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Oral health affects overall health, social and emotional well-being and economic mobility. Consequently, addressing inequities in oral health and access to dental care is key to advancing health and racial justice. As we celebrate the 12th anniversary of the passage of the Affordable Care Act (ACA), it’s worth reflecting on the ways in which this landmark law has advanced oral health equity and the ways in which we can build on this progress moving forward.
The ACA’s most significant oral health achievement has been the increase in access to dental coverage through the health insurance marketplaces and Medicaid expansion. The ACA specifically included pediatric dental care as part of the essential health benefits that must be covered in individual and small group insurance offerings, ensuring that more children and adolescents have access to oral health services with no annual dollar limit. And while adult dental coverage is not included in the ACA’s essential health benefits requirements, millions of adults have been able to purchase health and dental coverage for themselves and their families through the ACA’s health insurance marketplaces. Moreover, thanks to the ACA provision allowing dependents to remain on their parent’s health insurance until age 26, fewer young adults have had to forego dental care due to financial barriers.
And 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, meaning nearly every state that has expanded Medicaid now also offers some level of dental coverageto adults in the expansion population. We know that this policy improves access to dental care for adults and children because children are more likely to get needed dental care when their parents are able to see a dentist. In addition, the expansion of adult dental coverage in Medicaid has been shown to reduce racial disparities in access to dental care and reduce emergency department visits while also improving employment opportunities, particularly for low-income communities of color.
Yet, our work on eliminating inequities in oral health and access to care has only just begun. Despite the accomplishments of the ACA, oral health remains out of reach for millions of people. In addition to closing the remaining coverage gaps in states that have yet to expand Medicaid, we must also ensure that Medicaid provides comprehensive and affordable dental coverage in every state. The current variability of optional Medicaid adult dental benefits means that a person’s access to dental care is highly dependent on where they live. This dynamic particularly harms people who are Black, Latino and other people of color; people with disabilities; and those in rural and tribal communities. Moreover, we know that making comprehensive adult dental coverage mandatory is a wise investment and can help improve health outcomes beyond oral health.
Similar to Medicaid, we must ensure that marketplace coverage includes oral health services for all people. The ACA does offer us a mechanism to achieve this by requiring the Secretary of Health and Human Services to periodically review and update the essential health benefits to address gaps in access to coverage. Such a review could allow the administration to add much-needed services like adult dental or more comprehensive SUD treatment services.
Finally, while the ACA sought to support expansions in coverage through greater investments in oral health data collection, state infrastructure and workforce, these issues warrant greater attention. One such approach is a renewed investment in the training and deployment of dental therapists and other community-based providers. Dental therapists have been repeatedly proven to provide high-quality care and improve access to care for the communities they serve. Congress and the administration can help support the expansion of this model by funding the ACA’s alternative dental provider demonstration grants, investing in new dental therapy education programs and eliminating restrictions on the use of dental therapists by Tribes through the Community Health Aide Program.