Tooth decay is the most common chronic health problem in children, according to the Centers for Disease Control and Prevention. More than a quarter of kids have decay in their baby teeth by the time they enter kindergarten. Nearly 68 percent of teenagers 16 to 19 have decay in their permanent teeth.
The Affordable Care Act provides an opportunity to improve children's access to dental care starting in January 2014 if the California state health exchange, called Covered California, does things right.
Currently, the vast majority of families who get insurance through their employer are offered dental coverage separate from their medical coverage either in a "stand-alone" dental plan or in a "bundled" plan where an ancillary dental plan is added to a medical plan.
The Affordable Care Act makes children's dental coverage one of 10 "essential health benefits," providing the opportunity to offer a wider range of choices, including "embedded" plans where dental coverage is part of the medical plan, like covering pregnancy or prostate cancer tests.
Unfortunately, the California exchange solicited bids only for stand-alone or bundled plans and last month approved six companies to provide children's dental health plans nine stand-alone, one bundled. Yet nothing in the federal law prevents the exchange from offering embedded plans that include children's dental.
This has got to change and soon, in time for the October rollout of the exchange and January 2014 opening.
The aim of the exchange should be to provide affordable insurance for people who aren't currently covered. Under the Affordable Care Act, people who buy medical insurance on the exchange are eligible for federal subsidies on a sliding scale if they have annual income ranging up to $45,960 for individuals and $94,200 for families of four.
Here's where the choices matter. Plans that embed children's dental coverage in a single medical plan are eligible for subsidies. Stand-alone and bundled dental plans, however, are not eligible for subsidies, subjecting families to additional out-of-pocket costs.
Stand-alone premiums range from an estimated $10 to $30 per child per month with no subsidy. Last November, plans prepared to submit embedded plans and the cost of including dental was about $6 a month which is less than the stand-alone plans, and eligible for subsidies.
Insurance Commissioner Dave Jones and health advocates are calling for the exchange to consider embedded plans. Why not solicit embedded proposals from insurance companies now and see what they look like, and then figure out when embedded plans can be added to Covered California? If not by the Oct.1 rollout for Jan. 1 coverage, then when?
Consumer choice is key. Stand-alone plans are one choice, but should not be the only choice.
If couples without children don't want an embedded plan, they could buy a medical plan without a children's dental plan which would reduce their premium cost.
But parents who need affordable access to dental coverage for kids ought to be able to access an embedded option where subsidies are available.
At its Aug. 8 special meeting, the Covered California board should insist on consumer choice and access to subsidies by allowing and soliciting plans that embed children's dental coverage in health plans. With the right coverage, widespread tooth decay in children should become a thing of the past under the Affordable Care Act.