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A patient receives dental care at a free rural clinic.

Patients receive dental care at a Remote Area Medical Clinic on February 1, 2019 in Knoxville, Tennessee. More than a thousand people were expected seeking free dental, medical, and vision care at the event, as millions of Americans report avoiding seeking care to save on costs. (Photo: Spencer Platt/Getty Images)

Dental, Insurance Lobbyists Quietly Target Democrats' Medicare Expansion Plan

Insurance companies' opposition to comprehensive coverage, said one lawmaker, is "all the more reason, in my opinion, that we need to do it."

Julia Conley

Underscoring the for-profit healthcare industry's tireless efforts to avoid any reduction in its bottom line—no matter the cost to the American public—lobbyists for health insurers and dentists are ramping up pressure on lawmakers to leave comprehensive Medicare coverage out of the $3.5 trillion spending plan now making its way through Congress. 
 
Sen. Bernie Sanders (I-Vt.), who has led negotiations on the package as chairman of the Senate Budget Committee, has long called for Medicare to include dental, vision, and hearing care and has demanded those provisions, in addition to lowering the eligibility age, be included in the bill.

"The opposition of the American Dental Association to a universal dental benefit in Medicare is reminiscent of the AMA's initial opposition to Medicare itself."
—Larry Levitt, Kaiser Family Foundation

 
According to Politico, groups including the American Dental Association (ADA)—threatened by the possibility that patients will switch to traditional Medicare plans instead of higher-paying, private Medicare Advantage plans—are pushing Congress to apply means-testing to the provisions.
 
"Let's focus on those who currently can't afford to see a dentist, people who are most likely to end up in the emergency room," Michael Graham, senior vice president for government and public affairs for the ADA, which wants Congress to limit dental benefits to people earning less than 300% of the federal poverty line.
 
Polls show millions of Americans—not just those living in poverty—have significant trouble affording dental care, and frequently go without to save money. Last year, one in five older adults told the National Poll on Healthy Aging that they had delayed taking care of their oral health in the previous two years, with a majority saying cost had played a role in their decision. 
 
In 2018, nearly half of Americans polled by NORC said they went without a routine cleaning or dental checkup that year, and 39% said they avoided getting treatment for a dental problem. 
 
Ninety-three percent of older adults told the National Poll on Healthy Aging that they favored including dental coverage in traditional Medicare. 
 
Considering the popularity of including more comprehensive benefits in the program, Politico reported, "the industry is mindful of the optics of publicly opposing coverage of eyeglasses, dental care, and hearing aids, and is largely lobbying behind the scenes."
 
Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, said the ADA's current pressure campaign is reminiscent of healthcare lobbyists' efforts in the 1960s to prevent the creation of the Medicare program, when the American Medical Association told the public Medicare would "put the government smack into your hospital" and warned against socialized medical care. 
 
In addition to means-testing, at behest of healthcare lobbyists, lawmakers are currently debating a longer phase-in for dental care or more cost-sharing for patients to protect the profits of insurers that sell additional coverage for hearing, vision, and dental care. 
 
Insurance companies, Rep. Lloyd Doggett (D-Texas), who chairs the House Ways and Means health subcommittee, told Politico, "don't have an interest in having traditional Medicare provide comprehensive coverage."
 
"That's all the more reason, in my opinion, that we need to do it," Doggett said.
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