Earlier this month, House Republicans publicly released their Affordable Care Act (ACA) replacement: the American Health Care Act (AHCA). While the plan is currently just a proposal, it has many wondering how it could change the shape of our health care landscape.
Health Talk: Right now, how does the ACA affect dental care?
Sheila Riggs: Actually not much, because there’s no adult dental benefit in the mandated package. There is a mandated children’s benefit package, but it’s only mandated that the package is offered, not purchased. Minnesota is one of a handful of states that offers some dental coverage for adults in Medicaid.
HT: Under the proposed AHCA, would dental care be affected? And if so, in what ways?
SR: Under the ACA children’s package there is a healthy orthodontics benefit. If the new plan eliminates all mandated benefit sets, we would lose that.
Cutting Medicaid could also cause some issues. Unfortunately, Medicaid reimbursement rates are so low in Minnesota many struggle to find care anyway. That’s not a product of the ACA, but an issue at the state level. The AHCA would not fix this problem, either.
HT: Can you elaborate on the reimbursement rates?
SR: Minnesota has one of the lowest reimbursement rates for pediatric dental care in the nation. The term refers to the amount the government pays dentists when the care for someone covered by Medicaid or some sort of public program. Because Minnesota’s rates are so low many dentists can’t care for low-income patients. Sometimes the reimbursement won’t even cover the cost of providing care so the dentist actually loses money caring for those patients. Unfortunately, dentists, especially those in small practices, have to consider those costs. The Minnesota reimbursement rate for dental care provided to adults is also low.
HT: So low-income Minnesotans are hit hardest when it comes to dental care?
SR: Yes, exactly. Those covered by Medicaid and the state’s public programs are poor, underserved individuals who struggle to access care. This is a state issue. The AHCA won’t change that. If anything, the AHCA would be detrimental, because it could cut benefits for the few that can find dental care under the low reimbursement rates.
*Note: The reimbursement rate for Minnesota is 26.7 percent. Some neighboring states like North Dakota and South Dakota reimburse more than 50 percent. However, Wisconsin and Illinois also lag, offering just over 30 percent reimbursement.
HT: Could the AHCA impact dental insurance from an employer-employee angle?
SR: No employer has to offer dental insurance in the first place. It’s a total gift. The only reason employers offer dental is to attract a better workforce. Minnesota has one of the highest rates of dentally insured in the country. Employers take care of their employees here. But for those who can’t get dental insurance, the options are slim.
HT: Anything else?
SR: The only other risk for Minnesota is the policy option of turning Medicaid into a block grant from the federal government to the state. That would mean your state is locked into the amount you had in 2016. Then the states start having to make choices on where to spend the money, such as mental health or addiction.
If it goes to block grants, then every state is going to have a discussion about priorities and dental might lose.