Dental Coverage and the Affordable Care Act

Laird Harrison


December 05, 2012

In This Article

The Affordable Care Act

When the Affordable Care Act (ACA) passed in 2010, no one involved in oral health felt satisfied. But many cheered for what they thought would be its biggest effect on oral health: extending dental benefits to nearly all the children in the country. Two years later, serious questions have arisen about that expectation. The law is so complicated that the longer experts have spent digesting it, the more possible interpretations and unintended consequences they have found.

In one possible scenario, parents would not have to buy dental benefits for their children at all, allowing millions to remain without them. In another scenario, 5.3 million children would gain dental benefits -- but 11 million adults would lose them. These are just 2 of the nearly infinite possibilities that could unfold as state and federal governments decide how to enforce all the provisions of the 2409-page act.[1]

The implications of expanding or reducing dental coverage are important. Without insurance, Americans are 2.5 times less likely to get dental care.[2] Moreover, much research in recent years has linked oral health to systemic health, connecting periodontitis, for example, to heart disease and diabetes.[3]

For all of its ambition to transform the American healthcare system, however, the authors of the ACA also attempted to preserve continuity. President Barack Obama promised that "If you like your healthcare plan, you can keep your healthcare plan."[4] Among the elements of our existing system of care, the ACA has preserved a dichotomy between the mouth and the rest of the body. (The eyes get isolated as well.)

To understand how, let's take a step back. The law aims to expand healthcare coverage through 3 main provisions: It requires health insurance companies to accept almost everyone, regardless of how sick they are. It requires almost everyone to have health coverage or pay a special tax. And it provides subsidies to people who can't afford coverage on their own.

But oral care is half in and half out of this formula. In the first place, the law doesn't require anyone to have dental coverage. The individual mandate -- the most controversial part of the law -- says that everyone should have "minimum essential coverage." The definition of "minimum essential coverage" is vague. So far, the federal government has said that it will include most kinds of comprehensive medical insurance, both public and private, but it specifically excludes dental-only plans.[5] So where did anyone get the idea that the ACA would expand dental benefits to children?