I spent much of this morning in the lobby of an Aspen Dental branch, waiting for my mother to emerge from major dental surgery. As the designated adult caregiver I took her home, and at least for the next three hours I’ll be observing her for various conditions that are listed in this aftercare sheet next to me. Of course very few people enjoy going to the dentist, and my mother is certainly no exception, but long after the physical pain is gone she’ll still be dealing with the hit to her wallet – something along the lines of several thousands of dollars. That sum is going to be a not-insignificant burden to her; despite earning around the median national income and having employer-provided health insurance with dental coverage. I don’t imagine that her hesitation on undergoing this procedure while employed, insured, and not a spendthrift is especially uncommon. Anything over the most basic, routine, dental care is incredibly expensive for most people.
Yet you can still count her among the lucky for not being one of the 85 million Americans that have zero dental coverage.
The Affordable Care Act doesn’t change this basic approach to dental care in this country. Our current landscape remains much the same; incredibly segmented along the have’s and have-not’s.
More to the point, America already has an embarrassingly segmented dental-care system. We just haven’t owned up to it, or accepted the responsibilities that come with this reality. Oral health received embarrassingly little attention during the fight for health reform. Dental services weren’t included in Medicare. Adult dental care remains an optional Medicaid service. Children on Medicaid and CHIP enjoy limited options — though at least they are covered.
The ACA requires pediatric dental coverage, which is fantastic of course. But it doesn’t do much for adults beyond some funding for Federally Qualified Health Center which happens to have a dental component. That’s not enough. One of the more persuasive arguments for the ACA, or even just health care reform in general, continues to be the notion that people shouldn’t be forced into bankruptcy or severely financially debilitated over necessary medical care. Dental care and coverage is one of the largest untouched categories that could do so much for so many. That previous and current reform efforts have largely nothing to say about this is a useful reminder for proponents that health care reform doesn’t end with the ACA. Even as we work and write and fight for the current law we should be thinking of the next step.