POSITION STATEMENT ON HEALTH CARE REFORM THE NATIONAL ASSOCIATION OF DENTAL PLANS (NADP) is the nation s largest association of companies providing dental benefits. NADP members cover 136 million Americans over 80 percent of the dental benefits market through dental HMOs, dental PPOs, discount dental plans and dental indemnity products. NADP strongly believes that all Americans should have access to affordable, quality dental care. NADP is committed to working with federal and state policymakers to develop solutions for the dentally uninsured that reflect the differences in the dental and medical care delivery systems so that access to affordable, quality dental care is expanded. NADP PRINCIPLES FOR EXPANDING ACCESS TO DENTAL HEALTH BENEFITS As the leading representative of the dental benefits industry, NADP offers the following core principles that should be incorporated into any health care reform policy proposal: Oral Health is Vital to Overall Health. Oral health is an integral part of overall health, and efforts to improve access to medical benefits must include dental benefits. Cost is a Key Barrier to Dental Care. Concerns about the cost of dental procedures keep Americans from the dental office. Consumers report that the main reason they do not visit a dentist is lack of insurance coverage. Dental Benefits are Key to Expanding Access to Affordable, Quality Dental Care. Expertly managed dental plans reflect the differences between dental and medical care delivery and build on this expertise to offer benefits that promote oral health, maintain affordability through the development of dental networks and support high quality, low cost dental care. Employers Play a Critical Role in Providing Access to Dental Benefits. Employees value their dental benefit options, which are offered on a discretionary basis by employers. Proposals to expand access to health care should preserve these choices. The proposals also should expand employers capacity to sponsor dental benefits and employees ability to purchase employer sponsored dental coverage for themselves and their families, including: Maintaining employer and employee tax preferences for the purchase of dental benefits; and Allowing individuals and families who are eligible for public programs and public program expansions to use these subsidies to purchase comparable employer sponsored dental coverage (e.g., premium assistance programs). Dental Plans Help Government Programs Work for Beneficiaries. Dental plans experience and expertise in ensuring access to appropriate and affordable care make dental plans excellent business partners for government purchasers seeking to increase access to oral health care.
NATIONAL ASSOCIATION OF DENTAL PLANS POSITION STATEMENT ON HEALTH CARE REFORM NADP looks forward to working with policymakers to expand access to dental benefits in a way that is consistent with NADP s principles principles that value oral health and the role of the dental benefits industry in improving access to affordable, quality dental care. The dental benefits community works with employers, public programs and individuals across America to provide affordable, quality dental plan options. ABOUT NADP AND THE DENTAL BENEFITS MARKET NADP is the Voice of the Dental Benefits Industry. NADP represents over 75 dental benefits companies that provide dental benefits to 136 million Americans more than 80 percent of all Americans with dental coverage today. Member dental plans operate in all 50 states, the District of Columbia and Puerto Rico. Dental Benefits are Designed to Meet the Needs of Consumers, Employers and Government Programs. Dental benefits are offered through a variety of products including stand alone dental plans and integrated medical/dental plans. This range of offerings meets the diverse needs of individuals, large and small employers, and government programs such as Medicaid, Medicare Advantage, the Federal Employees Health Benefits Plan and the State Children s Health Insurance Program. Dental is Different: The organization and delivery of dental care differs from the medical care model. Dental disease is largely preventable. It is limited to well established conditions tooth decay and gum disease that rarely require hospitalization. As a result, 85 percent of dental care is provided in a primary care setting by general dentists, which is markedly different from the medical care model. The provider systems also are dissimilar. Almost 80 percent of dentists are in solo practice, compared to less than 10 percent of physicians. Given the distinct nature of dental care and delivery, effectively organizing dental networks requires an expertise that differs from medical plan management. Dental Benefits Work. Dental benefit plans understanding of the dental marketplace allows plans to develop prevention oriented programs such as creating financial incentives to encourage regular office visits, fluoride treatments, cleanings and dental sealants for children. Dental plans build comprehensive networks of dentists, negotiate fee discounts, develop educational information and offer administrative efficiency by managing claims and networks in a cost effective manner. As a consequence, dental premiums remain affordable and are growing more slowly than medical premiums. VALUING ORAL HEALTH: GOOD ORAL HEALTH SUPPORTS GOOD OVERALL HEALTH The National Institutes of Health (NIH) reports that oral health and overall health are inextricably connected, noting that oral diseases affect the most basic human needs, including the ability to eat and drink, swallow, maintain proper nutrition and communicate. Adopted: May 2008 2
