Veterans' Dental Care in Congressional Spotlight

An interview with U.S. Rep. Gus M. Bilirakis

By Gail Gourley

ONE ASPECT OF VETERANS’ HEALTH CARE receiving heightened attention involves dental care. A clear example of expanded congressional focus on this topic emerged at a recent hearing before the Health Subcommittee of the House Committee on Veterans’ Affairs. During that September hearing, Rep. Gus M. Bilirakis, R-Fla., highlighted legislation he introduced in May 2019 in an ongoing effort to expand the Department of Veterans Affairs’ (VA) existing dental care services to an increased number of veterans.

The Veterans Early Treatment for Chronic Ailment Resurgence through Examinations Act of 2019 (H.R. 2628), or the VET CARE Act of 2019, would authorize administrative support for community providers of dental care and establish a pilot program providing dental services to 1,500 eligible enrolled veterans who currently receive no periodontal care. This pilot program would serve to determine whether there is a correlation between receiving these services and experiencing fewer complications of chronic ailments.

Rep. Gus M. Bilirakis, R-Fla.

Increasing evidence supports a link between periodontal disease and chronic conditions including cardiovascular disease, stroke, and diabetes, and indicates it is a contributing risk factor in pregnancy for premature birth and/or low birthweight. While the VA does provide outpatient dental services to certain eligible veterans as defined in Title 38 of the U.S. Code, eligibility requirements differ from those for most other VA medical benefits, resulting in many veterans receiving no dental care.

At the Health Subcommittee hearing, Bilirakis said, “If we’re able to improve the VA health care system by providing preventive dental services that lead to fewer complications of chronic ailments, it not only shows that we are looking at the long-term outlook of our veterans’ health, but it could also prove to be done in a cost-effective manner. The VET CARE Act is a practical, commonsense way to demonstrate this approach for dental services, replicating already-established research in the community.”

Bilirakis represents Florida’s 12th Congressional District. Elected in 2006, he serves on the Energy and Commerce Committee and the Veterans’ Affairs Committee. He is the ranking member of the Veterans’ Affairs Economic Opportunity Subcommittee and a member of the Disability Assistance and Memorial Affairs Subcommittee. In the week prior to the Health Subcommittee hearing on H.R. 2628, Bilirakis spoke with Veterans Affairs & Military Medicine Outlook about the importance of the VET CARE Act of 2019 and expanding dental services for veterans.

Veterans Affairs & Military Medicine Outlook: Before discussing the details of the legislation that you introduced, how would you describe the current state of VA dental care for veterans?

U.S. Rep. Gus M. Bilirakis: Well, it’s not adequate. This is [based on] hearing from veterans in my district, but veterans all over the country are having a very difficult time getting dental care. We do have several nonprofits in the Tampa Bay area, where I’m from, that help out veterans, and we actually partner with the dental association here in Pasco County. They see as many veterans as they possibly can, but it’s never enough. And right now, it’s very limited in what they can do, as far as who qualifies for dental care. You have to be 100 percent disabled, or a [former] POW [prisoner of war], or it has to be a service-connected [dental] injury, meaning if someone gets injured in the mouth during combat. It’s certainly not enough.

advertisement

You introduced the VET CARE Act of 2019 earlier this year. In broad terms, how do you hope to change things with this bill?

First of all, our veterans deserve the dental care. And we want to prove to the VA that you can save money on the back end. If we treat these veterans, who are so worthy, then they won’t develop exacerbated health complications, in a lot of cases, including those associated with diseases such as diabetes. A study was presented to me by a dentist in my area, [Zacharias Kalarickal, DDS], who knew a good friend from the University of Pennsylvania, Dr. [Marjorie] Jeffcoat, [DMD], the former dean of the dental school. She conducted a study having to do with heart disease, diabetes, and other chronic diseases. We feel that we can make our point by passing this pilot project, and comparing those who have type 2 diabetes and receive dental care to those that have type 2 diabetes that do not receive dental care, proving that, in the long run, you can keep veterans with diabetes healthier if you provide preventative oral health care, and that treating their underlying diabetes is less costly when the veteran has access to dental care.

