ADA questions healthcare reform's pediatric benefit

Mar 25, 2010

A new mandate to extend dental benefits to children may not make much difference, the ADA said in a news brief explaining its position on the healthcare reform bill signed into law by President Barack Obama on March 23.

The new law mandates dental benefits for all insurance programs offered through new state-run exchanges, starting in 2014, the organization noted. (According to analysts from the Children's Dental Health Project and Delta Dental, these mandates will eventually extend to new insurance programs outside the exchanges as well.)

But the ADA questions the value of this mandate. "There are no assurances that this dental coverage will be substantial, and we fear that the desire to control premium costs will prevail and the benefit will be as meager as is currently found in medical plans that promise a dental benefit," the ADA said.

Standalone dental plans, such as Delta, could be offered in the exchanges, but whether or not they will satisfy the new mandate outside the exchanges is unclear, according to Delta Dental Government Relations Manager Chad Olson.

Regardless, medical plans may try to fulfill the requirement by offering an "insubstantial" dental benefit as a strategy for reducing premium costs, the ADA said. Historically, dental benefits in medical plans "often focus on tactics to decrease utilization, not to increase it," the organization noted.

Unlike a version of healthcare reform originally proposed by the U.S. House of Representatives, the new law doesn't spell out how the requirements it imposes on new insurance plans will be enforced.

The ADA brief does note that the association supports some provisions in the new law, in particular increased funding for prevention programs, public clinics, and education of dental professionals.

But the ADA ultimately opposed the law because other provisions weren't included. The ADA especially wanted the federal government to require states to include adult dental benefits in Medicaid. It also wanted other Medicaid reforms and malpractice liability reforms, and to prohibit dental plans from capping fees they don't cover. In addition, the association doesn't like new restrictions on flexible spending accounts.