Along with the recent Supreme Court decision on federal health reform comes a challenge to all of us who care about improving the health of Americans, especially children. Can we make the dental care provisions work for children who -- for the first time in history -- are now entitled to dental care as part of their health coverage?
Last summer, the highly respected Institute of Medicine (IOM), whose reports have been called "the gold standard" for health policymakers, sent a wakeup call to state legislatures around the country. The IOM urged them to address an already pressing problem that is only expected to get worse: access to dental care.
The IOM report and other studies have found that millions of U.S. children are not getting the dental care they need. In fact, untreated dental disease is the most common health problem children face. In my home state of California, roughly a quarter of the children under the age of 12 have never been to a dentist. In Los Angeles, a 2009 assessment found that 81 percent of children needed dental care. These grim statistics tend to translate into serious problems for children throughout the rest of their lives. Research has consistently shown that children who do not get needed dental care miss more school days, use expensive emergency room services more often, and face worsened job prospects as adults compared to children who get the dental care they need.
A major part of this problem comes down to the fact that for many people it's difficult, if not impossible, to find a dentist nearby. Roughly 50 million Americans live in rural or poor areas where dentists do not practice. Of California's 58 counties, 53 have one or more areas that are federally designated as having a dentist shortage (1); these areas are home to nearly one million children. Often, because families have to travel far distances or wait long periods to get dental care, children simply go without it.
The access problem is only expected to get worse. As the Patient Protection and Affordable Care Act (ACA) is implemented, approximately 1.2 million additional children in California are expected to gain dental coverage over time. While at the same time, nearly one million children will transition from the Healthy Families Program to Medi-Cal, as part of the recent state budget decision. These additional children seeking dental care will lead to an even greater mismatch between the number and location of available dentists and their ability to provide services for the increasing number of children seeking dental care.
Here in California, legislators are stepping up to the challenge and are working to address the state's dental workforce needs. They are currently considering legislation, which would authorize a study to allow for carefully trained practitioners to provide an expanded set of dental procedures under the supervision of a dentist. The goal would be to get necessary dental care to children in schools and other settings where they otherwise do not receive care. The bill also strengthens the state's oral health leadership so that kids truly get the care they need.
This type of model has been used successfully for decades in over 50 countries around the world, including Canada and Great Britain. Research demonstrates that this approach has increased access to dental care for children who would have otherwise gone without care. Thanks to a similar program implemented in Alaska, roughly 35,000 people now live in communities where there is regular access to dental care.
A broad and diverse range of organizations representing children, business, health and dental care have voiced support for State Senator Alex Padilla's legislation, including the California Dental Association, California Dental Hygienists Association, California Dental Assistants Association, American Academy of Pediatrics-California District, California Head Start Association, Los Angeles Area Chamber of Commerce, community health clinics as well as numerous other children's health advocates and organizations.
With over one million additional children coming onto California's health care rolls over the next few years and nearly one million new children enrolling in Medi-Cal, there is no time to waste. Senator Padilla's legislation is a forward-looking step that begins to address the state's dental workforce issues and will help get kids the dental care they so desperately deserve. It can also be a beacon to other states and give hope to the millions of children living across the United States who today get no dental care whatsoever.
(1) (US Dept of Health & Human Services, Health Resources and Services Administration