Specifically, what would Section 2 of the bill, “Administrative Support for Community Providers of Dental Care,” do? Could you explain how this would work?

This section would ensure that VA providers are entitled to advise patients in the pilot program of opportunities for dental care through the VADIP [VA Dental Insurance Program] and other community partners for low- to no-cost dental care. Currently, the VA is prohibited from advising its patients to go to nonprofit and other providers in the community for dental [care]. My bill would allow VA to have that conversation with these veterans who go through the pilot program by giving them a list of those potential providers in the community. It’s really common sense, and they should be allowed to do so anyhow, but this assures them that they can do this; they can make these referrals for our veterans.

advertisement

We have community providers for those who are participating in the pilot project – 1,500 veterans who have type 2 diabetes and are chosen, not by me, but in accordance with the legislation. Veterans who have a service-connected disability will be given preference with regard to this pilot project. But we also want to inform them in the meantime, until we can get dental coverage for all veterans, or at least those who are disabled or have these chronic illnesses. We want to make sure that they know about the [dental] resources available in the community.

There also is something that the Congress passed a few years ago. It’s really not sufficient according to the veterans that I speak to, but there is a discounted insurance program [VADIP] that will help. It provides discounted, low-cost insurance by private insurers such as Delta Dental [and MetLife]. The cost is a little lower, but still much too expensive for a lot of veterans to afford. So, we think that the opportunities within the VA and even outside the VA, even though they’re well intentioned, are just not adequate. Not enough veterans would be covered.

Could you please elaborate on Section 3 of the VET CARE Act, which outlines the “Pilot Program for the Provision of Dental Care to Certain Veterans”?

This is a four-year pilot program serving 1,500 veterans who have type 2 diabetes, giving preference to those who are disabled – not necessarily 100 percent disabled, because they already qualify for dental care, but those who are disabled. Those veterans will receive dental care with periodic visits to the dentist. After the pilot program is completed, we will measure those results – how the veteran is doing with the dental care provided as opposed to not having any dental care at all. And in this way, we [intend to] prove to the

advertisement

VA and the federal government that it does make a difference. We feel it will save a lot of money on the back end with this prevention. And that’s what it is – it’s preventive services. In general, I know that going to the dentist provides many benefits, and I know that there have been studies linking certain oral diseases to factors that will ultimately affect your heart, for example, and we want to prevent heart disease, obviously. So first, the veterans deserve this care, without question. And, secondly, we’re going to save money in the long run if we provide preventative dental treatments to veterans. We want people to know that [by expanding dental coverage], we’ll save the VA money that could be used elsewhere in the long run – for mental health care, for example.

How were the eligibility criteria determined regarding which veterans would be included in the pilot study?

We had to limit it to a certain extent, and we chose diabetes. Type 2 diabetes is very rampant and it is a chronic disease, so we thought that we could measure that as opposed to a chronic disease that is not as common. I’ve always relied on experts’ [input], and we’ve fine-tuned the bill over the years, including fiscally. You can have the best bill possible, but if it’s not heard in the VA Committee and doesn’t get on the floor of the House of Representatives and the Senate, it’s not going to go anywhere and it’s not going to do good. So sure, I would like to file a bill to cover all veterans with regard to [dental] care, or at least those who qualify to receive medical care in the VA system. I would like to cover all of them to make sure that we provide dental care, but I know that we would face a lot of dissent [in some circles], and I know that more than likely the comprehensive bill wouldn’t go anywhere at this point. So, I thought this was a good way to start. But ultimately, we want all our veterans who qualify for health care within the VA to receive dental care.

What are some of the possible outcomes after the pilot study concludes?

If we can prove that we’re saving money in the long run and treating our heroes – and it’s not costing us a lot of money for the pilot project; I understand the expense is very negligible – then we’ll file subsequent legislation. As a matter of fact, I’ve spoken to [U.S. Rep.] Julia Brownley, [D-Calif.], chair of the Veterans’ Affairs Health Subcommittee, and she has a comprehensive bill to cover VA [dental] care. I don’t think that it would go [forward currently], because you’re taking away some money possibly from another program, an existing program. I don’t really think that we can get all that. This [pilot study] will show the VA and members of Congress that we’ll prove that prevention will definitely save money in the long run, and we’ll file a bill to have our veterans covered.

