Sample Healthcare Paper on Letter to Congress Representative, Andy Harris

Purpose

The purpose of this letter is to uncover an alarming trend in the United States (U.S.) dental health-care system which has affected the majority of the population. The bottom line is that while healthy teeth are vital for the overall health in the U.S., insurers and third-party payers have not yet considered the priority of dental insurance. According to the U.S. Department of Health Services, there are approximately 108 million Americans who do not have dental insurance. The idea behind the ACA was to keep Americans healthy by addressing minor health issues before the health conditions turned out to be deadly. As such, the emphasis was on preventive medicine. Consequently, the value of oral health was neglected as there was no provision in the ACA to tame dental health issues, especially among the adults. Conversely, the U.S. Centers for Disease Control and Prevention (CDC) found out that at least a quarter of Americans aged 65 years and above had lost their teeth. Additionally, CDC notes that a third of the population had untreated decay, thus establishing that poor dental health is associated with increased risk of developing heart problems. It is particularly alarming that Medicare and other federal programs intended to keep Americans healthy have never provided insurance for teeth cleanings, fillings, and exams. Dental care is more devastating to low-income earners who leave their teeth to decay because they cannot afford to pay for dental care services.

Context

A majority of American citizens are struggling to access the basic dental care because of cost implications. Dental care is becoming unbearable because most citizens do not have dental care insurance; hence, they have to pay out of their pockets or leave their teeth to deteriorate. Notably, CDC reported that in 2018, more than a third of Americans did not see a dental professional as a result of cost implications. While a simple check-up costs approximately $100, fillings cost approximately $300 (Kranz & Dick, 2019). Notably, crowns are more expensive at a cost of more than $1000  (Kranz & Dick, 2019). The problem is further aggravated by the surging dental costs because the CDC studies indicate that 67 percent of Americans who lack dental benefits are likely to have heart diseases, osteoporisis diabetes, or pharyngeal cancer (Kranz & Dick, 2019). As a result, the CDC estimates that approximately 8000 people die of pharyngeal cancers yearly, with most of them being the elderly with underlying dental issues.

Presentation of Facts Under Consideration

Affordable Care Act for Children Versus Adults

Under the ACA, dental coverage is defined as an “essential benefit” for children. Hence, insurers must provide dental coverage for persons under the age of 18 years (Kranz & Dick, 2019). The coverage can either be part of a health plan or it can be separate. The ACA also requires insurers, such as Medicaid, which provides insurance to low-income earners, to offer dental benefits to persons aged below 18 years. However, Medicaid programs vary from one state to another, and the insurer does not provide adult dental services in most states (Shi & Singh, 2019). Lack of provision for dental services in some states is against the acceptable health care delivery system which requires all citizens to obtain needed health care services (Shi & Singh, 2019). Thus, according to the ACA, dental care is “essential for children but not the rest” (Kranz & Dick, 2019). Therefore, there is need for re-evaluating the ACA so that adults can also benefit from it.

Dental Issues and Other Dental-Related Health Complications

Undervaluing and isolating dental health can have far-reaching effects . Previous studies establish a close connection between heart disease and periodontal disease (Kranz & Dick, 2019). A research conducted by American Heart Association (AHA) found out that individuals prolonged dental issues increased the risk of heart complications. Although AHA continuously conduct further research to expand their findings, there is need to address dental health issues, especially among the elderly. In a separate study, AHA established that gum disease appears to worsen blood pressure, which, in turn, affects hypertension treatmentKranz & Dick, 2019) Thus, with mounting evidence that dental health complications can affect other parts of the body, there exists a need for policy makers and insurers to consider improving on the existing system to address the underlying challenge.

Dental Health and Cost

Most of the population in the low-income category cannot afford to pay for dental services. In fact, 32 per cent of adults in the United States are likely to skip dental care check-ups because of cost (Shi & Singh, 2019). Since the Affordable Care Act does not require adults to have dental insurance, it is difficult for an adult to access dental care at a fare price in the US. Thus, dental issues such as tooth decay may turn out to be critical as most of the low-income individuals may avoid booking an appointment with a dentist for fear of unbearable costs . The financial burden faced by Americans seeking for dental care services is an indicator that necessitates re-viewing dental care needs and the underlying cost. This way, most Americans would be able to access dental care services without worrying about the financial implications.

Recommendations

To minimize financial burdens in the U.S. dental care system, especially for adults, several policy options can be considered. The options can be divided into two categories: expansion of dental insurance coverage and redesigning the ACA to provide financial protection for everyone.

Expanding Dental Insurance Coverage

Expansion of dental insurance coverage will require a shift of both state and federal policies with regard to adult dental care provision. The most effective way to expand the dental insurance coverage is defining dental care for adults as an essential benefit within the Affordable Care Act. Consequently, dental care will become a required benefit in Medicaid, and therefore, it will be mandatory for Medicare to incorporate dental coverage. A recent study by CDC found out that the implementation of a comprehensive dental benefit plan for Medicaid adults would cost approximately $1.6 billion each year (Kranz & Dick, 2019). The Medicaid plan will only be needed in the twenty two states that currently lack dental coverage for adults.

Redesigning the Affordable Care Act

Apart from expansion of the ACA, there exists a need to reexamine dental insurance both in the private and public sectors. Dental benefit plans ought to be re-evaluated to cover a beneficiary’s oral health and well-being instead of only offering checklists and enforcing tooth-by-tooth restrictions (Gruber & Sommers, 2019). Additionally, the arbitrary dollar limit for dental care coverage should be eliminated so that beneficiaries can have access to a wide range of dental services. As such, the existing dental design for children is a reliable blue-print for redesigning the Affordable Care Act. Thus, redesigning of the ACA is a commendable starting point to prevent a health crisis.

Summary

Indeed, it is alarming that dental health care crisis among the adult population is a growing concern in the United States. The Affordable Care Act, which was signed into law by president Barrack Obama, did not adequately cover dental care among adults. As a result, surging costs are evident in dental care. Notably, a majority of the low-income population cannot afford to pay for dental services because they do not have dental coverage. Most of the essential dental care services such as teeth cleanings, fillings, and exams are expensive and this is a major set-back to the US health system. Further, previous studies indicate that poor dental care increases the risk of worsening other health conditions such as heart disease. As a result, the overall health of Americans may worsen if the status quo remains. To mitigate the escalating dental care issues, there is need to expand and redesign the Affordable Care Act to suit the emerging trend. As such, dental care for adults should be treated as an essential benefit in the Affordable Care Act to address the high costs of accessing dental care in the United States. Similarly, the ACA should be re-evaluated to cover the overall oral health and well-being of beneficiaries rather than just offering checklists. This way, Americans will benefit from the wide range of dental services that could be offered in each state.

 

 

References

Gruber, J., & Sommers, B. D. (December 07, 2019). THE AFFORDABLE CARE ACT’S EFFECTS ON PATIENTS, PROVIDERS, AND THE ECONOMY: WHAT WE’VE LEARNED SO FAR. Journal of Policy Analysis and Management, 38, 4, 1028-1052.

Kranz, A. M., & Dick, A. W. (April 01, 2019). Changes in dental coverage and visits following the implementation of the affordable care act. Health Services Research, 54, 2, 437-445.

Shi, L., & Singh, D. A. (2019). Delivering health care in America: A systems approach.