CT patients’ premiums should pay for dental health

The concept driving the much-needed reform is straightforward: dental patient premium dollars ought to be spent on patient care. The formal statement of purpose in proposed legislation at the State Capitol is succinct and unambiguous:  “To establish the same medical loss ratio for dental insurers as currently applies to medical insurers.”

The proposed legislation (HB 5813) would ensure that the percentage of consumers’ insurance premiums that are applied to patient care – and not bureaucratic and administrative overhead – would be no different for dental care than medical care.

Surprisingly, that is not true today.  In fact, the percentages are vastly different.  For medical coverage, at least 80% or 85% of patient premiums must be devoted to care, in accordance with the Affordable Care Act.  For their dental insurance coverage, consumers have no such protections – meaning that a much greater percentage of patients premiums could – and often do – go to insurance company expenses rather than the care and treatment they receive at the dentist’s office.

When one considers that oral health is an indispensable aspect of overall health, it is counterproductive to have patients pay for things other than what’s important to their health – especially at a time when costs are rising all around us and many families are deciding what they can afford and what’s just out of financial reach.

Plainly put, there ought to be a law requiring a minimum amount of dental premiums to be spent on patient care.  The result would be better dental benefits for patients, greater transparency and accountability, and more families empowered to seek the dental care they need.

The existing disparities risk compromising patient health.  It is time for parity, and consumer protections.  Patients should not be left to wonder how much of their money is going to their care and how much is going elsewhere.  Patients should be assured that state policy does not permit a greater percentage of their insurance payments to be siphoned off from paying for their care when they visit their dentist.

The legislation was proposed by one of the General Assembly’s longest serving legislators, Rep. Mary Mushinsky of Wallingford, first elected to the Connecticut House of Representatives in 1980.  Now a Deputy Speaker of the House, she has, over four decades, earned the respect of colleagues for sound judgement, bi-partisan leadership and commitment to the public good.

The proposed protections should be considered by the legislature, and discussed at a public hearing – to be attended by members of the public and industry experts.  It’s likely that  testimony will highlight why this common-sense proposal is indisputably in the best interest of Connecticut consumers. There is no vocal opposition to this proposed legislation and it benefits all Connecticut residents.

The imperative is inescapable: patient dollars should be spent on patient care rather than administrative and overhead costs, such as salaries and marketing, or profit.  This effort will mandate that dental insurance plans that don’t meet the requirement of spending at least 85% of patient premiums – 85 cents of every dollar – on patient care will now have to refund the difference to covered individuals and groups.

There’s no doubt about the level of public support for such long overdue reforms.  In Massachusetts last November, approval was overwhelming – the largest ballot passage in the state’s history with 72% of voters supporting their MLR ballot measure – widespread agreement that what patients pay in premiums should go to the actual care they receive rather than to insurers’ bottom line.  In a 2021 poll, 91% of Connecticut residents supported the state limiting the percentage of dental insurance premiums that could be used for administrative costs.

Connecticut patients deserve transparency and accountability, and for more of their hard-earned dollars to go directly to their oral health care, as opposed to funding the exorbitant CEO salaries of insurance companies.  This legislative session, lawmakers have a perfect opportunity to elicit change that benefits every citizen in the Constitution State.  These are basic, fundamental consumer protections in the public interest, and ought to be adopted sooner rather than later.  Doing so will mean better dental benefits and better access to dental care for patients.

Importantly, legislative action will reaffirm the principal that health is fundamental to our quality of life, and in Connecticut, every oral health care provider wants to attain one goal – provide the care that our patients need and deserve as a basic human right.

Dr. Bryanne Chandler and Dr. David Fried are co-Chairs of the Connecticut State Dental Association Council  of Government Affairs.