BILL ANALYSIS �
AJR 30
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ASSEMBLY THIRD READING
AJR 30 (Pan)
As Introduced March 7, 2012
Majority vote
HEALTH 13-5
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|Ayes:|Monning, Ammiano, Atkins, |
| |Bonilla, Eng, Gordon, |
| |Hayashi, |
| |Roger Hern�ndez, Torres, |
| |Mitchell, Pan, V. Manuel |
| |P�rez, Williams |
| | |
|-----+--------------------------|
|Nays:|Logue, Mansoor, Nestande, |
| |Silva, Smyth |
| | |
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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.
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FISCAL EFFECT : None
COMMENTS : 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 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.
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.
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.
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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.
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.
Analysis Prepared by : Cassie Royce / HEALTH / (916) 319-2097
FN: 0003193
AJR 30
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