You can work full time but not have the money to fix your teeth – visible reminders of the divide between rich and poor

As the distance between rich and poor grows in the United States, few consequences are so overlooked as the humiliating divide in dental care. High-end cosmetic dentistry is soaring, and better-off Americans spend well over $1 billion each year just to make their teeth a few shades whiter.

Millions of others rely on charity clinics and hospital emergency rooms to treat painful and neglected teeth. Unable to afford expensive root canals and crowns, many simply have them pulled. Nearly 1 in 5 Americans older than 65 do not have a single real tooth left.

Teeth generally are treated separately from the rest of the body, a tradition that dates to dentistry’s origins as a specialty of barbers, who performed oral surgery and pulled teeth. Today, many public health officials view that division as a mistake. Poor oral health can lead to heart disease and other serious medical problems, and tooth loss can lead to depression and difficulty eating and speaking.

 The separation extends to insurance. Even Medicare, the federal health program that covers 55 million seniors and disabled people, does not cover dental problems. For that, people must buy dental insurance, which typically limits annual benefits to about $1,500 per person — an amount that has barely budged in decades, even as costs have risen.The price of employer-provided plans varies greatly, and can cost a family $500 a year or more, industry experts said. For those whose jobs don’t offer dental benefits, it can be even more expensive. So tens of millions go without: More than a third of American adults have no dental coverage, according to the ADA’s Health Policy Institute.

Children’s coverage has been improving. All states are required to provide dental benefits to children on Medicaid and the Children’s Health Insurance Program. Obama’s Affordable Care Act currently requires medical plans to offer dental care to those younger than 19. But that requirement – and the dental benefits of 5 million adults newly covered under the ACA – are jeopardized by the Trump-backed health overhaul now being debated in Congress.

Adults who are poor enough, and live in certain states, can get coverage through Medicaid, the state-federal health program for low-income Americans. But only about 38 percent of dentists accept Medicaid — about half the rate of physicians — in part because of low reimbursement rates. On average, Medicaid covers about 37 percent of the bill, according to a recent ADA analysis. Dentists who don’t accept Medicaid also complain of bureaucratic hassle and high rates of canceled appointments.

In a handful of states, Medicaid offers no dental coverage for adults.

Mission of Mercy Missouri offers a free dental clinc held June 9-10, 2017 at the Leggett & Platt Athletic Center on the campus of Missouri Southern State University in Joplin, Mo. joplin_std


(Excerpted from Washington Post 5/13/17)