The court’s ACA ruling and oral health

The law affects dental care in one key way

The U.S. Supreme Court released its decision last month in the latest Affordable Care Act case, King v. Burwell, brought by opponents of President Obama’s health care reform law, and President Obama won.

The court ruled that eligibility for the ACA’s health premium tax credit is not limited to people purchasing a health plan on a state-based exchange. This means that the 6.4 million people who received health premium tax credits for their 2015 health plans when they purchased health coverage on HealthCare.gov, the federal exchange, will not have to drop their plan due to the loss of the tax credit (or subsidy) that make it affordable. Just short of 30,000 of those people live in New Hampshire.

What does this mean for those focused on good oral health and increased access to dental care? While the ACA does not impact access to dental care or dental coverage nearly as much as medical care or coverage, it does touch those issues in one key way.

The ACA’s drafters recognized oral health care as a necessity for good overall health when they included dental coverage among the 10 “Essential Heath Benefits.” While the applicability of that requirement is limited to children (that coverage is referred to as the “Pediatric Dental Benefit”), its inclusion was nonetheless a big step on the part of policymakers toward recognizing and treating the mouth as part of the body.

Yes, clearly the mouth is part of the body, but the structures of our current medical and dental care systems and insurance industries are largely separate, and thus, the mouth and the body are treated like neighbors, not family.

The 30,000 people in New Hampshire whose tax credits were saved by the court decision can continue to apply their health premium tax credit (subsidy) toward medical and dental plans that cover the pediatric benefit. This can only help to reduce the number of New Hampshire children who do not have dental insurance coverage.

With a New Hampshire DHHS study reporting that, in 2014, still over 35 percent of New Hampshire children experienced tooth decay, one of the most preventable childhood diseases, the need for more affordable dental treatment is clear. Insurance helps with that.

And if receiving the health premium tax credit frees up some funds for a family to use to purchase dental coverage for its adult members, we could see improved oral health care outcomes for New Hampshire adults, too.

What comes next for the ACA? We see the implementation of the “Cadillac tax” as the next really big ACA wave that insurers, employers and subscribers will need to ride out. The Cadillac tax is an excise tax employers will pay on health plans that exceed a certain value and that will take effect in 2018, unless it is amended before then.

However, predicting what challenges to the ACA will come next, or their outcomes, or what the Supreme Court could have to say about them is a game of chance best left to clairvoyants.

Tom Raffio is president and CEO of Concord-based Northeast Delta Dental.