BIRMINGHAM, Ala. 鈥� Carolyn Thompson鈥檚 tight-lipped smile hides a health care problem the 81-year-old retired nurse can鈥檛 afford to correct and Medicare won鈥檛 pay for.
She needs dentures. Her missing bottom teeth make chewing difficult, so she avoids hard fruits and foods that provide valuable nutrients. Thompson hasn鈥檛 seen a dentist in years, even though there鈥檚 one聽where she lives, in the Fair Haven retirement community here.
鈥淲hen I was working I always took care of my teeth, but in the last couple of years 鈥� I don鈥檛 have the money to pay for it,鈥� said Thompson.
Thompson鈥檚 predicament is common. About 1聽in 5聽people 65 and older have untreated tooth decay, federal researchers But Medicare rarely covers dental care and fewer than half of elderly Americans see a dentist even once a year 鈥� often because they can鈥檛 afford to 鈥� according to a Johns Hopkins University published in Health Affairs last year. Just 12 percent of Americans over 65 have dental insurance, that
Dental benefits weren鈥檛 recognized as a priority when Medicare was enacted in 1965. , nearly half of Americans ages 65-74 had lost their natural teeth; today, 87 percent in that age group still have some or all of theirs, according to the American Dental Association.
Research shows that untreated dental problems can exacerbate health problems such as diabetes and heart disease, leading to costlier bills for Medicare. That鈥檚 why a nonprofit think tank devoted to improving oral health is working toward an audacious goal: Medicare-paid dental care for America鈥檚 elderly.
The Santa Fe Group鈥檚 objective looks daunting in post-election Washington, where repealing the Affordable Care Act and cutting federal health spending are priorities for both the Trump administration and Congress鈥� Republican leadership.
What鈥檚 more, the costs of expansion would be significant. Such a benefit would likely be heavily used in an aging America whose 65-and-older population is to grow at least 30 percent by 2030. Also, while dentures were (and are) relatively cheap, newer techniques to preserve native teeth, such as dental implants, cost many thousands of dollars per tooth.
The Santa Fe Group鈥檚 members include academics, dental industry executives and former government officials. Among sponsors: Colgate-Palmolive, DentaQuest and Henry Schein 鈥� three companies whose oral health products or services stand to profit from increased dental care delivered at the government鈥檚 expense.
Santa Fe understands the uphill climb for coverage, but its sights are set on the 2020 elections, said Dr. Claude Earl Fox, a former senior health official in the Clinton administration who鈥檚 spearheading the group鈥檚 effort. Its strategy: to start building public demand for a Medicare dental benefit so that every major presidential candidate will support it the next time around.
鈥淲e have a long road to go, but we think it鈥檚 doable and there will be a growing audience for this,鈥� said Fox, who worked as a professor at both Johns Hopkins and University of Miami medical schools after his career in federal government.
The Johns Hopkins study estimated a dental benefit could cost from $4.4 billion to $16.2 billion a year, depending on what鈥檚 covered, how much seniors pay out-of-pocket and the level of premium subsidies provided to low-income beneficiaries.
鈥淢ost of the talk in Medicare reform is how do we reduce cost rather than expand costs, and adding a dental benefit can make folks [on Capitol Hill] very nervous,鈥� said Amber Willink, the study鈥檚 lead author and assistant scientist at the Johns Hopkins Bloomberg School of Public Health.
Prescription drugs were the last major benefit Congress added to Medicare. That was after more than a decade of pleading from advocates.
Senior citizens at every income level report an increase in untreated cavities in the past decade, according to federal surveys, though the problem is most acute among the poorest.
Dentist Lillian Michell works at the Fair Haven dental clinic. (Phil Galewitz/KHN)
Those untreated dental problems have real consequences. About 24 percent of seniors report difficulty biting or chewing. Among low-income seniors, 36 percent do, according to the American Dental Association鈥檚 .
Without Medicare to help, seniors have few options to get comprehensive coverage. Private coverage is typically too expensive for many of them.
Medicare Advantage, private plans that cover about one-third of seniors, sometimes offer a limited dental benefit for additional costs but typically only for a small network of dentists.
Medicaid, the state-federal health insurance program for low-income people, aids only about 12 percent of seniors. Even then, state Medicaid coverage for adults is usually limited and nonexistent in states such as Alabama. Many dentists don鈥檛 accept Medicaid because reimbursement rates are low.
Eighteen states cover only emergency services.
The Santa Fe Group acknowledges that lobbying Congress about seniors鈥� trouble eating or their teeth pain will get it only so far. It鈥檚 also promoting dental care鈥檚 dividends: reducing tooth decay and gum disease can sometimes more serious issues such as diabetes and pneumonia. Dentists can spot oral cancers early. And those diseases to treat than a cavity.
鈥淚t is important to show a benefit can be structured to save money for Medicare,鈥� Fox said.
Supporting evidence from large studies is limited, however. It鈥檚 uncertain whether the Congressional Budget Office 鈥� the official scorekeeper on federal legislation 鈥� would agree with the dental industry鈥檚 savings estimates from a Medicare benefit.
Politics aside, some advocates point to firsthand experiences to show that older adults鈥� health improves with regular dental care.
The Fair Haven retirement community in Birmingham, which includes a nursing home and an assisted-living facility, added a dental clinic in 2012. Pneumonia rates dropped soon after, said Lillian Mitchell, a dentist who oversees the office and is the director of geriatric dentistry at University of Alabama, Birmingham. Mitchell and other faculty oversee dental students who treat patients at the clinic.
The downward trend is consistent with that report the same outcome from giving older people regular dental care.
鈥淭aking care of oral health affects their overall health by reducing the inflammation [in their mouths] that has been linked to heart disease, diabetes and other chronic conditions common to the elderly,鈥� Mitchell said.
The clinic鈥檚 services cost about half the price of private dentists.
Peggy Batcheler, 87, visits聽the dental clinic inside Fair Haven, a large retirement community in Birmingham, Ala. (Phil Galewitz/KHN)
Patients say easy access to the clinic in the building where they live makes a big difference. 鈥淭his is such a comfort knowing we can go to the dentist without having to leave the facility,鈥� said Peggy Batcheler, 87, a former nursing professor who has lived at Fair Haven nearly 30 years. 鈥淲e just feel so fortunate.鈥�
Fair Haven is one of a few dental clinics nationwide specializing in affordable dentistry for seniors, especially low-income ones.
But it can help only a small percentage of the elderly in Alabama, one of that provide no dental coverage to adults on Medicaid.
In 2016, Alabama鈥檚 dental care for older adults as the worst of all states by an advocacy group, Oral Health America.
The state鈥檚 lack of Medicaid dental coverage, its high rates of adults without any teeth and its failure to do a recent survey of adult oral health needs all factored into Alabama鈥檚 poor ranking, the group said.
Alabama health officials say they are trying to address the problem through strategies that don鈥檛 require legislative action, such as working with the University of Alabama, Birmingham, to expand geriatric dental screening.
鈥淭he fact that one of our most vulnerable populations faces more barriers in accessing dental services than any other state in the nation is unacceptable,鈥� said Chris Haag, a spokesman for the Alabama Department of Public Health.
The Santa Fe Group hopes to draw the American Dental Association, AARP and other seniors鈥� groups into its campaign for a Medicare dental benefit.
鈥淚t is not our No. 1 issue, but it is on top of our conversation list,鈥� said Joseph Crowley, a Cincinnati dentist and president-elect of the American Dental Association. He鈥檚 optimistic.
This year, four dentists are members of the House of Representatives.
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