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Pediatric Oral and Vision Care Included in ACA's Ten Essential Benefits

Dentists in Practice at Buzbee Dental
Tyler, Gary and Todd Buzbee (Credit: Buzbee Dental)

Although kids might not look forward to a visit with the dentist or eye doctor, the care is important for keeping their teeth and eyes healthy.  But for many families, that care isn’t affordable at a regular dentist or eye doctor’s office.

The Affordable Care Act is expected to result in an increase in the number of people who have dental and vision coverage, especially children.

Dentist Dr. Gary Buzbee, with Buzbee Dental in Springfield, says it’s important for kids to have access to dental care for a couple of reasons.

"I think it's very important that they have a good, you know, solid background of dental care, preventive and everything, but the education component of it for parents of these children is incredibly important, and there's lots of programs out there now through the ADA and the government about stop the sweets and all those, so lots of education I think are going to be very important there also," he said.

According to Dr. Mark Rushefsky, a political science professor at Missouri State University, dental and vision are included in the Affordable Care Act’s ten essential benefits for children.

Rushefsky says the Pew Center for the States has come up with a figure for how many kids are expected to receive dental coverage through the ACA.

"They are estimating, and, again, it's just an estimate--we don't really know, that about 5.3 additional children will get dental coverage under the Affordable Care Act.  Some of that's gonna come through the exchanges and some of that's gonna come through Medicaid," he said.

Under the ACA, states must include dental and vision on their health care exchanges, either as part of a healthcare plan or as stand-alone policies.  But parents aren’t required to purchase the plans.

Georgia Cable, manager with eligibility services at Mercy, says she hasn’t seen any vision plans on the federal healthcare exchange available to Missourians.  But there are some stand-alone dental plans.  Most, she says, have a premium of between $19 and $50 per month with $700 deductible and anywhere from 0 to $100 out of pocket max.

She acknowledges that even when kids have dental insurance, it doesn’t necessarily mean their families will be more likely to take them to the dentist.

"Even though it's considered, you know, an essential health benefit, I do think that there's still going to be people that are not able to afford the out of pocket expense," she said.

She says the folks who have been coming to the CAC’s at Mercy for help with the federal healthcare exchange are curious who will accept the dental plans.  States are required to provide adequate access to care, but it’s up to the states to define the term “adequate.”

Dr. Buzbee isn’t expecting a huge influx of new patients into his practice, and he isn’t worried that the ACA will change too many things for him and his co-workers.  He says he’s been in practice for 37 years and has always taken Medicaid, so the transition for him won’t be significant.

According to Dr. Buzbee, it’s estimated that the Affordable Care Act will have reduced the number of kids without dental insurance by 55% or 8.7 million by 2018.  He says, even if families have high deductibles, just having dental insurance will be a good thing.

"I think people feel a certain amount of comfort in knowing  that the coverage is there for them if they have--I mean, if we can get to these kids preventively at an early age and teach them the right dental habits from the beginning, if that portion of the act works then it's a success," he said.

As far as vision care, at least one local ophthalmologist is thinking about how the ACA might impact his practice.  Dr. Shachar Tauber with Mercy Clinic Eye Specialists, says the law at this point is creating a lot of uncertainty.

"We're in the throes of tremendous confusion, and as an ophthalmologist, we deal with patients that are primarily elderly--cataracts, glaucoma, macular degeneration.  These affect patients later in life, and they are not as savvy to ways of signing up and all the confusion that's going on.  I think it's creating a tremendous concern amongst our patients," he said.

How to handle that, he says, is challenging because they don’t have the answers those patients would like.

He says they’ve been told to expect an influx of new patients, but he’s not sure that’s going to happen.

"As an ophthalmologist we are in a different situation.  I think the issue that we have is that our patients are less likely to  care for their eyes and more likely not to make eye care a priority, so we may not see that influx come in," he said.

According to Tauber, no matter what happens, he and his co-workers will continue to provide care for their patients.