May 20, 2019
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Dental care shouldn’t come from the emergency room

Johanna S. Billings | BDN
Johanna S. Billings | BDN
New York University dental student Farzan Mojgani works on a patient during a weeklong dental clinic in Machias last year. The annual clinic provides dental care to residents who don’t routinely get dental care.

Dental problems are a top reason for emergency department visits among poor residents in Maine. This reality highlights a fundamentally flawed system. Rather than routine dental care, those with no insurance or state-provided health coverage wait until problems are so bad — and painful — that they go to the ER for relief. Not only is the ER the wrong place to get this care, it costs much more than preventive dental care.

LD 860 would take a modest step to address this by providing preventative dental care through MaineCare to pregnant women.

Maine is one of only 10 states that does not provide dental care to pregnant women through its health insurance program for low-income residents. This change would benefit Maine mothers and their children. Tooth decay and gum disease during pregnancy have been linked to low birth-weight babies and preterm birth, according to information from the Maine Primary Care Association.

In 2010, the Muskie School of Public Service published a report on emergency room use in Maine. It found that many of these visits were preventable. Dental problems were the number one reason for emergency room visits by adults without insurance or with MaineCare coverage. Chest pain was the top reason for visits among those with private insurance.

Because of frequent ER use for dental problems, a group tasked with finding savings in the MaineCare program in 2012 recommended some dental coverage for MaineCare participants.

Last year, lawmakers considered a bill to provide MaineCare dental coverage to pregnant and postpartum women. It also directed the department to develop rules to cover dental care for MaineCare recipients when it would avoid more costly medical or dental care. That bill, LD 474, was melded into an amended version of LD 860, which was carried over to be considered in the current session that began last week.

The Maine State Chamber of Commerce took the unusual step of testifying in favor of LD 474. “As a matter of course, the Maine State Chamber rarely, if ever, supports adding mandates on private insurers or on the state’s MaineCare Program,” Peter Gore, vice president of advocacy and government relations, wrote to members of the Committee on Health and Human Services in April. “However, this is one of those instances in which a modest investment today can lead to greater savings, better health outcomes and a more productive workforce in the years ahead.”

When the uninsured and adults with MaineCare seek emergency room treatment for dental problems, the costs are passed on to businesses and individuals that purchase private insurance, Gore wrote. On a more personal level, some struggling to become employed are too embarrassed by the condition of their teeth to interview with potential employers. Businesses also lose money when workers take sick days because of dental pain, he added.

There’s a strong case for extending dental coverage to all adult MaineCare recipients. What is currently before the committee is a much more modest step, but still worthy of support.

 



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