Pulling Teeth: Why Dentists Wrongly Oppose Adding Dental Coverage to Medicare

The American Dental Association (ADA) is a dentist membership organization with a mission to “help dentists succeed and to advance the oral health of all individuals.” If advancing oral health for everyone is a crucial part of their mission, why does the ADA oppose expanding Medicare Part B to include a dental care benefit?

Medicare currently does not cover dental care, but after months of negotiations, the Build Back Better legislative proposal wanted to change that by adding a dental benefit to Medicare Part B. Doing so would bring dental coverage to millions of beneficiaries. Most people would expect the leading organization representing America’s dentists whose stated mission includes advocating for oral health to support this proposal, but the ADA is very clear in their opposition. The ADA wrotein a letter to the Chairman of the House Ways and Means Committee that they “cannot support the legislative proposal being considered by the House Ways and Means Committee to expand Medicare Part B to include dental care.”

The real question is why? The ADA has concerns that this proposal would not “benefit those low-income seniors who need dental care the most” and the proposal would not adequately reimburse dentists for the services provided. The ADA instead advocates for creating a separate Medicare program focused on dental care that is means tested, covering seniors up to 300 percent of the federal poverty level. In the end, it looks like the ADA has succeeded in blocking dental care for millions of seniors touting that “[a]fter intense ADA lobbying for a targeted benefit and strong grassroots efforts” the Medicare dental benefit was removed from the White House’s Build Back Better legislative outline.

For many, dental care is unaffordable and routinely is care that people forgo altogether because of cost. Deconstructing the ADA proposal makes clear that it prioritizes reimbursement for dentists over care for patients. Creating a separate program in Medicare is a mimicking of the Medicare Part D prescription drug benefit that is wholly privatized. Private insurance reimburses providers at higher rates, but is more expensive for patients and they are more likely to have instability in their coverage compared to public insurance programs. 

The ADA proposal would also means test their new program bringing out the same argument used by people opposed to public programs—that a universal benefit helps rich people more than it does those who are low income. Contrary to the austerity informed policies that the ADA advocates for, universal programs ensure longevity and protect low-income individuals with the security that their coverage will not be snatched away next Congress. Means testing a program like dental care extrapolates a larger issue within health care policy in the United States—that helping anyone above a certain income level is bad policy. 

In challenging austerity politics, it is importantmuch like Ginia Bellafonte did in the New York Times and Megan Day inJacobin—to posit, so what? So, what if people, including rich people, can receive dental care? Accepting austerity eliminates conversations about universal rights. It forgoes questions of whether everyone deserves dental care, and for that matter all health care. Organizations like the ADA, and issues like dental care are one part of a commodified health care system that accepts means testing, privatized benefits, and austerity as solidified—that is just the way things are. 

Health care policy is infused with this mindset, universality until recently was confined to progressive think tanks, academia, and a subset of progressive politicians but has burst into the mainstream. American health policy needs to expand its horizons to recognize that health care is a human right, and human rights should not be means tested. Austerity politics carves people up, separating people who are deemed needing of care and those who can obtain it themselves. Universal programs bring us together, it opens up a dialogue on the right to receive care not the ability to pay for it. Advocating for public health—like the ADA states it does—should not include privatization or means testing dental care, it requires shifting the debate on health care to focus on covering everyone. 

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