medicare C D A J O U R N A L , V O L 5 0 , Nº 7
One More Look at Medicare and Why a Dental Benefit Is Still Needed for All Elisa M. Chávez, DDS
abstract Medicare was originally envisioned to include oral health care. But the opposition to its inclusion prevailed, and nearly 60 years since its enactment, older Americans struggle to afford needed dental care. An opportunity came and went to include provisions for oral health care in Medicare with the Affordable Care Act and most recently in the Build Back Better Act. The need and benefit of regular oral health care for older adults has been demonstrated time and again. There has been strong support from advocates for older adults and their families, including many medical and dental professional groups and patients themselves. Yet, there was not enough support to surmount resistance to the financial, social and professional investment that is required to get older and disabled Americans the resources they need to improve their access to care and maintain good oral health. And so there remains a known gap in our health care system that will continue to present a barrier to achieving the best outcomes for patients in both dentistry and medicine. Keywords: Aging, dentistry, oral health, health policy, disparities, Medicare, vulnerable patients
AUTHOR Elisa M. Chávez, DDS, is a professor in the department of diagnostic sciences at the University of the Pacific, Arthur A. Dugoni School of Dentistry in San Francisco and the director of the Pacific Center for Equity in Oral Health Care. She graduated from the University of California, San Francisco, School of Dentistry and earned her certificate in geriatric dentistry from the University of Michigan, Ann Arbor. Dr. Chávez has practiced in private, community health center, skilled nursing, hospital
and PACE (program for all-inclusive care for elders) settings. She recently served on the California Dental Association Medicare task force and as a founder’s fellow and scholar with the Santa Fe Group advocating for the oral health needs of older adults nationwide. Conflict of Interest Disclosure: None reported.
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he concept of integrating medical and dental care in America is not novel. In 1932, the inclusion of dental care as part of a comprehensive health plan was considered by then Secretary of the Interior Ray L. Wilbur, MD.1 President Harry Truman sought a national health plan in 1945 that would provide for routine health care such as doctor and hospital visits, laboratory services, nursing and even dental care. Then in the early 1960s, President John F. Kennedy called for a health program specifically to support seniors after a study revealed more than half were without health insurance at
the time.2 This is interesting in light of 2016 data showing 62.7% of adults aged 65 and older lacked dental insurance.3 In 1965 under President Lyndon B. Johnson, Medicare was enacted, but without dental benefits. Both the American Medical Association (AMA) and the American Dental Association (ADA) were opposed to Medicare. The ADA prevailed, and ultimately oral health care was left out of Medicare.4 In 1966, some 19 million older adults signed up for Medicare in the first year. In 1972, Medicare was extended to individuals under age 65 if they had a long-term disability or end-stage renal disease. The 1980s saw expansion in home JULY 2 0 2 2
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