“More than 16 million children in the U.S.—22 percent of all children live in families with incomes below the poverty level.” This quote is from Columbia University’s National Center for Children in Poverty.

Dental Crisis in America,The Need to Expand Access, a February 2012 report from the Subcommittee on Primary Health and Aging, U.S. Senate Committee on Health, Education, Labor & Pensions Chaired by Bernard Sanders [I Vermont] found that because of low-income one out of every five U.S. children go without dental care every year.

The report notes: “Dental carries (cavities) are the most common chronic disease among children, affecting 60% of American kids. Poor children are more than twice as likely as their affluent peers to suffer from toothaches. For kids with special needs, the likelihood is even greater.”

The report singled out for special mention: “February 25, 2012 marks the five-year anniversary of the tragic and untimely death of 12-year old Deamonte Driver of Maryland. Deamonte died from an infected tooth. His Medicaid coverage had lapsed, and yet even with insurance, Deamonte’s mother struggled unsuccessfully for months to find a dentist who would see her children and accept their Medicaid coverage.”

The American Dental Association (ADA), in a report Breaking Down Barriers to Oral Health for All Americans: Repairing the Tattered Safety Net stated, “As the economy has worsened and stagnated, and safety net dental programs suffer cutbacks, hospital emergency departments increasingly bear the burden of oral health emergencies, a large portion of which are preventable….

“Approximately half of these ‘emergencies’ resulted from preventable conditions which, owing to the lack of regular dental care, deteriorated to the point where the patient was in sufficient pain to seek emergency care. The worst part of the equation is that most of these patients do not receive dental care during these episodes. Instead they typically are given antibiotics and pain relievers, which relieve the symptoms temporarily. But absent dental treatment, such symptoms generally return, often engendering the same fruitless cycle, not solving the real problem while contributing to the to the continuing increases in health care costs borne by all.”

The Surgeon General of the United States and others have concluded that poor oral health care can lead to stroke and heart disease and other serious physical problems.

This brings us to Obamacare and the pretense of caring about pediatric dental care. The official name of the legislation signed by the President on March, 2010 is the Patient Protection and Affordable Care Act (Public Law 111-148).

The law defines the 10 Essential Health Benefits it is intended to provide, produced here verbatim from Section 1302 B:

“(A) Ambulatory patient services.

(B) Emergency services.

(C) Hospitalization.

(D) Maternity and newborn care.

(E) Mental health and substance use disorder services, including behavioral health treatment.

(F) Prescription drugs.

(G) Rehabilitative and rehabilitative services and devices.

(H) Laboratory services.

(I) Preventive and wellness services and chronic disease management.

(J) Pediatric services, including oral and vision care.”

The problem is while pediatric services are defined as “essential” their impact is negligible regarding access to dentists treating, reducing pain and restoring smiles to poor children. A family selecting a plan on the Health Care Exchanges is required (the relevant word is “mandated”) to select insurance that includes, for example, hospitalization but does not require coverage for oral care for minor children.

Colin Reusch, Senior Policy Analyst at the Children’s Dental Health Project, explains that parents are mandated to obtain a policy that provides dental care for their children. “The mandate only applies to individual and employer-based plans.” Regarding employer-based plans the Administration has extended implementation beyond 2014, plus the family of minor children may not be employed. If an individual wants to purchase an independent insurance plan—going directly to the insurance company and avoiding the exchanges entirely (the probability is extremely low), the individual is mandated to make sure the plan has dental coverage.

The key to the hypocrisy of promising to protect children’s teeth and not delivering on the promise is right here: If the parent purchases an insurance plan on the Exchanges, she or he is released from the mandate to provide coverage to one’s minor children.

++++

The best reporting I have read on the Affordable Care Act is: Landmark, The Inside Story of America’s New Health-Care Law and What it Means for Us All by the Staff of The Washington Post. The authors write: “A few days before Congress took its final votes on the legislation, the president of the American Dental Association dispatched a letter to House Speaker Nancy Pelosi saying that the group opposed it. The bill was missing “a commitment to improve the oral care for those citizens at the lowest end of the economic ladder,’ the letter said.”

Since publication in 2010, the book’s subsequent description of how children might receive real dental coverage under Medicaid has been made irrelevant by the portion of Obamacare  where the Supreme Court approved the legality of the mandate but ruled unconstitutional health care benefits to the poorest of our citizens. When talking about dental coverage under Medicaid or even the Children’s Health Insurance Plan, one must be careful to recognize coverage rarely results in the ability to see a dentist on a regular basis. The vast majority of dentists will not work for the cynically low rates provided by Medicaid illustrating the empty promise of dental care.

Last year, State College, PA Mount Nittany Medical Center performed a study on access to health care here in Centre County. The study concluded: “There is a shortage of dental providers who accept Medical Assistance. Even among providers who do accept public insurance, not all are accepting new patients. CVIM [Centre Volunteers in Medicine] provides free primary medical and dental care to Centre County residents who pass a means-based test …. CVIM‘s services are in demand; there is a waiting list of over 2,000 individuals in Centre County…. “

++++

Author’s note: Writing about dental care for children in poverty is depressing.

The reality is if you are poor and a child, your ability to see a dentist and receive the care available to the rich and middle class is negligible. There is widespread recognition across the political spectrum that pediatric dental care should be a priority and our children in the U.S., in Pennsylvania, and in Centre County where I live ought not to be in pain.

To reach this realistic conclusion, one must analyze a complex variety of public and private programs some of which do some good but have a negligible effect on the overall problem. If, in this presentation I have failed in my understanding of the nuances, please provide corrections.

Understand, the complexity is part of the problem. If I had not been able to support dental care for my now adult children, I would have been handed a list of organizations that might help. In the past 20 years, resources have declined substantially; the evidence points toward the conclusion that seeking help may very well be a waste of time.  Consider, for example, the fact that more dentists are retiring than are graduating from medical school.

++++

I began this article awaking in the middle of the night screaming because of dental pain. In April, I had successful cancer surgery. The surgery means I will have 10 years more of life. The pain questions my rationale for staying alive if staying alive means living with the kind of dental pain I have experienced and am likely to experience again. I am 66 years old. My sole income is my monthly social security check. I have a competent caring dentist and a modest dental insurance. I AM  seeking money to pay for my dental care. I am clear about the path I have chosen for my life.

https://fundrazr.com/campaigns/5gEj1/ab/d2khof

++++

Thanks to contributions, I received enough to obtain treatment to reduce the immediate pain. I know more pain is coming unless I raise the money for additional treatment. If I fail, it will be pain pills and misery.

This article on dental care for minor indigent children is my pay back. Internet services on how to raise funds suggest providing contributors with a keepsake—the moral equivalent of a key chain. Think of this article as a key chain that has allowed me to be productive again. I have now added to my list of life objectives working to make dental care accessible to all.

I started writing about children because I thought promises raised by the Affordable Care Act were real and because children are so vulnerable—especially to pain.

—  Joel Solkoff

Note: “One fourth of adults in the U.S. ages 65 and older have lost all of their teeth.” [Haley J et al. “Access to Affordable Dental Care: Gaps for Low-Income Adults.” Kaiser Low Income Coverage and Access Survey]

Note 2:  I will be able to produce another article on dental care once I receive the resources to get the required care and the resultant freedom from pain to be productive.