Adult dental care excluded from Vt exchange
By David Taube
VERMONT PRESS BUREAU | October 05,2012
Green Mountain Care Board members rejected a proposal Thursday to subsidize adult dental care coverage that could have cost the state tens of millions of dollars.
“If you had $36 million, would you start with my family with dental or would you start with the most vulnerable people in our society?” board member Al Gobeille said. “I think we agree on the problem. I think the question is, ‘How do we address the problem, and is this a good solution?’”
The measure initially would have affected some 118,000 people in 2014, but the board voted 3-2 against a midlevel tier of dental coverage.
Gobeille immediately read a prepared statement that the state will look into the issue, which the board approved.
Board members suggested adult dental coverage could be provided on a smaller scale.
Dr. Allan Ramsay, Gobeille and board Chairwoman Anya Rader Wallack cited financial concerns, among other reasons for voting against the proposal. Board members in favor were Dr. Karen Hein and Con Hogan.
The issue relates to the Vermont Health Benefit Exchange, a setup that will begin in 2014 and allow people to compare the costs of private insurance plans. The vote means adult dental coverage in the exchange will remain as it is typically covered: through supplemental plans.
The state had not recommended approving the measure in part due to costs. Projected expenses ranged from $17 million to $87 million, depending on how much coverage was provided. The measure would have given free coverage for certain dental procedures, such as two cleanings per year and crown replacements.
Under the federal Affordable Care Act, states can choose the plan that will serve as the benchmark for other private plans that want to participate in state exchanges. Vermont officials say that if a state adds benefits beyond essential coverage, states are faced with 100 percent of the costs.
For Vermont, that benchmark includes areas ranging from hospitalization to children’s dental coverage.
The board received some 1,700 comments regarding the essential benefits package for the Vermont Health Benefit Exchange. Most of the comments involved adult dental care, which is not covered under the state’s existing Catamount Health plan.
Donna Sutton Fay, policy director for a nonprofit group that seeks to make health care affordable, said the number of comments was unprecedented.
She said her organization, Vermont Campaign for Health Care Security Education Fund, was disappointed by the board’s vote Thursday. She said the measure could have been a step toward the state’s single-payer system.
Board members said the state is proceeding with steps toward single-payer. Ramsay said most of his colleagues think the state is moving too quickly but that once the state arrives there, people will say the change didn’t happen soon enough.
Hogan read a letter in favor of including adult dental coverage and said his father was a dentist in a poor area. He noted the board recently allowed the state’s 14 hospitals to increase their budgets by a combined $141 million, approximately, from the current fiscal year.
“We just approved $141 million for our hospitals, most of which was continuing to do things that (we’ve) already been doing,” Hogan said. “There was some investment in the future, but most of the money was spent on processes already in motion.”
He added, “I hate to say this publicly, but none of us can really say where Green Mountain Care’s going to come out. We all want it to happen. We’re all dedicated to try and make it happen. But there are a lot of major-league possible roadblocks. I look at this one as if you don’t do it now, it’s an opportunity that could be lost in the future.”
Hein compared the dental situation to health care benefits that are exempt from coverage.
“So many people emphasized that they just don’t understand (how) the mouth should be ‘carved out’ from the body,” Hein said at the meeting via conference call. “On a philosophical, moral, ... practical level, I see no reason to continue this disconnect between the mouth and the rest of the body.”
Board members stressed they weren’t creating an exemption for adult dental coverage. Board members said no one on the board was suggesting that oral health care was not important.
Instead, the board suggested the coverage could be narrowed so the most vulnerable people could be helped.
Board members also noted that due to the Affordable Care Act, some 30,000 or more Vermonters will become eligible for Medicaid, which would increase their dental coverage.
As a result of the approved motion to study the issue, the board’s executive director will deliver a project outline and cost estimate for a professional to analyze dental care issues, ranging from access to organization to financing.
The professional’s analysis will support future decisions by the board potentially to use state, federal or private funds to improve dental care access and insurance coverage.
The project outline and cost estimate are due before Nov. 15.