Sharon Marchio lacks teeth to eat, speak and smile.
For several years, after the extraction of her last teeth, she has been using dental prostheses. “My dentist calls them my floating teeth because no matter how much adhesive you use, if you eat something hot or hot, they come loose and it’s a pain,” said Marchio, 73, of Clarksburg, West Virginia.
Marchio thinks losing his teeth was just part of aging. It is quite common in West Virginia, where a quarter of people 65 and older do not have natural teeth, the highest rate of any state in the country, according to federal data.
Like half of those enrolled in Medicare nationwide, Marchio does not have dental insurance. Concerns about costs led her to skip regular cleanings and checkups, crucial steps in preventing infections and tooth loss.
Medicare doesn’t cover most dental care, but consumer advocates had hoped that would change this year after Democrats took control of the White House and Congress. President Joe Biden and the Progressives, led by Senator Bernie Sanders, have sought to add the benefit to a major national spending program, the Build Back Better Act, which Democrats are seeking to pass.
But those chances seem slim because at least one Democratic senator – Joe Manchin from, yes, West Virginia – opposes adding dental and other benefits for Medicare beneficiaries. He says it’s alright cost the federal government too much.
In a Senate split evenly between Republicans and Democrats, losing Manchin’s vote would likely sink the proposal, which is unlikely to win Republican votes.
Last month, the House passed the Democrats’ roughly $ 2 trillion national priority package that includes health measures, a free kindergarten, affordable housing programs and initiatives to fight climate change. He added Medicare hearing services coverage, but no dental benefits. The package is expected to undergo Senate revisions, and Democratic leaders are hopeful that a vote will take place in the chamber before the end of the year.
In West Virginia, one of the most Republican states in the country, oral health advocates and progressives say it is disappointing that Manchin is blocking the addition of dental coverage for dental beneficiaries. Medicare – especially given the state’s poor oral health record.
“It is unfortunate that our senator – with whom I respect and with whom I agree on a lot of things – is going to draw the line on this issue,” said Fotinos Panagakos, associate dean for research at the West Virginia University School of Dentistry and a member of the Santa Fe Group, a think tank of academics, industry leaders, and former government officials pushing for a Medicare dental benefit. “It would be a huge advantage.”
West Virginia has the third highest share of people 65 and over, behind only Florida and Maine. Panagakos said nearly 300,000 West Virginia Medicare beneficiaries would receive dental benefits under the bill. Yet Manchin’s efforts are not likely to cost him politically. He is not a candidate for re-election before 2024.
“What political price do you pay when four other Republicans vote ‘no’ against everything? Ryan Frankenberry, state director of the Progressive Working Families Party in West Virginia, said, referring to the three members of the State House and Senator Shelley Moore Capito, who all oppose the project. of law. “It’s a difficult argument to blame one person for not passing the advantage when every other Republican vote is against it.”
Manchin’s opposition, Frankenberry said, stems from the need to respond to political pressure to represent an increasingly conservative state – and from arguments by conservative commentators that Medicare is becoming insolvent and increasing the federal deficit.
Manchin, who has not responded to interview requests, has expressed concerns over adding new Medicare spending as the Medicare Part A hospital trust fund is set to become insolvent in 2026 if Congress takes no action. measure. But this fund would not cover the proposed dental service; it would be part of Medicare Part B, which covers outpatient services such as doctor’s visits.
Manchin also suggested that new social programs offered by Democrats under the Build Back Better Act should be means-tested – in essence, only offering coverage to low-income people.
Dentists fear Medicare – like Medicaid – will pay less than they normally charge, said Richard Stevens, executive director of the West Virginia Dental Association.
The American Dental Association has also called for limiting any new dental benefits of Medicare through resource testing. ADA officials say a resource test would ensure the benefit helps those who really need it and saves money for the Medicare program.
But critics say the ADA’s position is an effort by the powerful dental lobby to kill the edge – because it knows Congress has little appetite to turn to resource testing in Medicare. The program remains popular in large part because anyone 65 and over is entitled to all of its benefits.
“On the surface, their position seems altruistic,” said Michael Alfano, former dean of the New York University College of Dentistry and helped found the Santa Fe Group. “But Congress has no interest in making this a means-tested advantage.”
While adding a Medicare benefit would increase the demand for dental services, it would also reduce what is considered to be dentists’ most lucrative patients, those who pay out of pocket and do not benefit from reduced fees by insurers, Alfano said. “In my mind, the ADA didn’t have the public interest at heart – they put dentists’ financial returns at the top of the ledger when developing this approach,” he said.
Alfano said there was still hope for a last minute change in the bill. “It’s not dead, but I would be lying if I said I wasn’t disappointed,” he said.
Seniors in West Virginia have other options for getting dental coverage.
Many enjoy certain benefits when enrolling in private Medicare Advantage plans. And in January, West Virginia added an adult dental benefit to Medicaid, the federal-state health insurance program for low-income people, offering enrollees a maximum annual benefit of $ 1,000. Previously, West Virginia was one of a dozen states that either provided no adult dental benefits to Medicaid recipients or only covered emergencies.
As of September, about 53,000 of the nearly 390,000 adults enrolled in West Virginia’s Medicaid program had used this benefit.
Stevens of the West Virginia Dental Association said he couldn’t explain why so few Medicaid enrollees had used the benefit, although he noted that the $ 1,000 maximum might not be enough to persuade some to seek treatment. “For people with more serious oral health problems, $ 1,000 doesn’t go very far,” Stevens said. “It’s hardly worth the time for the patient and not the time for the dentist. “
Craig Glover, CEO of FamilyCare Health Centers at Charleston, West Virginia, said a Medicare benefit would help the many older patients who visit his dental clinic. He said some patients are not returning for necessary follow-up care due to cost concerns.
Without dental coverage, West Virginia seniors depend on community health centers – which offer a sliding scale of rates based on income – and free health clinics for care. But they can still face higher costs than they can afford or long waits for care.
Dental appointments at the Susan Dew Hoff Memorial Clinic in Milford West, where Marchio received treatment, are booked several months in advance, said office manager Gail Marsh.
This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism on health issues. KHN is one of the three main operating programs of KFF(Kaiser Family Foundation), an endowed nonprofit organization that provides information on health issues to the nation. The story has been published with permission.