Gus M. Bilirakis pictured with three veterans in August 2019. In May 2019, Bilirakis introduced the VET CARE Act, legislation that aims to expand existing dental care services to an increased number of veterans.

What would passage of this bill mean for veterans?

It gives them hope. First of all, the 1,500 [veterans in the pilot study] would get dental care, those who are selected, and again, not by me. But secondly, it gives the veterans hope that we’re working towards solving this issue. I’ve participated in several town hall meetings, particularly veteran meetings, and vets come up to us and, case by case, they say, “We need surgery. We need dental care. We need a root canal, or a crown,” and we’ll refer them, we’ll try to get them help individually, and in a lot of cases, we’ll find a dentist that will do it. Or we’ll have a one-, two-, or three-day clinic that’s open to all veterans. But we want to solve this problem for every veteran that qualifies.

What would passage of this bill mean for the VA?

It will prove to the VA that this service is affordable.

The bill has a bipartisan group of cosponsors. Is there anything you’d like to highlight about the bipartisan nature of this bill’s cosponsors?

For the most part, in our VA Committee – and I’ve been on there since 2007 – we’ve worked in a bipartisan fashion. We want to prove to fiscal conservatives that this is a worthy program, and of course, save money in the long run.

What do you see as the biggest challenges in passing this bill?

Because we’re having a hearing on the bill next week, I think that we’ve convinced the chairman and the ranking member and committee staff that this is something that’s doable. So, I think we’ve gone through that. We’ve overcome those hurdles with regards to challenges. Again, preventive dental services and better health lead to better health outcomes. This is definitely a worthy goal.

To summarize, is there a message you would like to convey to America’s veterans?

Yes. I want them to know that it’s a priority on the Health Subcommittee, and the VA Committee, and it definitely is my top priority to get our veterans the services that they need and have earned.

END OF INTERVIEW

SIDEBAR:

ORGANIZATIONS EXPRESS SUPPORT FOR THE VET CARE ACT OF 2019

While addressing key questions posed by Rep. Gus M. Bilirakis, R-Fla., during a recent House Veterans’ Affairs Committee Health Subcommittee hearing about H.R. 2628, the VET CARE Act of 2019, representatives from three veterans service organizations offered strong support for the bill, which would expand the Department of Veterans Affairs’ (VA) dental care services for veterans.

Referencing written remarks supporting the legislation, Roscoe Butler, associate legislative director, Paralyzed Veterans of America (PVA), stated during the hearing that a person’s “oral health has a major impact on their physical health, and gum disease is often associated with diabetes, heart disease, and many other serious medical conditions. A large number of veterans who receive care from the VA are not getting the appropriate dental care needed, which could later add to other health complications.” The written PVA statement continued, explaining, “The VET CARE Act would require VA to establish a four-year pilot program for older veterans with type 2 diabetes. Since the VA spends most of its health care costs on treating veterans with chronic conditions like diabetes, expanding dental coverage to these individuals will help improve their overall health and may bring those costs down.”

Joy J. Ilem, national legislative director, Disabled American Veterans (DAV), said, “DAV has been a long-time advocate of dental care for all veterans being within a comprehensive care package.” She added, “I think [this] bill is very reasonable in terms of a start to look at the conditions, as Mr. Butler indicated, that are prevalent in the veteran population,” utilizing the pilot program study “as a first step of really offering that benefit.”

DAV written testimony affirmed the organization’s strong support for the legislation as a “measured and reasonable way to assess the full costs and benefits associated with regular and preventive dental care for service-connected veterans,” and to assist policymakers in improving VA dental services in the future.

In his written statement of support for the bill, Jeremy Butler, chief executive officer, Iraq and Afghanistan Veterans of America (IAVA), referred to the legislation’s “pilot program to expand dental care to veterans that have certain chronic conditions. This type of care has been proven to increase overall health and reduce health care costs. It is for these reasons that IAVA supports this legislation.”

At the hearing, Jeremy Butler referred to the existing “disconnect between dental care and medical care,” adding, “we’re all in agreement here that it’s [veterans’] whole health that is the important part, and these should be seen as one thing.”