Romney’s right: Obamacare does not include dental care

November 16, 2012

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In his now infamous remarks on the Obama administration's "gifts" to voters, Mitt Romney offered Democrats some free advice on how they could continue to sweeten the deal for the American electorate.

"It's a proven political strategy, which is give a bunch of money to a group and, guess what, they'll vote for you," Romney told donors in audio obtained by ABC News. "What I would do if I were a Democrat running four years from now — I'd say dental care ought to be included in Obamacare."

That led more than a few people to ask: Wait, there isn't dental care in the Affordable Care Act already?

The answer is pretty much no: The subsidized health insurance plans that will become available in 2014 are not required to offer dental services to adults. They are, however, required to provide such oral health services to children.

The health-care law outlines 10 major benefit categories that all insurance plans will need to cover by 2014. These are known, in the health-care law, as the "essential health benefits:" The medical services that are crucial to keeping Americans healthy.

The essential health benefits include things like maternity care and hospitalizations. It includes "pediatric services, including oral and vision care." The American Dental Association estimates that about 3 million children will gain dental benefits as a result of this provision.

There's nothing, however, that would require coverage of such services for adults. 

This is actually true of a lot of public insurance plans: Medicare barely covers much in the way of dental benefits (the AARP offers private, supplementary plans for such coverage). In Medicaid, 22 states either offer no dental coverage at all or only do so in emergency situations. 

Dentists, meanwhile, haven't exactly been gunning to be included in public-health systems. Staying outside of the insurance system means they can charge whatever prices they want, without a health plan pushing back. "Organized dentistry flexed its muscles in 1965 to keep dentists out of the Medicare system," The Wall Street Journal's Alica Mundy reported in a recent article on the dentist lobby.

This is a situation that troubles a lot of public-health advocates. About 33 million Americans live in areas where there aren't enough dentists to meet oral health-care needs. Research has linked poor oral health to increased use of emergency services and higher risk for diabetes and heart and respiratory diseases.

As University of Chicago's Harold Pollack tweeted Thursday, "Hey Romney's right. Dental care SHOULD be in Obamacare. That is a huge ph problem. He's serious, right?"

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Dylan Matthews · November 16, 2012