With the Supreme Court’s recently upheld decision regarding the Affordable Care Act, it is now more important than ever that both business owners and consumers understand the effects of the pending changes to our state’s healthcare system. Even with Washington state’s recently signed law regarding rules for insurers preparing for the online insurance exchange, there is still a great deal of uncertainty surrounding healthcare reform, mandates and cost. It gets even more confusing when you start to look at specific benefits, such as dental, and how businesses and patients will be impacted by any changes.
When the changes take effect January 2014, in Washington state oral healthcare for children will be included in the mandated plans, which will be designed to cover those who were previously uninsured or those who work for companies with fewer than 100 employees. While dental benefits will not be mandated for adults, it is important to remember that good oral health is as important for adults as it is for children, especially given its relationship to other diseases such as diabetes.
The younger population will be covered but what about seniors? We have 10,000 people turning 65 each day in the United States. Theirs is the first generation of senior citizens to have their teeth, due in large part to the fact they were the first to grow up with fluoridated water and see their dentist on a regular basis. Dental benefits providers are developing benefit structures that are both cost-effective and health-effective for them. These products will be available for purchase both on and off the exchange.
When it comes to employee-sponsored benefits, many of us are heading into unchartered territory. Traditionally, employers have offered a host of benefits for their employees, who were glad to have the coverage but probably did not spend a lot of time reviewing the details. With reform, small businesses will have the option to refer employees to the exchange to choose their own coverage. Considering the ever-increasing cost of healthcare, I’d venture to say it’s likely that many small businesses will do so.
But when it comes to dental, I’d encourage these business owners to consider maintaining coverage as a valuable employee benefit. In this time of tightening, providing preventive care for employees and their families adds value that people will appreciate and benefit from – particularly in terms of oral and overall health. If employers choose to forgo sponsored benefits, individuals do go out to the open market to choose a plan they think fits their needs. In this scenario, it will be up to consumers to understand the need for a dental benefits plan, and to educate themselves. In turn, we as a dental benefits provider will need to do a better job communicating our value proposition.
With increased options, some consumers may choose to save money and forgo preventive dental coverage for annual cleanings. I would direct these folks to a recent report by the Washington State Hospital Association, which found that dental related problems were among the top reasons that Medicaid and uninsured individuals sought emergency room care. During an 18-month period, the cost of more than 54,000 dental-related visits to ERs exceeded $36 million. Preventive care often catches conditions before they become emergencies, which in theory would significantly decrease the number of emergency room visits.
As healthcare reform becomes a reality, it is imperative that consumers continue to educate themselves in the ever-changing marketplace. In turn, our industry must continue to communicate the importance of providing innovative dental benefits and high-quality care in a manner that allows consumers to choose the most effective option. As the connection between oral and overall health becomes increasingly apparent, the industry will move toward greater integration and care coordination, ultimately enforcing the necessity of oral health as an imperative piece of the healthcare reform puzzle.
Dr. Ron Inge is vice president and dental director for Delta Dental/Washington Dental Service and executive director of the Institute for Oral Health.
