On Nov. 1, people across the country began navigating the health care open enrollment process, a complex ritual that happens every year to secure health insurance. As a part of that process, individuals will inevitably encounter gaps and inconsistencies in coverage for services most of us understand to be essential. Among the services that aren’t covered for most adults — oral health care.
Over 20 years ago, former Secretary of Health and Human Services (HHS), Donna Shalala, said “you cannot be healthy without oral health.” Since then, we’ve gone through seven HHS secretaries, four presidents, four national recessions, and an unprecedented global pandemic. And tens of millions of adults still do not have access to affordable dental care. That’s because for the last decade, the federal government has excluded dental care from a list of “essential” services that most health insurance plans are required to cover.
The Biden administration can and should change this. The administration has the power to add dental care to the list of services deemed essential and they don’t even need to go through Congress to do so. It’s a simple action that would have enormous impact, not only in improving people’s health outcomes but also their financial futures.
In Community Catalyst’s work to make health care more accessible, affordable and equitable, we hear stories from people across the country about how one unexpected dental emergency put people and their families into years of debt.
When Mary H, from Pennsylvania, went to the dentist, she was encouraged to apply for Care Credit, a medical credit card. The credit card was heavily marketed at her dentist office, but she was assured that her credit limit would only be a little more than her bill and that she wouldn’t need to start payments for one year.
“A few months went by, and I started receiving phone calls. They demanded payment in full, and the balance was much higher than my credit limit,” Mary wrote.
She asked for an explanation and was directed to read her card’s terms and conditions. “They called daily, even while I was making monthly payments. They are awful and should not be permitted to market the credit card in medical or dental offices.”
Sadly, Mary is not alone. Dental services continue to be a leading driver of medical debt amongst U.S. households, with far too many people signing up for predatory deferred interest credit cards in dental offices or forgoing the care they need altogether. This is especially true for marginalized members of our community such as uninsured adults, women, Black and Hispanic adults, and people with lower incomes.
In one of the wealthiest nations in the world, no one should be forced to choose between getting the care they need or putting food on the table for their family.
When the Affordable Care Act was signed into law it was one of the most significant health policies in the past decade because it finally set a baseline for how comprehensive private insurance plans must be with their coverage. But health care, and society, has changed a lot in the last decade and we need the Affordable Care Act, and specifically what it designates as essential benefits, to change too.
The Biden administration has the power to help bring dental coverage to tens of millions of people and, by doing so, tackling one of the biggest drivers of medical debt in this nation. Dental care is essential care. Beyond that, they also have the power to expand essential services so that people have greater access to comprehensive maternal health care, mental health supports, prescription drugs, and gender-affirming care.
They should do so without delay. The millions of people drowning in debt cannot afford to wait any longer.
Shah is senior director of policy and strategy at Community Catalyst.