White House, Congress Focus on Improving Access to Dental Care

Efforts to improve Americans’ access to oral health care, particularly in underserved rural and urban areas, have been in the news recently, with a flurry of developments at the federal level in the final months of 2018.

On Dec. 3, the White House released a report on health reform that includes a call for states to consider authorizing dental therapy and to remove restrictive supervision requirements on dental hygiene. Both steps could help more people get access to routine dental care.

And on Dec. 11, President Donald Trump signed the Action for Dental Health Act of 2018, which Congress passed in November. This law enables more organizations to qualify for federal grants to develop oral health prevention initiatives and programs. It also expands how grants can be used to pay for activities to address access to oral health care.

On Nov. 26, Surgeon General Jerome Adams launched the first planning meeting for a new report on oral health to be released in 2020. That document will update a landmark 2000 analysis that called national attention to the disproportionate disease burden and care access barriers faced by low-income and certain racial and ethnic minority groups.

“A lot has changed in 20 years,” Adams told a packed room of oral health stakeholders. He explained that the new work, spearheaded by the National Institute of Dental and Craniofacial Research, would update and document inequities in disease burden and care access, address the adequacy of the provider workforce “head on,” and probe the role of dentistry in the opioid crisis.

“Workforce issues are touchy for some,” Adams said. “Some issues that have been taboo … we must have the courage to address them.”

The new study by his office will explore topics such as oral health across a life span, possibilities for integration of medical and dental care, the effects of oral health on communities and the economy, and the impact of the opioid epidemic. Next steps in the planning process include a webinar Jan. 10 to update the public on the status of the report—and to request public input to help shape its content.

Meanwhile, in the report released this month, the White House issued a call for reforms to health care markets more generally to improve care quality and expand access while reducing costs. The report discusses steps to remove or revise “certain federal and state regulations and policies that inhibit choice and competition,” changes that could have a direct impact on access to dental care. Among the agencies that contributed to the analysis are the departments of Health and Human Services, Treasury, and Labor, and the Federal Trade Commission.

The administration report refers to the need to expand the ranks of providers, particularly of dental care. “Healthcare occupations, such as dental therapy, can increase access and drive down costs for consumers, while still ensuring safe care,” the authors wrote. “States should be particularly wary of undue statutory and regulatory impediments to the development of such new occupations.”

The report calls for states to evaluate dental therapy as a way to help achieve these goals, particularly in underserved areas. It says states should consider removing certain supervision requirements on dental hygienists “that are not justified by legitimate health and safety concerns”—and that reduce access to care.

The recently signed Action for Dental Health Act (H.R. 2422/S. 3016) amends the Public Health Service Act to allow more organizations to qualify for grants through the Centers for Disease Control and Prevention—in conjunction with the Health Resources and Services Administration (HRSA)—that could be used for activities relating to oral health education and dental disease prevention. The law adds nonprofit community-based organizations, state or tribal health departments or oral health programs, dental education programs, and dental associations to the list of those eligible for the grants.

The measure also expands an HRSA program that awards grants to states to support initiatives focused on increasing access to oral health care services. Eligible activities now include efforts to reduce visits to emergency rooms for dental problems and to establish what are known as dental homes for vulnerable populations, such as children, the elderly, and people living with disabilities. Dental homes are places where patients can have consistent relationships with dentists and receive comprehensive and continuous care.

The law represents an acknowledgment of the critical need to reassess our dental care delivery system to ensure that more Americans have greater access to needed care. Although this measure takes a step in the right direction, lawmakers should consider more comprehensive and long-term policy solutions that reduce the many barriers to care for children and adults across the country.

Jane Koppelman is a senior manager and Allison Corr is an officer with The Pew Charitable Trusts’ dental campaign.