(This story has been updated to add new information.)
Courtney Sands couldn’t escape the throbbing pain in the back of her mouth: The Pennsylvania mom needed root canal treatment and crowns on two back teeth to get rid of the infection that was causing the pain.
But a visit to an endodontist this spring produced a different kind of pain familiar to many dental patients: Before the specialist could begin filing away at the tooth, the office staff asked the patient for thousands of dollars in advance.
Sands returned to the hospital a week later to get crowns on two back teeth. Though she had dental insurance through her job and her husband, she had to pay before getting treatment, so she ended up paying more than $6,000 on her high-interest credit cards.
Dental insurance plans ultimately reimbursed her for only a small portion of what she paid to treat her oral health emergency: One dental insurer paid her $1,000, another paid $395.
Sands might be considered one of the lucky Americans when it comes to dental care: More than half of U.S. adults don’t have access to regular dental care, and untreated problems like oral infections can negatively impact their overall health. Despite the barriers many face to accessing routine care, dental coverage has little support among political leaders.
Vice President Kamala Harris and former President Donald Trump have been locked in fierce sparring over abortion and lowering insulin prices, but one health-related topic neither candidate has emphasized is how to provide dental care to the tens of millions of uninsured Americans.
After all, covering oral care is a popular stance: An overwhelming majority of voters want their leaders to shore up the nation’s flawed dental health system.
About 9 in 10 voters support adding dental benefits to Medicare, according to a poll of 1,000 registered voters commissioned this summer by the CareQuest Oral Health Institute and the Oral Health Advancement Equity Network, nonprofits that focus on access and equity. The issue has near-universal support among Democrats and 85% of Republicans.
Neither Ms. Harris nor Mr. Trump has mentioned expanding dental coverage in their policy platforms or major speeches. Priorities for both candidates in the Sept. 10 debate included grocery prices and the future of Obamacare, but neither has consistently championed dental care or oral health.
The need is undeniable: About 69 million U.S. adults lacked dental insurance and lacked access to regular oral care last year, according to CareQuest, and millions more lost their dental coverage last year when states began cutting off Medicaid coverage to people who had signed up during the COVID-19 pandemic.
Medicare, the federal health insurance program that primarily covers adults over 65, doesn’t offer coverage for routine dental care, and as of 2018, nearly half of people enrolled in Medicare hadn’t visited a dentist in more than a year, according to an analysis by KFF, a nonprofit health policy group.
“Too many people in this country find oral health care too expensive and out of reach,” said Melissa Burrows, public policy director at CareQuest, “and yet this issue has really been pushed to the back burner in policy conversations and political efforts to solve it.”
More important than abortion?
An online poll by CareQuest asked voters to rank the nine health issues they found most important: adding dental coverage to Medicare was rated the second most important issue, behind lowering prescription drug costs.
Voters prioritized Medicare dental benefits over topics frequently raised by Democratic and Republican presidential candidates, such as abortion rights and the future of Obamacare. Voters also prioritized dental benefits over access to mental health services, the cost of insulin, health care transparency, the opioid crisis, and changes to Medicare eligibility.
“This is one of the most popular things in health care, according to voters, and we can’t continue to let this fade into the background,” Burrows said.
Consumers who enroll in private Medicare Advantage plans typically have the option to choose a plan that covers dental, hearing, and vision care, but terms and coverage vary by plan and vendor. Seniors who enroll in traditional government-run Medicare can enroll in dental insurance. Still, according to KFF, nearly half of Medicare enrollees did not have dental insurance as of 2019.
The 2024 Democratic platform calls for adding dental, vision and hearing coverage to Medicare, but doesn’t detail how those benefits would be paid for other than to “make the wealthy and big corporations pay their fair share.”
The Republican plan makes no mention of dental care or oral health.
CareQuest said additional polling found broad support for adding dental benefits to Medicare among voters in the three states of interest: More than 90 percent of voters in Michigan, Ohio and Pennsylvania supported adding dental benefits to Medicare.
That’s not surprising for Sands, who lives in Factoryville, Pennsylvania, northwest of Scranton. She works as a nurse and her husband has steady employment. But the out-of-pocket expenses for her dental emergency have left her with less cash to buy materials to continue her DIY home improvements. She said she’s prioritizing paying off her credit card balances.
Congress could tackle dental care reform
While dental care has not been a topic of the party’s election platform, the Biden administration and lawmakers have proposed ways to close the dental care gap.
The administration finalized rules earlier this year to give states the option to add adult dental coverage as part of their ACA plans. Although the 2010 health insurance law did not cover dental coverage for adults, states were required to offer pediatric dental care as an essential health benefit in ACA plans.
Two related bills in Congress would expand dental insurance through Medicare, Medicaid and the Veterans Administration, and increase the number of dentists, dental hygienists and dental therapists nationwide. Vermont Independent Sen. Bernie Sanders introduced the Comprehensive Dental Reform Act of 2024 in the Senate in May. On Tuesday, Michigan Democrat Sen. Debbie Dingell introduced an amendment to the bill in the House of Representatives.
Neither bill is scheduled for a vote, and the Congressional Budget Office has not estimated how much the bills would cost.
Dingell said too many people avoid the dentist because they’re afraid of the bill.
“Lack of dental care can worsen other serious medical conditions, but without adequate insurance coverage, millions of Americans don’t get the critical oral care they need,” she said when introducing the bill last week.
Groups representing dentists say they support efforts to expand Medicare dental coverage.
In a statement to USA Today, the American Dental Association said it supports comprehensive dental benefits for low-income adults and seniors. The association also supports legislation to provide adult dental insurance to Medicaid recipients and reauthorize grant programs to help dentists practice in underserved areas, including rural communities.
“Comprehensive dental coverage means low-income seniors can have a full range of affordable dental services they need to maintain healthy mouths that allow them to eat and sleep comfortably, free from chronic pain,” the ADA said.
Sands, who lives in Pennsylvania, knows how important dental care is to overall health, and she’s grateful she was able to get financing to go to the dentist. Others in her community aren’t as fortunate.
“I know people who have been in pain for years and haven’t gone to the dentist,” Sands says. “I’ve seen people with swollen gums and pus coming out of their mouths, and there’s nothing they can do.”
Have you ever struggled to get dental care because of cost or lack of health insurance? Tell consumer health reporter Ken Alltucker at alltuck@usatoday.com about your experience.
