Proposed changes to health policy:
On January 20, 2017, President Donald Trump was inaugurated as the 45th president of the United States. Just a week before the inauguration, both the U.S. House of Representatives and U.S. Senate passed budget resolutions that serve as initial steps in repealing the Affordable Care Act (ACA). President Trump’s health care reform plan strongly supports the repeal of the ACA, and make no mention of dentistry or oral health, perpetuating the status quo of oral health being left out of general health. As the country faces a major potential shift in health policy, it’s important that we consider how this may affect our profession.
Affordable Care Act and oral health:
As far as oral health is concerned, the ACA did not require adult dental benefits or address issues of dental insurance being separate from medical insurance. However, the ACA had some redeeming features affecting oral health. It ensured every state’s Medicaid included pediatric dental benefits and also required health care exchanges to offer pediatric dental benefits. Additionally, the ACA’s expanded dependent coverage—that’s the provision that allows you to stay on your parents’ health insurance until age 26—has been shown to improve affordability of dental care for young adults. In 2015, the American Dental Association estimated 5.4 million adults gained dental benefits through the expansion of Medicaid under the ACA. Medicaid children’s dental utilization has risen in 49 states (between 2000 and 2013).
An unpredictable future of oral health:
With the absence of dental care in the brief health care reform plan put forth by President Donald Trump, it is difficult to say what the future will hold. There are two main objectives set forth by the Trump administration that have possible direct effects on oral health:
- Repealing the Affordable Care Act: The ACA defined pediatric oral health as an essential health benefit. And while actualizing this claim was a struggle in the U.S. health care system, repealing the ACA could have unforeseen effects on access to care for children who gained dental coverage through the ACA. Repealing the ACA without a plan to replace it leaves U.S. children at risk for losing dental coverage and also at increased risk for dental disease.
- Block-granting Medicaid to states: Currently, both the federal and state governments jointly fund Medicaid. The federal government has a significant role in administering Medicaid and deciding what the states should provide in their state Medicaid plans. President Trump’s plan to block-grant Medicaid would change the way Medicaid is funded and run. In his plan, the federal government would provide each state with a lump sum of money to provide insurance to its Medicaid population. States would have more freedom to decide who qualifies for services. Currently, four states offer no adult dental benefits in Medicaid, and thirteen only cover emergency services. With vast changes to Medicaid funding, the number of states that provide dental benefits could drastically change.
Dental students and health policy changes:
Much of the health policy debates and discussions happen thousands of miles away from the days I spend as a Medicaid provider at the UCSF School of Dentistry (in fact, ASDA has a policy encouraging all dental schools to accept Medicaid patients). Yet these proposed changes have the potential to affect my clinical dental education. I am fortunate to live in a state with fairly comprehensive Medicaid dental coverage, and most of my patients are able to gain access to dental care because of this. If my patients did not have Medicaid, they would struggle to afford the care needed to achieve good oral health. Medicaid dental care is part of the solution to solving access to care issues and it enables me to gain the clinical education I need by providing patients. As we see aggressive proposals to change health policy in the U.S., I will be asking that my elected officials remember the importance of oral health and access to dental care.
To voice your opinion on the importance of oral health, repealing the ACA or the effects of changing Medicaid, you can contact your senator, contact your house member, and lobby your state officials. As dental students, we can ensure that oral health is not left out of the future of health policy.
~ Jean Marie Calvo, San Francisco ’17