Dental Coverage and the Affordable Care Act

Laird Harrison

Disclosures

December 05, 2012

In This Article

A Need for More Dental Providers?

Other groups looking at the law have asked this question: If more patients get dental coverage -- and therefore start trying to get oral care -- who will provide the care?

The ADA (which provided background material for this article) has been arguing with public interest groups such as Pew about whether the country has enough dentists to meet its needs. The ADA says if you pay dentists enough -- and streamline the paperwork -- dentists already in business will find plenty of chair time for everyone who needs it. A few might need to hire some extra assistants and hygienists, and other paraprofessionals might help in getting patients matched up to practices, but essentially no big changes in the workforce are needed.

Pew, on the other hand, argues that the existing dental workforce can't accommodate everyone who needs care. Along with the WK Kellogg Foundation and some other advocacy groups, Pew would like more states to license midlevel providers such as the dental therapists in Alaska and Minnesota who can do advanced work such as extractions and restorations -- but who don't have as much training as dentists.

"We have the worst dental shortage we have had in 80 or 90 years," says Shelly Gehshan, Director of the Pew Children's Dental Campaign. "It's really great that we're going to get more kids with dental coverage, but without more delivery it's just giving them a hunting license."

The ACA allocates funds for demonstration projects to test various kinds of midlevel providers, but the American Dental Association opposes the programs, and the US House of Representatives has blocked appropriations for them.

ACA: Other Provisions

The ACA aims to lower medical costs by creating incentives for medical providers to keep their patients healthy rather than treating them when they get sick. So far, no one has described how these provisions might apply to dentistry. The act allocates funds for prevention, training, research, and public education about oral health, but Congress has not appropriated these funds. And any appropriation bills face a tough fight in a government facing a fiscal crisis and sharply divided about healthcare.

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