Millions of Americans endure pain and shame because they can't afford dental care.
The issue is particularly pronounced in rural areas, as emphasized by a recent report by National Public Radio.
People in rural areas are not only more likely to lack the jobs that connect them to dental insurance or the money to pay for basic treatment, but they are less likely to drink water that contains fluoride and less likely to live near a dentist. Dentists in rural areas often don't accept Medicaid, NPR reports.
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"You've got a double whammy if you're on Medicaid and you're living in a rural area," Jane Koppelman, research director for the Pew Charitable Trusts' dental campaign, told NPR.
In addition, four states don't include dental care as part of their Medicaid programs and 15 only cover emergency dental care.
As a result, many of the nation's poor turn to charity dental care, but the occasional one-day clinics where dentists or hygienists volunteer their time to give people free dental work aren't enough to address the problem.
An encouraging trend has emerged in Wisconsin, where the Marshfield Clinic, a nationally renowned medical center, has been setting up dental centers throughout the state. The full-time centers employ 45 dentists and 44 hygienists, but they only charge what patients say they can afford, whether or not they are insured. Many of the patients are Medicaid beneficiaries, and their care is typically covered entirely by Medicaid.
It may seem surprising that Wisconsin, a Republican-run state that has refused to embrace the Medicaid expansion offered by the Affordable Care Act, would have such a good dental deal set up for its program beneficiaries. However, the dental benefit preceded the GOP takeover of state government and, as explained by Greg Nycz, who heads the Marshfield dental operation, many state legislators were getting complaints from constituents who couldn't find a way to see a dentist.
Although dental health is widely considered an important component of comprehensive health care, even many of those who enjoy dental coverage neglect customary care. One third of those with dental insurance did not go to the dentist in the past year, a recent study found.
Dental care was also not included among the 10 core benefits that must be included in an ACA medical plan, although many do include it.
Another challenge in improving the nation's dental health is the fact that dental insurance, unlike traditional medical plans, often only cover 50 percent of major procedures, no matter how expensive they are. As a result, many with insurance forgo operations that could relieve serious pain because they can't afford their share of a major bill.
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