Since the ACA’s passage in 2010, there have been important gains in dental coverage; while the dental uninsured rate previously hovered around 35 percent, by 2016, it had dropped to 28 percent. Core components of the ACA have helped more people get coverage and access to dental services, which are critical for oral health and for physical and mental health. Research shows oral disease is associated with other diseases and chronic illnesses including diabetes, cardiovascular disease, stroke and adverse pregnancy outcomes. Poor oral health also impacts nutrition, diet, emotional well-being, sleep and ability to work or study. Proactive policies that improve the ACA could build on this foundation and further improve access to dental care and oral health.
Instead, the Trump administration’s position in Texas v. United States would tear away these important gains. The U.S. Department of Justice and Attorneys General from 17 Republican-led states have fought against the needs of consumers and the desires of the majority of the American public to completely dismantle the ACA, along with the protections and coverage it provides for the oral and overall health of millions of people across the country.
Along with integral protections for people with pre-existing conditions, at stake are key components of the ACA that led to dental coverage gains:
Medicaid expansion has been vital for expanding access to dental care for low-income adults. While adult dental benefits are optional under Medicaid, almost all states offer some dental coverage to Medicaid-enrolled adults. With Medicaid expansion, the ACA offered states an opportunity to expand dental care to more low-income adults and 31 of the 32 states that have expanded Medicaid also offer dental coverage to adults in the expansion eligibility population. Additionally, because children are more likely to get needed dental care when their parents are able to see a dentist, adult dental benefits also trickle down to improve access for children. Without Medicaid expansion – or with half-baked sabotage efforts like block grants or partial expansions – millions of adults, and their children, may stand to lose access to essential oral health benefits.
The dependent coverage policy that allows young adults to stay on their parents’ private insurance policy up to age 26 has resulted in increases in dental coverage and use of dental care among young adults. Without this important policy, many young adults would go without dental coverage, potentially forgo needed care and experience new or worsening oral health problems and associated complications to physical health and ability to work or go to school.
The ACA’s requirement that all individual and small group plans cover 10 essential health benefits (EHBs) has ensured that children without access to employer-sponsored insurance can get the dental care they need. The ACA specifically included pediatric dental care as an EHB, ensuring more children have access to oral health services with no annual dollar cap.
More than 1.7 million adults and more than 170,000 children received coverage through standalone dental plans on the ACA marketplaces.
In addition to these oral health-specific impacts, the deep relationship between oral health and other health outcomes means that other coverage losses caused by ACA sabotage could trickle down to have devastating effects. For example, individuals who lose health insurance coverage and become unable to afford insulin, may experience the negative oral health outcomes associated with uncontrolled diabetes. Similar relationships emerge with other physical health conditions closely related to oral health. Furthermore, if people lose the dental coverage they gained through Medicaid expansion or other parts of the ACA, associated oral health problems are likely to cause other health issues and increase health care costs.
By expanding dental coverage in Medicaid and private plans, for both children and adults, the ACA became a crucial part of the fabric of the dental coverage landscape. Because oral health is so intricately tied to other health outcomes, the ACA has expanded coverage and improved access to dental care in many of the same ways that it has for other types of care. Texas v. United States. is just one of many harmful, misguided and politically-motivated attempts by the administration to sabotage the ACA.
You can take action to push back against this harmful lawsuit by contacting your state’s Attorney General and using Community Catalyst’s sample op-ed to raise the issue through your local media outlets. Check out our collection of state-specific fact sheets for more information on how Texas v. United States could affect consumers in your state and learn more about the history of the case with our timeline and explainer video.