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August 7, 2013
Editorial: State should make dental care a priority

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(Aug. 7 -- By the Editorial Board)

A major aim of the nation's Affordable Care Act is to increase access to affordable dental coverage for children starting in January 2014.

Not surprisingly, children whose families don't have health insurance are more likely to have severe and untreated tooth decay, which the California Dental Association notes with understatement hinders a child's "ability to eat well, sleep well and function well at home and at school."

California is well on its way in setting up an exchange - a marketplace called Covered California where people will be able to buy health insurance starting in January 2014 if their employer doesn't provide coverage. Unfortunately, children's dental coverage to date has been treated as a rushed afterthought.

After hue and cry from legislators, children's health advocates and Insurance Commissioner Dave Jones, the exchange board today is holding a special meeting to take up the issue. Time is running out to correct missteps in time for enrollment to begin Oct. 1 and coverage to begin Jan. 1, making today's meeting urgent.

Currently, the vast majority of families who get insurance through their employer get dental coverage in an optional "stand-alone" dental plan, where the cost is on top of regular medical coverage. The Affordable Care Act, however, provides an opportunity for the California exchange to offer a wider range of choices to families - from stand-alone dental plans to "embedded" plans where dental coverage is included as part of a comprehensive medical plan.

In the early going, however, the exchange missed that opportunity. The staff report for today's meeting admits the omission, saying that "Covered California should have allowed for the submission of embedded plans" in April. It notes that allowing families to pay a single rate that covers both medical and dental "creates cost advantages for consumers" by spreading costs and allowing access to federal subsidies based on income.

But at this late date, less than eight weeks from the launch of October enrollment, the staff recommends not reopening bidding for dental plans that are embedded in medical coverage for 2014, instead opting to "improve our offering in 2015."

The situation may not be as dire as the staff portrays, however. Last November, insurance companies prepared to submit embedded plans and the cost of including dental was about $6 a month. In contrast, stand-alone dental premiums range from an estimated $10 to $30 per child per month.

Five children's health organizations in an Aug. 2 letter suggest that the only way to find out if health plans are prepared to offer embedded coverage this year is to "start that process now." The health plans already have designed and priced embedded plans, so that with "sufficient encouragement" from the exchange board, "we believe that an extended bidding opportunity could produce acceptable embedded plans in time for open enrollment."

No harm would be done in immediately requesting bids for embedded children's dental plans. But the advantages would be clear. It would send a message about the importance of children's dental coverage and give families better, more affordable choices. The exchange board today should direct staff to request bids for embedded dental plans.

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