A disturbing policy climate for dental coverage

By: Deborah Vishnevsky

So much for a sleepy September on the health policy front. With the end of fiscal year approaching, we are rapidly edging towards a vital deadline for the Children’s Health Insurance Program (CHIP). Additionally, Congressional Republicans have revived efforts to repeal and replace the Affordable Care Act (ACA) before the budget reconciliation window closes on September 30. Senator Bernie Sanders (I-Vermont) and many Senate Democrats have laid down their maker by introducing a bill to extend Medicare coverage to all Americans.

Needless to say, all of these policies would impact the oral health of children and families, so let’s review these developments and try to sort this all out.

CHIP Funding

As we mentioned last week, Senators Orrin Hatch (R-Utah) and Ron Wyden (D-Oregon) introduced the Keeping Kids’ Insurance Dependable and Secure (KIDS) Act. This bipartisan bill is currently the best hope for continuing comprehensive health and dental coverage for the nearly 9 million children who benefit from the CHIP program. Their bill would extend CHIP for five years while temporarily extending the current federal matching rate before it tapers off after 2019.

It looks unlikely that a bill to extend CHIP funding will be passed before the September 30th deadline. 

Although the introduction of this CHIP bill is encouraging, it looks increasingly unlikely that it will be passed before the September 30th funding deadline. Any delay in funding CHIP pushes states closer to the necessary but resource-heavy task of planning to wind down these programs. In addition, due to recent hurricanes and other budgetary challenges, some states are likely to run out of CHIP funding much earlier than originally projected.

Renewed Threats to ACA and Medicaid

Unfortunately, any momentum for CHIP could be stalled by renewed efforts to repeal and replace the ACA. Following failed efforts to repeal the ACA earlier this year, it was determined that Congress would have until September 30 to use “budget reconciliation” procedures to make changes to the law. (Under budget reconciliation, changes can be made with a simple majority vote.) As such, Senators Lindsey Graham (R-South Carolina) and Bill Cassidy (R-Louisiana) have been been aggressively seeking support for one last ACA repeal effort before this deadline.

The Graham-Cassidy bill to repeal ACA would make deep cuts to Medicaid programs.

The Graham-Cassidy bill features many of the most concerning components of previous ACA repeal-and-replace proposals. It would end much of the ACA’s Medicaid expansion and assistance for middle- and lower-income families, including tax credits and cost-sharing reductions for private insurance. Graham-Cassidy also would allow states to waive essential health benefits requirements (such as pediatric dental) and would eliminate funding for important public health initiatives. These cuts would then be used to fund lump-sum payments to states (block grants) for health-related programs through a complex formula.

Most troubling, Graham-Cassidy’s plan would make severe cuts to Medicaid programs, instituting a per-capita cap or allowing states to choose the alternative of a block grant. Neither of these approaches would provide adequate funding for the care that children and families need most. The Graham Cassidy plan’s Medicaid cuts would leave states with the difficult choice of replacing those funds or, more realistically, limiting eligibility, coverage, and access to care. In addition, under the block grant option, dental services for children may be directly at risk.

History has shown that when state budgets are tight, dental benefits are an easy target for cuts. Similarly, looser benefit standards and inadequate support to purchase private coverage could leave many families without affordable health or dental coverage options.

And Now for Something Completely Different

These last few weeks have also seen increased attention on Senator Sanders’ Medicare for All plan. While many have conflicting perspectives on the potential impact of this bill on the healthcare debate, we want to give Senator Sanders credit for recognizing the importance of oral health by including dental coverage as component of his plan. While dental benefits are not currently covered by Medicare, its inclusion in this bill reminds Americans that oral health is an integral part of overall health and should be viewed as such by politicians, caregivers and patients.

Take 15 Minutes to Contact Congress

With so many bills in the air, it is impossible to predict what the future holds for children’s and families’ access to quality oral health care. But if we at CDHP have taken anything from this year, it is that elected officials are listening. We encourage you to contact your Congressional representatives and governors now. Let them know that any changes to current law should not hurt children or families’ access to comprehensive and affordable coverage, including oral health care. Be specific. Make it clear that the implications of Graham-Cassidy are dangerous to families and CHIP is a critical, life-saving safety net that demands their attention now.

Our elected officials should #KeepKidsCovered and #ProtectOurCare. For more information on how to engage policymakers, visit our Why Dental Coverage Matters toolkit for call scripts, talking points, and graphics to share on social media. You can also follow this blog or our social media for updates.

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children ages 6-12 suffered a toothache in the previous six months.
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