By Nicole Fauteux
On February 22nd, Congressman Elijah E. Cummings (MD-7) convened an
event at the University of Maryland School of Law to honor Deamonte Driver,
whose death at age 12 provided the
catalyst for long needed action on children's access to oral health care.
Legislators and others in Maryland have made significant strides in this area,
with Congressman Cummings and Senators Ben Cardin and Barbara Mikulski taking
the lead at the national level. All three lawmakers were in attendance and
spent the morning listening to two panels of experts. Their testimony shed
light on what has been accomplished since Deamonte’s death and on the
challenges that lie ahead.
At the federal level, the Children's Health Insurance Program (CHIP)
now includes a guaranteed dental benefit for CHIP enrollees. The Affordable
Care Act (ACA) mandates inclusion of pediatric dental benefits in every
insurance package offered through the new health insurance exchanges that
states will be creating. And for the first time, Healthy People 2020, the Centers for Disease Control’s (CDC's)
framework for improving the health of the American people, lists oral health as
one of only12 leading health indicators.
At the state level, Maryland is the recognized leader in addressing the
problems that led to Deamonte’s death. Maryland has increased its Medicaid
reimbursement for dental services to 70% of median retail fees, one of the
highest reimbursement rates in the country. As a result, the state has seen an
85% increase in the number of dentists who agree to treat Medicaid enrollees.
But as Senator Mikulski, a social worker by training, pointed out, dentists do
not see children in a vacuum.
Dr. Harold S. Goodman, Director of the state’s Office of Oral Health
and one of the panelists at the event, concurred. He briefly described a case
management program that his office has instituted on Maryland's Eastern Shore.
The program employs social workers to facilitate the provision of oral health
care. "They schedule appointments and make sure the patients arrive,"
Other programs in the state are bringing dental services to children in
Head Start programs and in schools and also educating them about proper oral
health care. Senator Cardin praised the mobile dental vans he observed treating
children in Hagerstown.
"It's one thing to say they are covered,” he remarked. “It's
another to provide the care." The senator was also impressed by a child
who, when asked if she remembered to brush her teeth, replied, "You also
have to brush your gums and your tongue."
This indication of growing oral health awareness among the youngest
generation of Maryland residents prompted Congressman Cummings to share a
recollection from his own youth. “When I was growing up,” he told the
gathering, "many people didn't know there was a connection between the
teeth and the body. Toothaches were considered a routine part of life."
According to Dr. Goodman, "In the late 1990s, Maryland had one of
the worst records regarding oral health care for its underserved
population." He credited Deamonte's death with breaking what he called the
cycle of non-action, allowing proponents of oral health to make strides in the
state. "Maryland now faces the task of keeping oral health as a top public
health priority," he concluded.
What Remains To Be Done: Access
The Pew Children's Dental Campaign has produced two 50-state report
cards, which grade states on eight policies related to children's oral health.
Shelly Gehshan, the campaign’s Director, appeared on the panel and praised
Maryland for its dental sealant programs, community water fluoridation,
Medicaid reimbursement and enrollment, and collection of data on children's
dental health. She also pointed out that unlike some other states, Maryland
does not require a dentist’s exam before a dental hygienist sees a child in a
school-based sealant program, eliminating one barrier to care. Ms. Gehshan
congratulated the state for receiving an A in the Pew report, but noted that
the benchmarks were set very low. "If we had set them where we think they
ought to be, every state--including Maryland---would have gotten a much lower
grade," she said.
ADEA member Dr. Burton L. Edelstein, Professor at the Columbia
University College of Dental Medicine and founding Director of the DC-based
Children's Dental Health Project, also appeared on the panel. He began by
stating that his testimony would focus on the empty half of the glass, and he
emphasized that much more needs to be done to reach the youngest children
before they acquire dental disease.
When Senator Mikulski pushed those testifying to offer concrete
proposals for further government action, Dr. Edelstein urged lawmakers to look
closely at how dental benefits are treated in the insurance plans that the new
state health exchanges will offer so that "dental care is affordable as
well as covered." He also noted that the Affordable Care Act authorized a
$100 million National Oral Health Literacy Campaign, but that funds have yet to
be appropriated. He urged active consideration of a $5 million investment in fiscal
year 2013 to get the program started, noting, "As Maryland has learned in
its public [oral health literacy] campaign, basic knowledge among parents and
caregivers is our most powerful tool when it comes to preventing disease and
maintaining good oral health."
What Remains To Be Done: Work
The lawmakers also expressed concern about shortages of health care
providers, student debt, and the need for a more diverse health care
workforce—areas where ADEA is well poised to play a leadership role. ADEA President
Dr. Leo E. Rouse, Dean of the Howard University College of Dentistry, picked up
these themes in his testimony. He urged the federal government to broaden the
dialogue concerning the health care workforce beyond the Department of Health
and Human Services to include the Department of Labor, the Department of
Defense, and others who might play a role in workforce development. "It
haunts me every night when I evaluate the class [of Howard students] and see
such high levels of debt. Students want to know, will my financial aid be there
next year? Will my stipend be available?"
He also stressed the need to engage the entire health care team in
ensuring access to oral health care. "We talk about dental homes and
medical homes," he said. "It's time to talk about health homes."
The other panelists described federal efforts, community-based programs
including a novel initiative to prepare inner city high school students for
oral health careers, and the difficulties of accessing care for children with
special needs. Throughout the proceedings, one message came through loud and
clear: oral disease is preventable, and with enough political will, the problem
can be solved.
Despite budgetary concerns at all levels of government, the panelists
urged the lawmakers to increase federal and state investment in the kinds of
programs and policies that have produced such positive results in Maryland. Dr.
Edelstein used an unabashedly dental metaphor when he implored lawmakers to
"take the provisions in the CHIP Reauthorization Act and the ACA and make
them into substantive programs with teeth."