It’s barely past opening time, and the waiting room at the Mercy Care clinic in downtown Atlanta is standing-room-only.
Bruce Williams, 53, grimaces. He has a gum infection and needs surgery. But he doesn’t have dental insurance, or a job, or money. So he gets by as best he can, eating soft foods in tiny bites.
“I have headaches all in the front of my head,” said Williams, trying to talk without moving his lips and mouth too much. “I’m just here to see what they can do.”
Williams, who lives in Atlanta, is one of the estimated more than 4 million Georgians without dental coverage. Many haven’t seen a dentist in decades. Places like Mercy Care offer free dental clinics, but resources are limited and the clinic staffs are only able to help a small fraction of the people who need care.
The Affordable Care Act aimed to provide access to those without medical or dental insurance, but dental wasn’t considered one of the law’s “essential health benefits.” Roughly 85,000 Georgians enrolled in one of more than a dozen stand-alone dental plans sold through the law’s online insurance marketplace in 2014, compared with upwards of 300,000 people who got medical coverage, according to the nonprofit Kaiser Family Foundation.
Of the about 90 medical policies that included dental benefits for the second year of open enrollment, there’s an array of deductibles, out-of-pocket expenses and premiums that confuse dentists and their office staffs, not to mention consumers. There are no reliable figures for how many Georgians gained coverage through one of those plans.
“Unfortunately, if you’ve seen one, you’ve seen one,” said Dr. Maxine Feinberg, president of the American Dental Association, whose group has viewed policies from all over the country, including Georgia. “They’re all different. It’s been a very steep learning curve for our members.”
Also, the federal tax credits to help make insurance more affordable generally did not apply to dental policies. Typically, the credits were exhausted in paying for medical coverage, with essentially none left over to help consumers pay for dental care, said Colin Reusch, senior policy analyst with the Children’s Dental Health Project, which also analyzed adult enrollment in various states across the country.
The result: the Affordable Care Act has done little to lower the number of Americans who lack dental coverage.
‘If I had my teeth’
While dental disease seldom kills, it does lead to tooth loss and infections. It also can affect how a person eats, drinks and interacts with society.
It may be linked to cardiac disease, premature births and other maladies. Problems with the tongue and gums can also be indications of cancer, and dentists can often detect problems early, before these cancers become advanced.
Americans age 23-34 are the largest single group buying standalone dental coverage through the Affordable Care Act’s insurance marketplaces, according to the Department of Health and Human Services, suggesting young adults might be purchasing the plans as they transition off their parents’ policies, experts say.
In that group is Liese Redd of Decatur, 27, who works at a veterinary clinic. She receives medical insurance from her employer but bought dental insurance in November through Obamacare.
Redd said she’s thrilled with her coverage. She pays $29 a month for dental/vision combined. The plan covers preventive services, such as two cleanings a year, and it covered the filling she recently had.
“It’s been on par with what I had before, or better,” said Redd, who was insured previously under her parents’ dental policy.
Meanwhile, Michael Wilkins can only imagine such access to a dentist. The 51-year-old Atlantan, who sought help recently at Mercy Care, was disabled when a Ford 150 struck him a few years ago while he was riding a bicycle. He said he’d like to train to find a job rather than remain on disability. But he avoids people because he is missing his upper teeth.
“If I had my teeth, I could smile at people,” Wilkins said. “I would not be ashamed.”
‘State lags behind’
The poor, both adults and children, also find it difficult to get preventive dental care in Georgia because few dentists regularly accept Medicaid, according to a study from The Pew Charitable Trusts. Obamacare couldn’t fix that.
Only about 17 percent of Georgia dentists actively participate in Medicaid, the government health program for the poor, said Jane Koppelman, research director for Pew’s children’s dental campaign.
“It’s nice to have a card, but if you can’t get treatment, what good is it?” Koppelman said.
Georgia has improved access to dental care and dental health over the years for children and adults, according to a May 2014 report by the Georgia Department of Public Health titled “The Burden of Oral Health.” For example, more than 90 percent of Georgians have access to fluoridated water, and the number of third-graders with untreated tooth decay has fallen.
But “the state lags behind … objectives in several oral health indicators,” the report adds. Gaps exist in access. For example, in 2009, twice as many non-Hispanic black and Hispanic high school students visited an emergency room or urgent care center for oral or dental problems than non-Hispanic white high school students.
According to the Pew Charitable Trusts, there were 60,000 visits to Georgia emergency rooms for dental pain in 2007, the most recent year for which figures were available. The cost of those visits totaled more than $23 million.
Going to the ER is “an expense that makes no sense,” said Feinberg of the ADA, because while patients might be given painkillers or an antibiotic to fight an infection, their underlying issue generally will not be treated.
The solution, dental advocates say, is improved access. That includes not only offering dental insurance under Obamacare, but also increasing how much Medicaid pays dentists and expanding Medicaid coverage.
The Georgia Medicaid program currently provides coverage to roughly 1.8 million poor children, pregnant mothers, the elderly and disabled. Expansion would extend coverage to an estimated 600,000 low-income Georgians, mostly adults under age 65 who don’t have children. But Gov. Nathan Deal and other conservative lawmakers have said Georgia cannot afford to expand Medicaid coverage for health care, much less dental care.
So for Georgians without a job, money or dental insurance, services such as the Mercy Care Clinic will remain their option. David Swift of Atlanta, 53, who hadn’t been to a dentist in more than 20 years until a recent visit to Mercy Care, when he feared a filling from childhood had fallen out.
“I’m just hoping they’ll be able to do something,” he said. “Dental care has become a luxury.”
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This story was done in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.