Many serious medical conditions have oral manifestations, such as diabetes, human immunodeficiency virus (HIV/AIDS) and osteoporosis. In fact, the clinical literature increasingly highlights linkages between periodontal diseases and life threatening medical conditions, including low birth weight babies, diabetes, cardiovascular disease and pulmonary disease. The U.S. Surgeon General reports that the burden of oral diseases and conditions in the United States is extensive and affects people throughout their lives. As the U.S. Department of Health and Human Services notes, this burden falls hardest on those persons who have the least access to prevention and treatment. The burden of oral disease impacts all age groups: Dental caries (tooth decay) are the single most common chronic childhood disease five times more common than asthma. Tooth decay among 2 to 5 year olds is on the rise. It increased from 24 percent of children in the Centers for Disease Control and Prevention (CDC) 1988 1994 survey to 28 percent in the 1999 2004 survey. Over 40 percent of poor adults (20 years and older) have at least one untreated decayed tooth compared to 16 percent of non poor adults. Most adults show signs of gum disease. Severe periodontal disease 1 affects about 14 percent of adults 45 to 54 years old. CDC data show that approximately 24 percent of Americans over the age of 60 have lost all of their natural teeth, a condition called edentulism that can result in limitations in chewing, avoidance of social contacts and difficulty speaking. ACCESS TO DENTAL COVERAGE: THE ROLE OF DENTAL INSURANCE IN ORAL HEALTH As the seminal U.S. Surgeon General s report Oral Health in America emphasized, dental insurance plays an important role in promoting oral health. The Centers for Medicare and Medicaid Services notes that oral diseases are progressive and cumulative and, if left untreated, become more complex and difficult to manage over time. Dental insurance is a major determinant of whether people receive dental care to address their oral health needs. NADP s 2007 Consumer Survey found that individuals without dental coverage are 2.5 times less likely to visit a dentist than those with insurance. Dental coverage has helped support marked improvements in the nation s oral health. In 1970, about five percent of total dental expenditures were paid for by private insurance. By 2005, 43 percent of dental expenditures were paid by private insurance. 1 Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth and, left untreated, can cause tooth loss. Adopted: May 2008 3
Children from families without dental insurance are three times more likely to have unmet dental needs than children with insurance. While millions of Americans have dental coverage through employers and public programs, approximately 35 percent of the population had no dental coverage in 2004. The federal Agency for Health Care Research and Quality estimates that approximately 158 million people had private dental coverage during 2004. About 12 percent of the population had dental coverage through public programs such as Medicaid in 2004. Nonetheless, the Surgeon General notes that state Medicaid programs have been unable to guarantee access to dental care for a variety of reasons, including limited funding. The 2007 NADP/DDPA Joint Dental Benefits Report: Enrollment reported that dental carriers administered public and private dental coverage to 170 million of the population in 2006. Medicare does not cover routine dental care and, as a result, many elderly individuals lose their dental insurance when they retire. DENTAL PLANS ARE PART OF THE HEALTH CARE SOLUTION Health care reform efforts should recognize that oral health is essential to overall health. Access to dental care must be considered in any health care coverage expansion proposal. Dental plans have successfully partnered with individuals, employers and government programs to offer dental benefits that are cost effective and highly valued by consumers. Reform efforts should build on these successes to expand access to affordable, quality dental coverage for all Americans. RESOURCES Annual Report Oral Health U.S., 2002. National Institutes of Health s National Institute of Dental and Craniofacial Research/Centers for Disease Control and Prevention Dental, Oral and Craniofacial Data Resource Center, U.S. Department of Health and Human Services. http://drc.hhs.gov/report/index.htm Beltrán Aguilar E, et al. Surveillance for Dental Caries, Dental Sealants, Tooth Retention, Edentulism, and Enamel Fluorosis United States, 1988 1994 and 1999 2002, Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention (CDC), August 26, 2005 / 54(03); 1 44. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5403a1.htm Dental Use, Expenses, Dental Coverage, and Changes, 1996 and 2004. Medical Expenditure Panel Survey, Chartbook No. 17. Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. 2007. http://www.meps.ahrq.gov/mepsweb/data_files/publications/cb17/cb17.pdf Dye BA, Tan S, Smith V, Lewis BG, Barker LK, Thornton Evans G, et al. Trends in oral health status: United States, 1988 1994 and 1999 2004. National Center for Health Statistics. Vital Health Stat 11(248). 2007. http://www.cdc.gov/nchs/data/series/sr_11/sr11_248.pdf Adopted: May 2008 4
Guide to Children s Dental Care in Medicaid. Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services. October 2004. http://www.cms.hhs.gov/medicaiddentalcoverage/downloads/dentalguide.pdf Healthy People 2010 Midcourse Review, Focus Area 21: Oral Health. U.S. Department of Health and Human Services. 2006. http://www.healthypeople.gov/data/midcourse/html/focusareas/fa21introduction.htm Oral Health in America: A Report of the Surgeon General. U.S. Department of Health and Human Services, 2000. http://silk.nih.gov/public/hck1ocv.@www.surgeon.fullrpt.pdf Strategic Plan 2003 2008. National Institutes of Health s National Dental and Craniofacial Research Institute (NIDCR). U.S. Department of Health and Human Services. http://www.nidcr.nih.gov/aboutnidcr/strategicplan/default.htm Fast Stats: Oral and Dental Health. Untreated dental caries by age, sex, race, and Hispanic origin, and poverty level, 1971 74, 1988 94, 1999 2002 United States: 2006, Table 75. National Center for Health Statistics, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. http://www.cdc.gov/nchs/data/hus/hus06.pdf#075 NADP Customer Satisfaction Benchmark Report, July 2005, Dallas, Texas. NADP/DDPA 2007 Dental Benefits Joint Report: Enrollment, August 2007, Dallas, Texas. Sommers, JP. Dental Expenditures in the 10 Largest States, 2005. Statistical Brief #195. January 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahcpr.gov/mepsweb//data_files/publications/st195/stat195.pdf V 04.08.08: The NADP Principles for Expanding Access to Dental Health Benefits is final, however the supporting document may be edited as additional oral health information becomes available. Adopted: May 2008 5