Interview: 'HC reform does not include provisions to meaningfully improve access to dental care'

Daniel Zimmermann: The ADA did not support the health care reform bill recently approved by Congress. Could you explain the rationale for your decision?
Dr Ronald Tankersley: As America’s leading advocate for oral health, our decision was primarily based on the oral health provisions of the bill. We could not support the health care reform legislation because it did not include provisions to meaningfully improve access to dental care for millions of American children, adults and elderly by properly funding Medicaid dental services.

You say that the reform does not do enough to assure that low-income families receive adequate oral health care. On the other hand, millions of people will finally be able to buy health insurance regardless of their social status or pre-medical condition.
While countless other groups can weigh in on the health care reform’s overall merits and flaws, people look to the ADA for a determination of how it could impact oral health. And when the government is willing to spend close to a trillion dollars over the next ten years, but not spend a dime on improving access to Medicaid dental services for those most in need, somebody has to raise an objection. If we didn’t do that now, how could we expect lawmakers to take our concerns seriously in the future? That was the basis for our decision.

You have also rejected the idea of workforce pilot programmes? Can you tell us why?
The ADA’s opposition to the alternative dental models pilot programme was limited and based upon our long held belief that certain surgical procedures must be performed only by licensed dentists.

The big losers of this reform are going to be the insurance companies. What effects do you think the reform will have on the dental profession itself?
Although the ADA could not support the final legislation, we did recognise that it contained many worthwhile provisions pertaining to oral health. These included increased funding for public health infrastructure including Centers for Disease Control and Prevention programmes, additional funding for school-based health centre facilities and Federally Qualified Health Centers. We also recognised increased Title VII grant programme opportunities for general, paediatric or public health dentists and funding for the National Health Services Corps loan repayment programmes.

These provisions, which the ADA supported and lobbied for, will have a measurable beneficial effect on dentistry and dental patients.

In your opinion, what should be changed in the reform bill to make it feasible for dentists and move patient care forward?
When it comes to improving access to oral health care, our message remains: Fund Medicaid, the Children’s Health Insurance Program and other dental public health programs properly.

These programmes are only capable of fulfilling their roles if they receive adequate funding. Many states spend less than 0.5 per cent of their Medicaid dollars on dental care—an astonishingly low rate, considering the importance of oral health to overall health. Further, poor dental reimbursement rates paid to dentists mean that many of them can’t participate in Medicaid, which is one of the reasons many states fail to provide oral health care for even half of their eligible children.

The federal government can and must do more to ensure states are able to come up with their share of these benefits.

Republicans and other interest groups have announced to further oppose the reform bill. Where will you position yourself once the law has become effective?
The ADA will continue to lobby for improvements to Medicaid dental benefits and will be watching closely as federal agencies implement provisions of the law. We want to ensure that the provisions we support are carried out correctly and will work to change the provisions we oppose.

Thank you for this interview.