Op-ed: Equity Requires Retaining Dental Coverage

Policymakers in Olympia confronting the financial damage caused by COVID-19 have some difficult decisions to make. The state’s Economic and Revenue Forecast Council estimates there is going to be a substantial budget shortfall for the current biennium and for the 2021-23 biennium as well. Significant budget choices are inevitable.

Yet, it would be a huge mistake to cut essential health care safety net programs for people who are the most vulnerable and are already experiencing health inequities.



In Washington, our safety net includes Apple Health (Medicaid), which provides health and dental coverage for lower-income families. It also includes Community Health Centers and other nonprofit and tribal dental clinics that are often the only option for health and dental care, especially in rural areas.

A fundamental focus of public policy should always be social justice and health equity, not just in a time of heightened public awareness.

Cutting safety net programs is shortsighted because it costs more in the long run. It is terrible public policy that devastates those with low incomes and communities of color who are most disadvantaged, and who have been hit hardest both financially and health-wise by COVID-19.

Unfortunately, history shows that dental care for at-risk populations can end up on the chopping block.

US census data shows that a higher percentage of Black, Indigenous and other People of Color have incomes below the poverty level.  Surveys of Washington residents indicate oral health problems are more common among communities of color and people with lower incomes. If the dental program is cut, the damage will have a disproportionate impact on these vulnerable populations.

In 2011 the state eliminated the Medicaid adult dental program. By the time it was restored in 2014, patients faced a significant accumulation of severe, expensive problems, including long-term pain, broken teeth, abscesses, unneeded extractions, and gum disease.

Policymakers need to remember: oral health is essential to overall health.

Gum disease is linked to heart disease, diabetes and respiratory illnesses — all major risk factors for COVID-19.  Oral disease also is linked to stroke and pregnancy complications. The health of your mouth affects the ability to get and keep a job. Mothers and primary caregivers can pass oral health problems onto their babies.

When people don’t have access to regular dental care, all too often they turn to crowded emergency rooms for care that is far more expensive, does not treat the underlying problem, and generally focuses on treatment of pain, often with opioids.

The state’s Community Health Centers (CHCs), Tribal/Urban Indian dental clinics and non-profit dental clinics, which provide free, sliding fee and Medicaid reimbursed dental care to hundreds of thousands of at-risk people in the state, are already reeling from COVID-19 impacts.

They rely on revenues from dental care to help sustain their operations.  All dental providers were required in March to stop non-emergency care due to COVID-19, and all dental providers, whether in private practice, in community health centers or other settings, are still dealing with the impacts of the closures, resulting in patient backlogs and the needed changes to their practices to make sure they protect their patients and staff.

Simultaneously, the need for care will only increase.  Rising unemployment means that more Washington residents are becoming eligible for Apple Health. Medicaid enrollees need and deserve access to dental care in their local communities. Community health centers, which are essential safety net providers, simply do not have the capacity to meet the full need. Private practice providers likewise play a critical role in the Medicaid dental delivery system.

Prevention and early treatment save money. Dental problems that fester become more damaging, costly and dangerous. Research has found that providing dental treatment to people with diabetes reduces their medical costs on average $3,200 per year and reduces hospitalizations by 61% in the first year of treatment.

Cutting the Medicaid adult dental program simply does not pencil out for the state. It would undermine the state’s recent $17.85 million capital investment for dental clinics to address a dental access crisis for low-income patients. Washington would lose a federal match that pays for more than 70% of total adult dental program costs. And as we aim for economic recovery, untreated dental needs are a barrier to seeking and retaining employment.

Sound fiscal policy, health equity and social justice all demand that we preserve our dental care safety net.

Vanetta Abdellatif is President and CEO of Arcora Foundation, the foundation of Delta Dental of Washington.  Carmen Méndez is a former Yakima City Council member and an Arcora Foundation Board member.  Arcora Foundation is focused on improving oral health for all, with no one left behind and recently provided more than $4 million in grants to support Community Health Centers, non-profit and Tribal clinics.