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Op-ed: Invest in oral health equity

As we begin to emerge from the COVID-19 pandemic, we can look back and once again see that barriers to accessing health services can have devastating consequences. These past 12 months have demonstrated how a global health crisis can further intensify long-standing systemic health inequities that have disproportionately affected Black, Indigenous and other communities of color, lower-income households and rural areas.

These inequities, and the disparate health outcomes they produce, are a call to action for health systems, community leaders, advocates, social service organizations, and policymakers to examine the current state of healthcare and see where improvements can be made.

Washington’s Legislature has an opportunity to make meaningful progress toward health equity by improving dental care access for lower-income adults. The Senate has proposed increased investments to the tune of $21 million in state funds, leveraging an additional $54 million in federal funds, over the biennium to help increase oral health care for the more than one million adults covered by Apple Health, Washington’s Medicaid program. We urge lawmakers to include this money in the final budget and ensure that this funding level is sustained moving forward.

While the Apple Health adult dental benefit is essential, coverage does not necessarily equate to access to care. Years of underfunding the program have led to significant access barriers. Washington’s low provider reimbursement rates hover near the bottom nationwide at about 32-cents on the dollar in comparison to what private insurance pays. Apple Health reimbursement rates have remained unchanged since 2007 even as the costs of delivering care continue to rise.

The result is that it is challenging for many dental providers to see Apple Health-insured patients when reimbursements fall so short of recuperating operating costs. Fewer dentists who are able to deliver care for Apple Health-insured adults limits access. This is especially so in rural and underserved communities that often have fewer providers overall.

Legislators have a chance to take meaningful steps to help address these access barriers in the coming days as they finalize the state operating budget.

Access to oral health care is a matter of health equity and overall wellbeing. If you’ve ever experienced a toothache, you understand firsthand how the pain can impact your health, productivity, demeanor and outlook on life. Poor oral health also is connected to overall health and chronic conditions like diabetes, pregnancy and heart disease. Visible decay and missing teeth can influence employability, job advancement opportunities, self-esteem and how others perceive you.

And dental problems don’t go away when people are unable to access care. The unfortunate consequence is people needlessly suffer through untreated dental pain, experience declining health, and risk that small problems become more serious, likely more expensive to treat conditions. Some will end up in the emergency room.

It’s heartbreaking to see people suffer this way, particularly when we know that oral disease is largely preventable. Coupling good oral health care practices like regular brushing, flossing and drinking fluoridated water with routine checkups and early dental care treatments can lead to improved oral health.

The COVID-19 pandemic has made painfully evident that disparities in health care access persist and that prevention is a critical part of a healthy, resilient community. Increasing our state’s investment in the Apple Health dental program would allow more Washington adults to access the care they need to live healthier, more satisfying lives. The one lesson we hope society has learned this past year is that investments that promote health equity and reduce barriers to care are not only good health policy, but they are also the right thing to do.


Vanetta Abdellatif is president and CEO of Arcora Foundation, the state’s largest foundation dedicated to improving oral health.

Andrew Lofton is Executive Director of the Seattle Housing Authority and a Board member of Arcora Foundation


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