Imagine your child waking up one morning with a horrible pain in his leg. You rush him to the doctor, who explains that your boy has a serious infection in his knee. "You need to see a knee specialist," she says, "but I'm afraid your health insurance doesn't cover knee problems." Worse, the only doctor who is willing to treat your son's knee is 150 miles away and completely booked for the next six months.
What an absurd form of health care and health insurance. But that is exactly the situation that exists when it comes to our teeth. If you have an abscess on your leg, your arm, even your face, no problem, you're covered. If that abscess happens to be in your mouth, inches from your brain, you may very well be out of luck.
We in Connecticut must stop relegating oral health care to third-class status. Dental disease is the most common chronic disease of children. Connecticut children miss an estimated 1 million hours of school annually because of tooth decay. What an impact on learning and educational advancement! Poor oral health in children can cause problems with eating, sleeping, speaking and normal growth. And not surprisingly, low-income children are at higher risk. They are far less likely to receive dental care and far more likely to suffer from dental disease.
The truly sad part is that we could virtually wipe out this disease with decent dental care for every child from an early age. But instead, more than twice as many children are uninsured for dental care as are uninsured for physical health care. Fewer than half of the children in our state's HUSKY program, which provides health care to low-income families, receive any dental service at all in a year.
The stumbling block is on the supply side. Only 1 in 10 Connecticut dentists accepts HUSKY or Medicaid clients. Waiting lists for subsidized pediatric oral care can be a year or more. This is because reimbursement rates for children's dental services do not cover the costs of care -- they have not been adjusted since 1993. "I have to see three HUSKY kids to earn what I would with one privately insured patient to begin to cover the real costs of care," said Michael Goodman, a Newington pediatric dentist who nevertheless remains committed to serving the neediest children. "It's not the kids' fault, but financially, the state's reimbursement rates are making it impossible to provide appropriate care."
Seven states saw improved access to oral care after they adjusted reimbursement fees to reflect market rates. Delaware, Georgia, Indiana, South Carolina, Tennessee, Indiana and Michigan are now paying dentists enough so they can afford to treat low-income families. Connecticut's children deserve no less.
Unfortunately, current budget plans by the state may make matters worse.
The Department of Social Services plans to "carve out" all oral health care under HUSKY and Medicaid, combine it with the state employees' dental benefits and give it to one managed-care company. This company will control dental care for 1 in 6 Connecticut residents. But the state's remarkably misdirected plan includes no increase in reimbursement rates for participating dentists, not even to cover costs. This scheme was devised behind closed doors, without input from the people who will have to make this work -- dentists, consumers and taxpayers.
Connecticut must start providing children with regular, preventive oral health care before they must be rushed to the emergency room for super-expensive treatment (if they can even find one that treats oral emergencies). We know that money is not the real issue. The states that now take care of their needy children's teeth are all cash-strapped. (Michigan, for one, faces a $1.8 billion deficit in the 2003-04 fiscal year.) But these prudent states know what an ounce of prevention is worth.
Pay dentists fairly to treat low-income children, starting at an early age and emphasizing preventive care. Save money in the longer run by doing the right thing for our most vulnerable residents. Quality oral health care for all -- now, that would be something to smile about!