Courtney Sands was suffering from a severe toothache due to an infection affecting her molars. The Pennsylvania resident urgently needed root canals and crowns to alleviate her pain.

However, her visit to an endodontist brought a different kind of distress that many patients experience. Before commencing treatment, the office required her to pay thousands of dollars upfront. When she returned the following week for the crowns, she found herself having to use a high-interest credit card to cover over $6,000 in costs, despite having dental insurance from both her job and her husband’s.

Ultimately, the dental insurance plans reimbursed her only a small portion of her expenses, with one payer returning $1,000 and the other just $395.

Compared to many Americans, Sands feels fortunate regarding her dental care access. More than half of adults in the U.S. lack consistent dental care, and ignoring dental problems like infections can negatively impact overall health. Despite these widespread issues, dental coverage has not captured significant attention from political leaders.

Political figures like Vice President Kamala Harris and former President Donald Trump have clashed over topics such as abortion and lower insulin prices, yet neither has focused on a crucial issue: expanding dental care for the millions of uninsured Americans.

Adding dental benefits to Medicare is a highly supported idea: a recent poll of 1,000 registered voters commissioned by the CareQuest Institute for Oral Health revealed that around 90% of respondents are in favor. Support is notably strong among Democrats and 85% of Republicans.

Despite this widespread support, neither Harris nor Trump include dental coverage expansion in their political agendas or key addresses. In their recent debate, discussions focused on grocery prices and the Affordable Care Act’s future, but neither candidate has prioritized dental health care.

The need for dental care is clear. Nearly 69 million U.S. adults lacked dental insurance or access to basic oral health care last year, according to CareQuest. Additionally, many people lost their dental coverage last year when states began resetting Medicaid for those who enrolled during the COVID-19 pandemic.

Medicare, primarily aimed at those aged 65 and older, does not include routine dental care. As of 2018, nearly half of Medicare recipients had not seen a dentist in over a year, according to KFF, a nonprofit health policy group.

“Many individuals in this country find oral health care too costly and inaccessible,” stated Melissa Burroughs, CareQuest’s public policy director. “Yet this matter has largely been neglected in terms of political dialogue and commitment.”

Is it more significant than abortion?

The CareQuest poll also asked voters to rank various health issues. Adding dental coverage to Medicare was identified as the second most crucial issue, second only to reducing prescription drug prices.

Respondents rated Medicare dental benefits as more pressing than abortion rights and the future of the Affordable Care Act—subjects frequently discussed by presidential candidates. Dental coverage also ranked higher than mental health access, insulin affordability, medical billing transparency, the opioid epidemic, and changes to Medicare eligibility.

“This is one of the most favored topics in healthcare among voters, and we cannot allow it to be overlooked,” Burroughs emphasized.

Medicare Advantage plans often provide options that include benefits for dental, vision, and hearing care, though specifics vary among plans. Traditional Medicare recipients can purchase dental insurance, but nearly half of them lacked any dental coverage as of 2019, per KFF.

The Democratic Party’s 2024 platform advocates for integrating dental, vision, and hearing care into Medicare but lacks specifics on funding these benefits, except for suggesting “fair contributions from the wealthy and large corporations.”

Conversely, the Republican agenda does not mention dental care or oral health issues.

CareQuest also found that polling in key states showed widespread voter support for adding dental benefits to Medicare, with more than 90% backing in states like Michigan, Ohio, and Pennsylvania.

This sentiment resonates with Sands, who resides in Factoryville near Scranton. She works as a nurse while her husband holds steady employment. However, the financial burden from her dental emergency has limited their budget for a home renovation project. She stated that settling her credit card balance is now her priority.

Congress could implement dental care improvements

Though dental care has not been a focal point in political campaigns, the Biden administration and Congress members have proposed potential solutions to address these gaps in coverage.

This year, the administration implemented a rule allowing states the option to include adult dental insurance in their Affordable Care Act plans. While the 2010 healthcare law did not provide dental coverage for adults, it mandated states to offer pediatric dental care as a required benefit for ACA plans.

Two related bills are currently proposed in Congress to enhance dental care access by integrating it into Medicare, Medicaid, and services for veterans. Senator Bernie Sanders, an Independent from Vermont, presented the Comprehensive Dental Care Reform Act of 2024 in May, followed by Rep. Debbie Dingell, a Democrat from Michigan, who introduced a similar proposal in the House on Tuesday.

As of now, there are no scheduled votes for either bill, and the Congressional Budget Office hasn’t provided any cost estimates for the proposed legislation.

Dingell expressed that many individuals hesitate to visit the dentist due to financial concerns about treatment costs.

“Not having adequate dental care can aggravate other serious health issues, and millions of Americans lack the essential dental services they require due to insufficient coverage,” she stated while introducing the bill last week.

Dental organizations are in favor of initiatives to broaden dental coverage under Medicare.

Katherine Merullo, the American Dental Association’s senior manager for public affairs and analysis, mentioned that the ADA advocates for comprehensive dental benefits for low-income adults and senior citizens.

According to Merullo, prioritizing dental coverage for low-income seniors promotes health equity. The ADA also supports legislation aimed at extending dental care coverage to adults on Medicaid and renewing a grant initiative for dental professionals to work in areas with limited access, particularly rural regions.

“Providing comprehensive dental care means ensuring low-income seniors have access to a wide range of affordable dental services necessary for maintaining oral health, alleviating chronic pain, and allowing them to eat and sleep comfortably,” Merullo explained.

Sands, a resident of Pennsylvania, understands the significance of having dental care access for overall health and feels fortunate to have had the financial means to visit the dentist. However, many in her community lack similar opportunities.

“I know people who haven’t been to the dentist in years, even while in pain,” Sands said. “I’ve seen individuals with swollen gums and pus coming from their mouths, and there’s nothing they can do about it.”