Understanding the Comprehensive Dental Reform Act of 2024
What is the Comprehensive Dental Reform Act of 2024?
The senate Committee on Health, Education, Labor, and Pensions (HELP) held a hearing on the status dental care in the United States. During that hearing, Senator Bernie Sanders (I- Vermont) announced his intent to file a bill entitled the Comprehensive Dental Reform Act of 2024 (COD2024). The bill does not yet have a number, and no action on the bill has been logged in congress.gov’s legislation tracking tool. Still, Senator Sanders’ recent hearing received some notable attention.
COD2024 targets 5 main areas: coverage, access points, workforce development, education, and research. Bill provisions include proposals to:
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Extend dental insurance coverage to all Medicaid, Medicare, and VA beneficiaries
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Make dental services an essential benefit under the Affordable Care Act (ACA)
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Allow states meeting participation and utilization requirements to receive enhanced Medicaid matching funds for dental services
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Require public reporting of states’ dental benefits and utilization
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Authorize, or increase, federal funding for programs that promote access, dental workforce development, education, and oral health research.
How does this affect dental care in Georgia?
At the moment, COD2024 has a long legislative road ahead of it, and bills of this kind rarely become law. Senator Sanders has a long history of introducing comprehensive dental bills, and none have passed. He proposed Comprehensive Dental Reform Acts with varying provisions in 2012, 2013, and 2015. Each one was read and referred, either to the Committee on Finance or to HELP, with no further action taken. Given the broad nature of COD2024’s provisions, as well as their likely cost, the bill is extremely unlikely to pass without strong bipartisan support in today’s Congress, and were it to pass, it would almost certainly only pass with amendment. Should COD2024 continue to move through Congress, we will publish further updates.
If it were to pass, predictions about the bill’s effects, and even its final form, would be highly speculative. Changes to insurance coverage provisions could enable people to better access dental care if they meaningfully reduce out-of-pocket costs. One would expect an increase in demand for dental services to follow. However, many low-income people already have some dental insurance coverage. At present, there is a patchwork of coverage available through Medicare, thanks to Medicare Advantage plans that offer it, and adult dental coverage under Medicaid is at each state’s discretion.
Requiring coverage as an essential benefit under the ACA may expand coverage, but it could also change the structure of available plans. Currently, dental plans are excluded from the ACA’s cost sharing protections, including maximum annual limits on out-of-pocket cost sharing. Many dental plans offered through the exchanges are embedded in health insurance plans, and beneficiaries may have to pay thousands of dollars prior to receiving any benefits from their plans.
The most noticeable effects would be dependent on insurance design.
Regardless of whether the discussion is about public or private insurance, it would be COD2024’s influence on the structure of insurance plan design that would have the most noticeable impact on utilization and fees. KFF’s Survey of Consumer Experiences with Health Insurance found that people tend to report delaying or avoiding dental care if out-of-pocket costs are too high, and 37% of marketplace enrollees reported delaying or forgoing dental care. Expanding coverage with plans that fail to sufficiently curb out-of-pocket spending, particularly for preventative services, would be unlikely to increase utilization.
Meanwhile, expanding Medicaid coverage does not guarantee a concurrent rise in reimbursement rates that would effectively incentivize dentists to participate. In 2021, a national review of Medicaid provider participation found that 81% of Georgia dentists treat no Medicaid patients. Low Medicaid reimbursement rates are a well-known cliché, and the American Dental Association’s Health Policy Institute found that Medicaid reimbursement rates in states providing extensive coverage in 2022 ranged from 13% to 61% of fees charged. Most states providing any Medicaid dental coverage reimbursed less than half of fees charged. Without clear and consistent plan design that minimizes out-of-pocket costs and allows for sufficient provider reimbursement, low-income people will likely continue to delay care, or face difficulty finding a provider when they do seek it. COD2024’s proposed enhanced matching funds incentivize, but do not guarantee, states to raise their reimbursement rates.
