Among children in the United States, dental decay is the most common disease—even more common than asthma, according to Charles Norman, president of the American Dental Association (ADA). “Decay left untreated becomes aggressive,” says Norman. "The pain could prevent them from focusing in school.” Left untreated, their teeth could abscess from a dental infection, or may develop gingivitis, an inflammation of the gums around the teeth, he says. The ADA pushed for pediatric dental care in the Affordable Care Act (ACA). However, it was not required at the federal level nor in all states in the end.
Consequently, millions of people will not have dental coverage in the coming years, even with the implementation of the Affordable Care Act, including children under 19 years old. “When we lobbied for a pediatric dental benefit in the Affordable Care Act, we assumed it would be a mandatory buy,” said Norman. It was not included in the 10 "essential health benefits" of the Affordable Care Act that insurance companies are required to cover, putting the cost out of reach for many families. In the federal insurance marketplace, purchasing dental care for kids is an optional benefit. 99% of dental benefits are separate from medical coverage, according to the National Association of Dental Plans. “It’s about whether the parents will purchase it and whether they can afford to purchase it,” says Norman.
Generally, dental insurance covers twice-yearly dental visits, x-rays, teeth cleaning, fillings and only medically necessary orthodontics; only limited coverage for braces is included with most policies. By 2018, provisions within the ACA to improve dental health for 8.7 million children will kick in but it will leave just as many children without coverage—mainly in the high-risk group. Under the provisions, about a third of the children will receive coverage through their parents’ employer-provided insurance. Medicaid will cover another third but every one else will have to purchase expensive stand-alone policies. “Decay and periodontal disease are preventable,” said Norman. “We’ve made tremendous strides in lowering dental disease in the United States, but we have a crisis in certain communities.”
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