William Stork needs a tooth out. That’s what the 71-year-old retired truck driver’s dentist told him during a recent checkup.
That kind of extraction requires an oral surgeon, which could cost him around $1,000 because, like most seniors, Stork does not have dental insurance, and Medicare won’t cover his dental bills. Between Social Security and his pension from the Teamsters union, Stork said, he lives comfortably in Cedar Hill, Missouri, about 30 miles southwest of St. Louis. But that cost is significant enough that he’s decided to wait until the tooth absolutely must come out.
Stork’s predicament is at the heart of a long-simmering rift within the dental profession that has reemerged as a battle over how to add dental coverage to Medicare, the public insurance program for people 65 and older — if a benefit can pass at all.
Health equity advocates see President Joe Biden’s Build Back Better agenda as a once-in-a-generation opportunity to provide dental coverage to those on Medicare, nearly half of whom did not visit a dentist in 2018, well before the pandemic paused dental appointments for many. The rates were even higher for Black (68%), Hispanic (61%) and low-income (73%) seniors.
The coverage was left out of a new framework announced by President Joe Biden on Thursday, but proponents still hope they can get the coverage in a final agreement. Complicating their push is a debate over how many of the nation’s more than 60 million Medicare beneficiaries should receive it.
Champions for covering everyone on Medicare find themselves up against an unlikely adversary: the American Dental Association, which is backing an alternative plan to give dental benefits only to low-income Medicare recipients.
Medicare has excluded dental (and vision and hearing) coverage since its inception in 1965. That exclusion was by design: The dental profession has long fought to keep itself separate from the traditional medical system.
More recently, however, dentists have stressed the link between oral and overall health. Most infamously, the 2007 death of a 12-year-old boy that might have been prevented by an $80 tooth extraction prompted changes to Maryland’s version of Medicaid, the federal-state public insurance program for low-income people. But researchers have also, for example, linked dental care with reduced health care spending in patients with Type 2 diabetes. When the World Health Organization suggested delaying non-urgent oral health visits last year to prevent the spread of covid-19, the American Dental Association pushed back, with then-President Dr. Chad Gehani saying, “Oral health is integral to overall health. Dentistry is essential health care.”
The ADA-backed Medicare proposal would cover only seniors who earn up to three times the poverty level. That currently translates to $38,640 a year for an individual, reducing the number of potential recipients from over 60 million people to roughly half that number. Medicare has never required means testing, but in a world where Congress is looking to trim the social-spending package from $3.5 trillion over 10 years to $1.85 trillion, the ADA presents