of constituent services at Special Olympics International; Dr. Nicholas G. Mosca, on behalf of the American Dental Education Association; Ms. Chris Koyanagi, policy director at the Bazelon Center for Mental Health Law; Dr. Jack Chapman, president of the Health Access Initiative; and Dr. David M. Krol, on behalf of the American Academy of Pediatrics.
