In 2009, at the height of the Great Recession, California lawmakers and the governor helped close a $41-billion budget deficit by slashing the social safety net for the old, poor and sick.

Some of those cuts, not a lot, have been restored as the economy improves, including some dental insurance coverage for poor adults. Those folks were totally on their own for awhile as they looked for affordable treatment, and a new study published in the peer-reviewed journal Health Affairs documents where they found it—emergency rooms.  

Researchers concluded that the loss of coverage resulted in 1,800 additional trips to emergency rooms in the state. Dental care in ERs is not good. For the most part, it consists of antibiotics and pain killers; not a very good health outcome.

“The money being spent on them at the (ER) is basically being wasted,” Dr. Peter Damiano, the study’s senior author, told Reuters. And it’s a fair amount of money. Average yearly costs of ER treatment increased 68%, the study found, although some of it is still billed to Medicaid as medical services.

One of the big savings from the Affordable Care Act (ACA) comes from insuring low-income people and keeping them out of pricey emergency rooms ill-equipped to deal with them. But it does not cover dental work for adults on Medicaid.

One-fourth of Americans lose all their teeth by age 65 because of decay and lack of treatment, according to the American Dental Association.

The study’s lead author, Astha Singhal, said, “The major takeaway [from the study] is that there are unintended consequences that need to be evaluated when you make policy decisions.”

Good idea.

The study, out of the University of Iowa, looked at six years of data centered around 2009. Dental coverage is an elective benefit offered under the federal Medicaid program. Medi-Cal, California’s version, elected to drop the benefit that year to save the state’s portion of the cost.

During the six years, 113,309 adult Medi-Cal recipients with dental problems made 121,869 ER visits. They averaged 42 visits a year per 100,000 recipients before 2009 and 56 a year after. The newly disadvantaged were mostly young adults, racial and ethnic minority groups and urban residents.  

Only 15 states offer extensive Medicaid dental coverage for adults. Most states provide emergency coverage. The law requires comprehensive coverage for kids.

–Ken Broder

To Learn More:

After Cuts in California Dental Insurance, ER Visits Went Up (by Andrew M. Seaman, Reuters)

Reducing Dental Benefits Is Expensive (DentalPlans blog)

Eliminating Medicaid Adult Dental Coverage in California Led to Increased Dental Emergency Visits And Associated Cost (Health Affairs)