3‑minute read

Join our guest blog­ger, Devin McBray­er, as she unpacks the Job and Tax Cuts Act of 2017 and its like­ly effect on den­tal ben­e­fits enroll­ment. Devin is a Leg­isla­tive and Pol­i­cy Ana­lyst based in Sacra­men­to, Cal­i­for­nia.

government workers walking down stairs

When most peo­ple think of the Afford­able Care Act (ACA) and the increase in Amer­i­cans with insur­ance cov­er­age, med­ical insur­ance is the first thing that comes to mind. What’s some­times over­looked is the sig­nif­i­cant growth in den­tal insur­ance, par­tic­u­lar­ly among adults.

Pedi­atric den­tal is con­sid­ered an “essen­tial health ben­e­fit” in the ACA, mean­ing insur­ance must cov­er it. Den­tal car­ri­ers are also able to offer stand-alone fam­i­ly den­tal cov­er­age on the health insur­ance exchanges as long as the pedi­atric ben­e­fits are includ­ed. This has made den­tal cov­er­age more wide­ly avail­able to the 1.9 mil­lion peo­ple who pur­chased stand-alone den­tal cov­er­age through the mar­ket­places in 2017.

Den­tal cov­er­age could be threat­ened, how­ev­er, due to the Job and Tax Cuts Act of 2017. This bill effec­tive­ly repealed the man­date requir­ing most Amer­i­cans to have health insur­ance by elim­i­nat­ing the finan­cial penal­ty for lack of cov­er­age.

With­out the indi­vid­ual man­date, it’s like­ly that med­ical and den­tal insur­ance enroll­ment will decrease in the com­ing years. The Con­gres­sion­al Bud­get Office, a non-par­ti­san agency that con­ducts analy­ses for Con­gress, pre­dicts that the U.S. will have 8–13 mil­lion more peo­ple liv­ing with­out health insur­ance by 2026.

Stand-alone den­tal plans on the exchanges in par­tic­u­lar will strug­gle to sus­tain enroll­ment in the mar­ket­place, because stand-alone den­tal plans can­not be pur­chased unless an indi­vid­ual has already pur­chased a med­ical plan. If con­sumers choose not to pur­chase med­ical insur­ance because they no longer have to pay the penal­ty, then those con­sumers will also not be able to pur­chase den­tal on the exchange.

Adding more strain on the uncer­tain future of the exchanges, heath­i­er and younger peo­ple who believe that they do not need insur­ance are most like­ly to drop their cov­er­age. The exchanges could soon face a sce­nario where old­er or sick­er indi­vid­u­als will choose to keep their cov­er­age, and health­i­er, younger peo­ple will choose to drop their cov­er­age. An unhealthy risk mix, due to health­i­er peo­ple leav­ing the exchanges, would like­ly cause health insur­ance pre­mi­ums to rise even high­er.

On the bright side, open enroll­ment totals for health insur­ance exchanges in 2018 exceed­ed expec­ta­tions. Near­ly 65% of state-based exchanges saw an increase in their over­all enroll­ment. Only time will tell if the exchanges can sus­tain their enroll­ment, while also main­tain­ing a healthy risk mix, after the tax reform bill repealed the indi­vid­ual man­date.

Despite the uncer­tain­ty fac­ing the mar­ket­place, Delta Den­tal is still work­ing hard to ensure that con­sumers con­tin­ue to have access to the den­tal care that they need.

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