The Children's Dental Health Project's blog
The powerful impact of dental coverage
Previously on the Children's Dental Health Project blog, I examined some potential replacements for the Affordable Care Act (also known as the ACA or “Obamacare”). With Congress continuing to debate the future of healthcare policies, it’s worth asking ourselves what we as a country have learned from the ACA’s strengths and weaknesses, and what we should strive to keep versus what should be changed. A new study in the Journal of the American Dental Association (JADA) gives a valuable perspective on the state of children’s oral health care needs both before and after the ACA was enacted.
The authors of the JADA article looked at National Health Interview Surveys from 1997 to 2014, seeking to understand relationships between having dental health insurance and accessing dental care accessed, and the connection between coverage and unmet dental health care needs due to cost. That data showed some interesting trends:
- From 1997 to 2014, the number of children without dental coverage dropped by 58%.
- During that same time, the rate of children covered by private insurance went down while the number of children covered by public dental health insurance (via Medicaid or CHIP programs) more than doubled.
- Uninsured children had the fewest dental appointments and their parents were most likely to report unmet dental health needs due to cost.
- The presence of insurance (private or public) was associated with more dental appointments and fewer unmet dental needs. While private dental coverage had a stronger link to reducing unmet needs than public coverage, having a dental appointment in the last year was associated with lower unmet needs, particularly for children with public insurance.
Many of these highlights may seem unsurprising, but they illustrate how far we have come in improving access to dental health care for children. More precisely, they demonstrate how expanding dental coverage improves kids’ oral health.
From 1997 to 2014, the number of children without dental coverage dropped by 58%.
The different impact that private and public coverage had on reducing unmet needs might interest you as much as it interested me. The study’s co-authors provide a persuasive “why” for this difference: children on private insurance are more likely to benefit from other factors that are associated with better oral health — for example, factors like parents’ educational status and children’s geographic proximity to dental providers.
Other research also supports this explanation. A recent article in Health Affairs compared children covered by public and private insurance sources in 2011 and 2012, examining their use of services and parental assessments of children’s health. Their findings showed that when they controlled for family income, children on public or private insurance accessed dental services at similar rates, but “oral health status was poorer for publicly insured children than for children with private insurance.”
Parents of uninsured children in the JADA study were most likely to report unmet dental health needs due to cost.
The authors of the JADA study point out that this pattern of publicly insured Americans benefitting from fewer unmet needs became even more consistent starting in 2009. Although the authors point to a number of trends, like “an upturn in the economy, slowing the growth rate of dental service prices, and the growing effectiveness of the Affordable Care Act (ACA) of 2010,” it seems safe to say that public insurance has been doing exactly what it is supposed to do for the 39% of U.S. children who rely on it for dental coverage — reducing the prevalence of dental disease in the most disadvantaged children. Certainly, there’s work to be done in terms of ensuring that preventive oral health care is tailored to each child’s individual needs, but if this trend of improved access to dental coverage continues, we ought to see the trend of improved oral health continue as well.
As legislators assess options for the future of our nation's healthcare, including funding for CHIP, Medicaid and the future of the ACA, it is imperative that they realize the positive impacts of these programs and preserve the gains we’ve made over the past two decades.
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