How the Affordable Care Act Will Affect Dentists

An Expert Interview With C. Scott Litch, MA, JD, CAE

Laird Harrison

June 05, 2012

June 5, 2012 (San Diego, California) — Editor's note: The Patient Protection and Affordable Care Act, passed on March 26, 2010, touches nearly every aspect of the American healthcare system, including dentistry.

A presentation on how the Affordable Care Act will affect pediatric dental care was featured here at the American Academy of Pediatric Dentistry (AAPD) 65th Annual Session. Medscape Medical News interviewed copresenter C. Scott Litch, MA, JD, CAE, chief operating officer and general counsel for the AAPD.

Medscape: Assuming it is not struck down by the Supreme Court, what is likely to be the biggest impact of the Affordable Care Act on dentists?

Litch: There will be more children seeking care with coverage they obtained through the new insurance exchanges. Also, more families are now eligible for Medicaid. That may put more strain on a system that does not currently work well for patients and dentists in many states. There are a lot of uncertainties.

For some dentists it may be a minor change, for other dentists it may be a major change, depending on where you're practicing and what coverage your patients have now.

Medscape: How many children will gain coverage through this law?

Litch: Theoretically, under the Affordable Care Act, eventually every child should be covered. According to an analysis by the Agency for Healthcare Research and Quality, about 18% of American children had no dental insurance coverage in 2006; at that time, there were around 74 million children in the United States. That would come out to about 13 million children without dental insurance at that time.

Medscape: How would the Affordable Care Act achieve coverage for all these children?

Litch: Some may be eligible under Medicaid. Others may qualify for the Children's Health Insurance Program (CHIP), an existing federal program that provides funds for dental coverage for children who are from low-income families but don't qualify for Medicaid. Others will receive coverage because employers will be required to offer it or because their families are required to buy it. There will be tax credits for families that can't afford health insurance and are not eligible for Medicaid, on a sliding scale. The Act lists dental coverage for children among the essential benefits that health plans must include to comply with the law.

Medscape: So all health plans will have to include dental coverage for children?

Litch: Not right away. Some of the requirements of the Act don't apply to existing insurance plans. These are grandfathered under the law. It's not clear how many. There will be more federal guidelines after initial experiences in 2014 and 2015.

Medscape: What standards would the dental benefit plans have to meet?

Litch: The Act appears to prohibit lifetime or annual caps on coverage. That's a significant change. Beyond that, we are trying to figure out the details. The US Department of Health and Human Services hasn't been very specific on dental benefit standards outside of consumer protections. Our understanding is that if a benchmark plan chosen by a state doesn't have a dental benefit, states can look to CHIP or the federal employees dental and vision plan to fill the gap. We remain concerned that without more specificity, children might end up with a limited benefit. The federal employees plans have different levels of coverage. We have determined that federal employees prefer separate dental and vision plans because the dental coverage is better; under the medical plan they have very limited coverage.

Medscape: How would the new insurance exchanges work?

Litch: Essentially, they are intended to make it easier for people to purchase coverage and allow comparison of the cost of the coverage. Only 2 states have much experience with them so far — Massachusetts and Utah. Large employers are not getting coverage through the exchanges. Right now it's small groups.

Medscape: Has the AAPD been able to influence these regulations?

Litch: We responded to a request for comments and, jointly with the American Dental Association, provided extensive background information to agency officials concerning dental insurance coverage for children. We are also advising our chapters what to ask for in individual states.

The AAPD thinks dental plans should be comprehensive and not just bare bones. We have a model dental benefits recommendation, which is available on the AAPD Web site.

One of our concerns is that the plans have flexibility for kids who need more care, such as children with special healthcare needs. We also want to make sure they promote children seeing the dentist by age 1 and establishing a dental home. Our policy center has produced technical briefs concerning dental disease risk assessments for children, and the need for some children to receive dental treatment under general anesthesia. Overall, if the plans wind up looking like current plans that are comprehensive and families are satisfied, we will be happy.

Medscape: What will the effects be for Medicaid?

Litch: We think Congress missed an opportunity with dental Medicaid. Ideally, we would like to get to a situation where it's just as easy for a family to find a provider whether they are in Medicaid, CHIP, or a private plan. That's not the situation right now. There are not enough providers who accept Medicaid, although our surveys indicate that 70% of pediatric dentists do so. If there were some kind of federal incentive for improved reimbursements and reduced administrative burdens, that would help. We would support that if Congress considers adjustments to the Affordable Care Act.

Litch has disclosed no relevant financial relationships.

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