BILL ANALYSIS �
AJR 30
Page 1
Date of Hearing: March 27, 2012
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AJR 30 (Pan) - As Introduced: March 7, 2012
SUBJECT : Medicare: dental care.
SUMMARY : Urges the President and Congress to enact legislation
to require Medicare to provide dental care coverage.
Specifically, this resolution :
1)Makes various findings and declarations relating to the need
for Medicare to include dental coverage to improve the quality
of life for senior citizens and lower the program's medical
expenses associated with covering medical illnesses that are
directly correlated with poor dental health.
2)Memorializes the President and Congress to enact legislation
to add comprehensive, preventative dental care coverage to
Medicare benefits.
EXISTING FEDERAL LAW establishes the Medicare program to provide
various medical services to adults aged 65 and older, younger
people with disabilities, and people with end stage renal
disease.
EXISTING STATE LAW establishes the Medi-Cal program to provide
comprehensive health care services and long-term care to
pregnant women, children, and people who are aged, blind, and
disabled.
FISCAL EFFECT : None
COMMENTS :
1)PURPOSE OF THIS RESOLUTION . According to the author, the
elimination of dental benefits from Medi-Cal since 2009 has
meant that adults who are poor and older than 65 in California
are not getting much dental care unless it is an emergency.
The author notes that, as a result, more seniors may be
suffering from tooth loss, experiencing more medical
complications, and going to emergency rooms. The author
asserts that the Medicare dental exclusion acts as another
barrier to care as many seniors live on fixed incomes and
AJR 30
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cannot afford routine dental care on their own. This
resolution is intended to urge the federal government to add
dental benefits to Medicare to provide low income seniors with
more access to oral health care.
2)DENTAL HEALTH AND OLDER ADULTS . According to the federal
Centers for Disease Control and Prevention (CDC), older adults
suffer a disproportionate and debilitating amount of oral
disease. Those with the poorest oral health are economically
disadvantaged, lack insurance, and represent racial and ethnic
minorities. Older Americans who are disabled, homebound, or
institutionalized are also at increased risk of developing
poor oral health. Nearly one-third of older adults have
untreated tooth and root decay that can lead to more serious
infections, such as bacteremia and septicemia, and result in
the loss of natural teeth. Nearly a quarter of 65- to
74-year-olds have severe periodontal (gum) disease, which is
associated with such chronic diseases as diabetes, heart
disease, stroke, and respiratory illness. The CDC notes that
many older adults take medications for their chronic
conditions that have side effects detrimental to their oral
health, such as mouth dryness, which contributes to more
rapidly advancing tooth decay and gum disease. The CDC
estimates that only 22% of adults 65 years and older are
covered by dental insurance; most elderly dental expenses are
paid out-of-pocket.
3)MEDICARE . Medicare is the national health insurance program
that guarantees access to health insurance for Americans aged
65 and older, younger people with disabilities, and people
with end stage renal disease. Medicare was established to
provide health insurance regardless of income or medical
history. Before Medicare, only about half of older adults in
the U.S. had health insurance, with coverage either
unavailable or unaffordable to the other half.
Medicare has four parts: A, B, C, and D. Part A (the Hospital
Insurance program), covers inpatient hospital, skilled nursing
facility, home health, and hospice care. Part B (the
Supplementary Medical Insurance program), covers physician,
outpatient, home health, and preventive services. Medicare
Parts A and B cover all "reasonable and necessary" medical
services and hospital services, including lab tests, skilled
nursing and some home health care, with the exception of
vision, hearing, dental, and long-term care. Part C (Medicare
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Advantage), allows Medicare enrollees to participate in
private health plans that must cover all the Part A and B
benefits as an alternative to traditional Medicare. Part D
covers outpatient prescription drugs.
4)MEDICARE DENTAL EXCLUSION . Medicare does not cover routine
dental care or most dental procedures such as cleanings,
fillings, tooth extractions, or dentures. It does pay for
dental services that are an integral part either of a covered
procedure (i.e., reconstruction of the jaw following
accidental injury), or for extractions done to prepare the jaw
for radiation treatment secondary to cancer. Medicare will
also make payment for oral examinations, but not treatment,
prior to kidney transplantation or heart valve replacement,
under certain circumstances. Coverage for services is not
determined by the value or the necessity of the dental care
but by the type of service provided and the anatomical
structure on which the procedure is performed.
The dental exclusion was included as part of the initial
Medicare program. In establishing the dental exclusion,
Congress did not limit the exclusion to routine dental
services, as it did for routine physical checkups or routine
foot care, but instead included a blanket exclusion of dental
services. Congress has not amended the dental exclusion since
1980 when it made an exception for inpatient hospital services
when the dental procedure itself made hospitalization
necessary.
5)DUAL ELIGIBLES . In California, as in most states, low-income
seniors and persons with disabilities who qualify separately
for both Medicare and Medi-Cal are called "dual eligibles."
According to data from the federal Centers for Medicare and
Medicaid Services, dual eligibles are among the most
chronically ill and costly individuals enrolled in both the
Medicare and Medicaid (Medi-Cal in California) programs, with
many having multiple chronic conditions and/or long-term care
needs. More than half of "duals" have incomes below the
poverty line, compared with 8% of other Medicare
beneficiaries, and 60% have multiple chronic conditions.
Approximately 19% live in institutional settings compared to
only 3% of other Medicare beneficiaries. As of January 2011,
70% of the 1.1 million duals in California were age 65 or
older. Most state General Fund dollars spent on duals are for
long-term care services.
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6)SUPPORT . The sponsor of this resolution, the California
Senior Legislature, states that a major factor in senior
citizens not obtaining dental care is financial and, even if
cost is not an issue, about 30% of older adults face
difficulties in getting to a dental office because they may be
frail, homebound, or live in nursing homes. The sponsor
maintains that it would be a worthwhile investment for
Medicare to include dental coverage because many of the
diseases associated with poor dental health in older adults
are preventable and could be avoided or mitigated through
access to routine dental care. Health Access California
writes in support that Medicare, which keeps seniors healthy
across the country, could remove cost as a significant barrier
to seniors seeking dental care by including dental care as
part of its benefit package.
7)TECHNICAL AMENDMENT . On page 2, line 9, delete "citizen" and
insert "citizens".
REGISTERED SUPPORT / OPPOSITION :
Support
California Senior Legislature (sponsor)
American Federation of State, County and Municipal Employees,
AFL-CIO
Health Access
Opposition
None on file.
Analysis Prepared by : Cassie Royce / HEALTH / (916) 319-2097