July 2017

July 25, 2017

Oral health matters. Adequate oral health reduces emergency department utilization and enhances health equity. Knowing these benefits, Governor Baker included an amendment in the proposals he sent to the legislature in connection with his budget vetoes that authorizes dental therapists in Massachusetts, a proposal we strongly support. By allowing mid-level dental therapists (DTs) to deliver basic but critically necessary care, this amendment would increase access to dental coverage for underserved Massachusetts residents. At Tuesday's hearing on the health provisions of the budget veto amendents, we urged the legislature to support the Baker administration and approve this much-needed reform:

Oral health is integral to overall health, and poor oral health is a risk factor for diabetes, heart disease, stroke and low-birthweight children. Yet, one in ten Massachusetts residents lives in a dental shortage area. As a result, about half of our children do not get annual dental care, and some 60% of our seniors in long-term care have untreated tooth decay. Qualified, trained, professional dental therapists can fill this gap by providing basic oral care in vital locations such as in schools, in senior centers, and in community health settings, all under a dentists’ supervision. Dental therapists would increase access to oral health care, improve overall health and save money.

Although almost everyone in Massachusetts has medical coverage, many struggle to access dental care. Common obstacles include the inability to find a dentist that accepts public insurance, the prohibitive cost of dental care, or challenges in traveling to a dentist’s office. Dental Therapists can help with all of these issue. Access to good dental health is major problem for low-income people in Massachusetts. Dr. Don Berwick outlined oral health disparities in the Boston Globe:

Kids on Medicaid visited emergency departments for preventable oral health problems six times more often than commercially insured children; for MassHealth adults, the figure is seven times. Over half of the residents in Massachusetts nursing homes have untreated dental decay. In 2014, low-income seniors in Massachusetts were seven times as likely to have lost all their teeth as those with means. Nearly a third of adults with special needs are missing six or more teeth.”

EOHHS Secretary Sudders also testified in favor of the proposal, pointing out that in addition to improving care, dental therapists would provide savings to the state by reducing inappropriate use of emergency rooms for preventable oral health issues:

The Health Policy Commission (HPC) has been examining some of these cost drivers including avoidable emergency department visits.  The most recent data published by HPC indicates that 40% of all ED visits could be avoided if there was greater access to care.  In 2014, there were more than 36,000 visits for preventable oral health issues, costing the state upwards of $36 million.  MassHealth was the primary payer of these oral health emergency department visits that year, paying upwards of $17 million.  Emergency department visits for oral health complaints represents suboptimal use of a very costly setting. 

DTs would work under the general supervision of a dentist, using technology to share X-rays and patient records with the dentist and consult on complicated cases. This would allow DTs to deliver critical dental services directly to people in schools, nursing homes, and other community settings.

Moreover, DTs offer low-cost interventions that could prevent more costly illnesses. They would be reimbursed by MassHealth, which would expand access to dental care for people who have some coverage but are still unable to receive appropriate oral health care.

We urge the state legislature to follow Governor Baker’s lead and prioritize the oral and overall health of Massachusetts residents by adopting the DT amendment included in the Governor’s recommended budget amendments. 

                                                                                                                                                   -- Ben Agatston

July 25, 2017

Health Care For All testified today, Tuesday, July 25th, during the public hearing held by the Joint Committee on Ways and Means and the Joint Committee on Health Care Financing on Governor Baker's proposed package of reforms to MassHealth.

We provided testimony in support for some of the Baker administration's proposals, including the authorization of dental therapists and the re-instatement of employer responsibility. However, we also expressed opposition to several reforms we found concerning, particularly policies that would disqualify over 140,000 Massachusetts residents from MassHealth, shifting them onto more expensive and less comprehensive coverage.

We have created a fact sheet detailing the specific effects these proposals would have on Massachusetts residents, which can be accessed here:

HCFA Fact Sheet

July 11, 2017

HPC Chart: Oral Health ED Visits

We smiled brightly during the Health Policy Commission’s (HPC) July 5 meeting because the agency highlighted one of our top priorities, the lack of access to oral health care. In their first DataPoint analysis, HPC found 11.5% reduction in oral health-related hospital Emergency Department (ED) visits from 2013 – 2015.

But despite this overall reduction in costly and preventable care, there was a substantial increase in oral health ED visits for elementary school aged children and adults age 55 to 84. Moreover, and perhaps most concerning, is that low-income populations accounted for a disproportionate rate of oral health ED visits.

It is unclear whether the overall decrease in ED utilization is attributable to certain demographics receiving better quality preventive care or increased access to dental services. What is clear, however, is that glaring inequities exist in dental care access, causing low-income populations to over-utilize hospital EDs.

This costly outcome occurs because we neither equip EDs to treat dental conditions nor train emergency room physicians to resolve these issues. And even if EDs could provide proper dental care, these visits are preventable and burdensome on hospitals.

Ultimately, this data suggests that that access to dental care remains elusive in Massachusetts even though coverage may in fact be increasing.

This is why we agree with Governor Baker, Secretary Sudders, and the Executive Director of the HPC, David Seltz, in their support of legislation to authorize dental therapists. This common sense policy would expand quality and access to preventive oral health care to vulnerable populations.

Dental therapists, who would reach out to patients, providing care in places like schools or nursing homes, can greatly reduce oral health-related ED utilization. After all, the patients most likely to utilize ED for dental care – children and seniors – are society’s least mobile. Dental therapists meet their needs by going to them  where they are and providing the care they need at a lower cost.

Dental therapists offer low-cost interventions that can prevent more costly illnesses. They would be reimbursed by MassHealth, expanding access to people who have some coverage, but are still unable to receive appropriate oral health care.

Legislation is pending that would allow dental therapists to practice in Massachusetts. Hearings should occur this fall. This is a key HCFA priority for this fall, and we urge you to join our campaign.

                                                                                                                                                                           - Ben Agatston

July 6, 2017

The Prevention and Public Health Fund was established in 2010 as part of the Affordable Care Act. As the nation’s first mandatory fund dedicated to improving public health, this fund has played a major role in funding prevention programs throughout the country. The current proposed legislation to repeal the Affordable Care Act would eliminate this fund.

This fund provided $17 million to Massachusetts during fiscal year 2016. The programs that benefited include programs dedicated to combating racial and ethnic health disparities, providing immunizations for children, and increasing prevention and control for heart disease, strokes, and diabetes. A new study reports that If the fund is repealed, Massachusetts will lose over $88 million over the next five years.

Preventable diseases are a major health care issue. These diseases cause an estimated 70% of all deaths, and are the main cause for around 75% of health care spending. Yet only about 3 percent of health care spending goes towards preventing these same diseases.

For Massachusetts, repealing this fund along with the ACA would mean cuts in valuable programs such as

  • vaccines for children ($3.6 million);
  • diabetes and heart disease prevention programs ($5 million);
  • lead poisoning prevention and tobacco cessation ($780,000).

The funds also supports $2.3 million to combat racial and ethnic health disparities.

Prevention programs are an important and under-utilized method for addressing these diseases. Supporting prevention programs is a fiscally responsible strategy - it's cheaper to prevent illness now than treat them later. Prevention programs help improve quality of life and reduce death rates by helping individuals combat preventable diseases.

Yet another reason to oppose the plans to "repeal and replace" the Affordable Care Act.

                                                                                                                                                           - Sean Connally