Should Federal Funding for Dental Health Programs be Increased? (H.R. 2422)

What is H.R. 2422?

(Updated February 12, 2020)

This bill — the Action for Dental Health Act of 2018 — would authorize $18 million in each of the fiscal years 2018-2022 for the oral health promotion and disease prevention programs at the Centers for Disease Control and Prevention (CDC). It’d establish a new “Action for Dental Health Program” to provide grants for oral health education, dental disease prevention, and reducing barriers to dental services. State or local dental associations, state oral health programs, dental education programs, and community organizations that help facilitate dental services for underserved populations would be eligible for these grants.

The bill would also expand initiatives to enhance oral health education and community-wide dental disease prevention, authorizing $13.9 million in each of the fiscal years 2018-2022 for the Health Resources and Services Administration's (HRSA) Grants to States to Support Oral Health Workforce Activities, which aim to increase access to dental care in underserved communities. These HRSA grants would expand programs providing oral health services in areas that are underserved by dental health professions through initiatives such as:

• Establishing dental homes, which the American Academy of Pediatric Dentistry has defined as comprehensive oral healthcare, for children and adults;

• Establishing initiatives to reduce the use of emergency departments for dental services; and

• Providing dental care to nursing home residents

Argument in favor

Proper dental care is important for people’s health, social well-being, and job prospects. Approximately 15 percent of the U.S. population is underserved by existing dental systems, and others aren’t able to access dental care due to poverty.

Argument opposed

There are already many public and private efforts to provide dental care to the poor. For those in poverty, Medicaid covers dental services for people 21 and up, and CHIP helps children up to age 19 who don’t have health insurance.

Impact

Dental care patients; dentists; dental care organizations; CDC; and HRSA

Cost of H.R. 2422

The CBO estimates that implementing this bill would cost $133 million over the 2018-2022 period, assuming appropriation of the amounts specified in the bill.

Additional Info

In-Depth: Rep. Robin Kelley (D-IL) introduced this bill to strengthen the impact of existing federal funding to organizations providing oral health care to underserved populations, especially seniors, children, and those in rural and urban communities:

“Unfortunately, too many Americans lack access to oral health care because of cost or a lack of dentists in their area. This bill starts to change that by making oral health care more accessible. In a time of a deeply divided Congress, I’m glad that Congressman Simpson and I could put forward a bipartisan bill that would win the support of hundreds of our colleagues.”

Original cosponsor Rep. Mike Simpson (R-ID), who is a dentist by training, adds that this bill improves resource utilization for a range of important oral health initiatives:

“I am thrilled with the overwhelming bipartisan support for the Action for Dental Health Act. With House passage today, we are advancing a solution to better utilize resources to improve early diagnosis, intervention and preventive treatments which can stop the progress of oral diseases."

The American Dental Association (ADA), which was heavily involved in the drafting of this legislation, is championing this bill as part of its nationwide community-based campaign to end America’s dental health crisis. In testimony to the House Subcommittee on Health, the ADA stated that this bill has the potential to change Americans’ lives through better dental health:

“Action for Dental Health (ADH) initiatives affect or have the potential to positively affect every patient in [a] practice...The bill will allow organizations to qualify for oral health grants to support activities that improve oral health education and dental disease prevention and develop and expand outreach programs that facilitate establishing dental homes for children and adults, including the elderly, blind and disabled. The ADH bill supports oral health initiatives that have the greatest impact on dental access disparities.”

Mary Otto, author of Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America, disagrees with the premise that dentists are the only ones who can play a role in providing better oral health for Americans. She explores “efforts to expand the use of auxiliary dental professionals in neglected areas of the country, sending dental hygienists or ‘dental health aide therapists’ to do tooth cleanings and other routine sorts of dental work,” arguing that these supplements to expensive dentists are needed to create a fully fleshed out dental care system. Otto also notes that there are extensive attempts to expand dental service access for those using Medicaid.

However, the New Republic’s Adam Gaffney points out, “a system in which the well-off see dentists and the poor see dental professionals with lower levels of training would be fundamentally inequitable.” And, Gaffney contends, no amount of preventative care would eliminate the need for dental care and dentists — making some form of universal dental coverage necessary.

This bill passed the House unanimously with 83 cosponsors, including 70 Democrats and 13 Republicans. It then passed the Senate unanimously with an amendment from Sen. Mitch McConnell (R-KY). The two versions of the bill now need reconciliation. This bill has the support of a range of dental professional associations. In addition to the ADA, the American Association of Orthodontists, American Dental Education Association, and others support this bill.

Of Note: Americans spend over $113 billion a year on dental care costs, but over 47 million people, or about 15 percent of the U.S. population, live in areas with limited access to dental care, and others forego dental care due to poverty or lack of health insurance. Included in this demographic are members of some of the most vulnerable populations: children and seniors. In children, tooth decay is the most common chronic ailment in that population — and poor children without dental care at most at risk, with potential consequences ranging from toothache to abscesses, which can lead to death in extreme cases.

In all people, poor dental care and lack of access to professional dentistry services can lead to cardiovascular disease, dementia, respiratory infections, and diabetic complications. In addition to these health consequences, poor oral health can become a social burden that leads to diminished quality of life due to disrupted ability to eat and communicate with others.

Poor oral care can also affect individuals’ employability. Many studies have shown that many employers make instant judgments based on potential employees’ appearances, including that of their smiles and teeth.

Media:

• Sponsoring Rep. Robin Kelly (D-IL) Press Release

• CBO Cost Estimate

• American Dental Association Congressional Testimony (In Favor)

• Dental Professional Organizations Joint Letter to Congress (In Favor)

• Republican Policy Committee (RPC) Summary

• Dentistry Today

• New York Times (Context)

• The New Republic (Context)