When Patient Dollars Are Diverted from Patient Care, Health Suffers


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“Wait ‘till next year” may be an appropriate refrain for sports fans disappointed in their team’s finish at season’s end, but it is not an acceptable response from legislators when Connecticut residents overwhelmingly want the premium dollars they pay to insurance companies for dental coverage to be devoted to their dental care, not diverted to insurance company overhead and profits.

Yet, that is the unmistakable message emanating from the State Capitol, more than two months into the current legislative session. Legislators apparently are uninterested in assuring their constituents that they will take action to ensure that dental premiums are spent in the same way that medial premiums are spent – predominantly on patient care. 

In fact, legislators have thus far been reluctant to even schedule a public hearing that would provide their constituents an opportunity to give voice to the well-documented concerns about the inequitable status quo. There should not only be a public hearing – which seems both obvious and fundamental – legislators should pass a law to establish parity in how patient premiums are spent.

The current disparity is unmistakable. As little as 40% of the dental premium dollars that patients pay to insurers goes to dental care. The vast majority – as much as 60% – is retained by the insurance company for executive compensation, corporate profits and administrative costs. For medical insurance premiums, it is just the opposite.  In accordance with federal law, at least 80% of medical premiums must go to patient care. 

What’s needed is parity in how health insurance payments are treated, whether they are for medical insurance or dental insurance. That is what the Connecticut proposal, House Bill 5813, would require. It would also ensure transparency – insurance companies would be required to disclose how dental insurance premiums were spent, revealing the percentage paid for dental care and the percentage retained by the insurance company. If an insurance carrier failed to invest at least 85% of premiums to patient oral health, the difference would be refunded to the patient.

Since the vast majority of dental premiums are retained by insurance companies, when premiums are increased it is the companies, rather than the patients, that realize the benefit. As we have seen in other industries, citizens and small businesses have little chance of breaking through the wall of corporate greed, to their detriment. 

That’s particularly alarming in this instance, because increasing premium costs are a disincentive for patients to continue their coverage, which can lead some to drop not only their coverage but their regular visits to the dentist – and that can, and often does, adversely impact their overall health. In Connecticut, that result should be unacceptable, which is why the Connecticut legislature must move forward with this bill and get it closer to becoming law. Their current refusal to act on this issue in the current legislative session is inexplicable and adverse to the public interest. 

When state residents were asked their views in a public opinion survey, 94% said that Connecticut should require dental insurance companies to report to the public the percentage of the premium dollars they collect that is spent on patient dental care and the percentage that goes to the insurer’s overhead. Additionally, 91% said they support the state imposing a limit on the percentage of the dental insurance premium that can be used for insurer’s administrative costs.  The results couldn’t be clearer.

Some at the State Capitol have apparently suggested that the issue is far too complex to unravel in the remaining three months of the legislative session.  What complexity?  Why can’t dental premiums be spent in similar proportions as medical premiums. Why is dental insurance not being given the same respect as medical insurance? Both are designed to promote public health.  It seems that legislators are desperately trying to hold on to a distinction that should not exist.  Why?

As a young, public-health-oriented dentist, I tend to look ahead, towards ways to forge progress for my profession and the population dental professionals serve. Though I can only treat so many of my own patients, I can serve as a patient advocate and raise awareness for the health and wellbeing of all this state’s citizens. Misguided current public policies that turn patients away and does not keep their best interest at heart, however, cloud the future I seek to build, not only for dental professionals, but for dental patients.

“There’s a misconception that oral and overall health are separate entities. They’re not. The mouth is the primary access point for the nutrition and oxygen every living body needs to survive,” Guardian recently pointed out on its website.  “Good oral health is an essential part of your overall wellbeing.” Simply put, there is no overall health without dental health, which makes legislative action on this issue vital. Bridging the gaps between the disparities of medical and dental insurance begins with ensuring that the majority of patient’s dental insurance premium dollars are spent on their care, just as their medical insurance premiums are.

Now is the time to act.  Now is the time to establish parity.  Now is the time to put public health and public policy in synch.  The importance of dental care is well known and widely recognized. Dental care is not secondary or supplemental, it’s vital primary care. Connecticut’s policy should reflect that, not ignore it.

Dr. Joseph Manzella is an associate dentist practicing full-time in North Branford, CT, and is an active member of the American Dental Association, Connecticut State Dental Association, and New London Dental Society. While in dental school, he concurrently earned his Master of Public Health degree and was American Student Dental Association Speaker of the House, 2020-21.