By Paul O. Walker
Making progress toward good health – particularly children’s health – is a good feeling. Parents of healthy children marvel at their milestones and upward trending growth charts. Providers enjoy seeing our smallest patients start out life with a solid foundation that will carry them into healthy adulthood.
However, when we stumble in our ability to provide these essential building blocks, or take steps backward in the programs that help make it possible, the effects are significant and long lasting.
Children’s dental health care is an area where policymakers and providers have made tremendous strides in past years, thanks to federal programs like the Children’s Health Insurance Program. Set to expire this September unless Congress votes to reauthorize its funding, CHIP has been a driving force in allowing millions of children to receive dental care since 1997, helping to reduce the number of young children with tooth decay and cavities to its lowest point in 25 years.
It’s noteworthy progress, since lack of early, preventive dental care has been directly linked to poor school attendance and performance, and can go so far as to impact employment in adulthood.
Dental care provided through CHIP has helped to keep my patients and millions of others healthy through affordable and accessible cleanings, screenings, and proper education. It’s also been good for containing avoidable healthcare costs. For example, low-income children who see a dentist by their first birthday are less likely to need expensive restorative or emergency room visits, and their average dental-related costs are almost 40 percent lower than children who did not see a dentist early.
Without the availability of CHIP for low-income children, I’m afraid this type of progress and cost-savings will become a thing of the past. It will definitely increase the burden on already financially strapped families who — even with the health benefits provided through the Affordable Care Act — will likely forego dental care due to the costs.
While the ACA contains provisions intended to help families obtain affordable dental care, the reality will almost certainly keep that care out of reach for many. Some families will be able to obtain dental coverage as part of their medical plans in the marketplace, while others will not. Only about one third of state marketplace plans contain children’s dental coverage included in the health plan, and subsidies typically do not extend to separate, standalone dental plans offered on the marketplace.
Parents of youngsters who previously enjoyed CHIP benefits will find much higher costs when seeking dental coverage in the marketplaces. Whereas CHIP limits premiums and cost-sharing for children’s medical and dental coverage to five percent of family income, when obtaining coverage through the marketplaces, some families could realistically be expected to pay more than eight percent of their income in health insurance premiums alone. Those who buy a separate dental plan for their children would likely pay closer to 10 percent of their annual income in health and dental premiums. Alarmingly, the non-partisan Medicaid and CHIP Payment and Access Commission (MACPAC) has concluded average cost-sharing in marketplace coverage is seven to 15 times higher in comparison to CHIP.
Not only costly, health insurance marketplaces have already proven themselves disturbingly ineffective in actually providing essential dental care to children. The most recent ACA Marketplace Enrollment Report shows just 14 percent of children under the age of 18 subscribed in a standalone dental plan.
While I’d like to think there’s still a safety net for children in need of dental care, it seems to now be a safety net full of holes.
The solution — one that would be in the best interest of our nation’s children — is for Congress to fully reauthorize CHIP so that each and every child can have access to affordable dental care. In order to build on recent improvements in children’s oral healthcare access, it’s essential that CHIP continue to remain available without lapse or gaps in funding.
It’s time for Congress to take action and fund CHIP for the future, and for the healthy smiles of our nation’s children.
Paul O. Walker, DDS, MS, is vice president of clinical quality at Kool Smiles.
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