When it comes to voting issues, proponents say it should be pretty simple: make sure the bulk of dental insurance premium costs end up in patients’ mouths.
Opponents argue the measure, a 21-13 voting matter, will increase premium costs, reducing consumer choice and blocking access to dental insurance for the state’s most vulnerable residents, especially children. .
The question, whether the signatures presented to Secretary of State William Galvin on July 6 are certified, would ask voters to approve a measure requiring dental insurers to spend 83% of insurance premiums on patient care, and whether funds are not spent, the excess would be returned to subscribers.
Staff in Galvin’s office are reviewing the submitted documents, a spokesperson for the secretary said. The process is laborious, but should be completed by mid-July.
What is an overall medical loss rate?
In Massachusetts, 88% of health insurance premiums must be used for treatment, otherwise they are returned to the policyholder as a refund. This is called an annual overall medical loss ratio.
Extending it to dental insurance makes sense, say proponents.
The two sides sparred in the shadow of the Massachusetts State House on July 6 when they made their case at a midday rally.
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Dianne Morad, a lobbyist working with the Voting Matters Committee, told the press conference that some large dental insurance companies are spending up to 40% of what they collect in premiums on “executive salaries , premiums and other administrative expenses” rather than on the patient care.
“A yes vote would help fix a broken system in which insurance companies benefit from denying claims and limiting coverage,” Morad said.
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Proponents of the measure swapped dental anecdotes: The routine cleaning that revealed the need for fillings? Not covered. The removal of impacted wisdom teeth that would be covered by a health insurance provider, but only if the medically necessary surgery was performed in a hospital rather than on an outpatient basis.
Congratulations,” Joseph Giannino said dryly, noting that hospitals don’t routinely perform these oral surgeries.
Tooth pain does not “go away”
“Tooth pain doesn’t go away, it needs to be treated,” Giannino said, noting that many illnesses resolve on their own, regardless of medical interventions, citing the common cold as an example.
Sen. Harriette Chandler (D-1st Worcester) has proposed a bill (S.632) that echoes what could be included as a ballot initiative in November.
Dental health is essential to overall health, according to the Massachusetts Dental Society (MDS). According to their informative leaflets, “Oral health plays a very important role in overall health” with many systemic diseases indicated by oral health symptoms. Plaque, periodontal (gum) disease, missing teeth all contribute to other conditions, including lung problems (COPD), heart disease and stroke.
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According to the MDS, pregnant women with periodontal disease are more likely to give birth prematurely. And low birth weight babies are more likely to have breathing problems, anemia, jaundice (yellowing of the skin due to liver problems), developmental delays and even congestive heart failure. . Teeth and gum problems can indicate diabetes and osteoporosis, a condition that affects some 10 million Americans, including 8 million women.
Giannino said that unless the bulk of premium costs are redirected to patient care, families with minimal policies or living on the economic margins could forego care until oral care issues erupt. dental become emergencies.
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The board of directors of MDS, a professional association representing some 5,000 member dentists, approved the measure. The group, dedicated to the professional development of its members through education, advocacy and advancement of professional standards, has been advocating for dental insurance reform for years.
The American Dental Association endorses the measure
“As an advocate for dental care for all Massachusetts residents, MDS endorses the Massachusetts Medical Loss Ratios initiative for dental insurance plans and encourages Massachusetts residents to adopt it in November,” said said Dr. Meredith Bailey, president of the organization. “Patient dollars should be spent supporting their oral health, and patients deserve to see how much of their dental insurance premiums pay for care as opposed to administrative costs,”
Bailey noted that the American Dental Association (ADA) is also in favor of passing the November ballot question. California, Bailey said, has already approved a similar measure after finding that only 76% of bonuses were earmarked for patient care.
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The measure includes requiring dental insurers to disclose the projected medical loss ratio for their plans. It also requires them to anticipate base group rates and file those advance fees by July. The measure also puts approval of base rates in the hands of the state commissioner of the Massachusetts Division of Insurance.
The Committee to Protect Access to Quality Dental Care, which is a coalition of dental plans, health plans, life insurers and professional associations organized in opposition to the initiative, said that he feared the measure would increase health care costs for consumers and small businesses. .
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“Supporters of this election issue are not being candid with voters,” according to a statement released by the commission. “What they’re not telling you is that their anti-consumer proposal will increase costs for Massachusetts families and employers – an almost 40% increase in premiums in a recent study – and may result in denial. access to much-needed dental care that thousands of residents care about.”
A study commissioned by the National Association of Dental Plans examining the costs and benefits of the proposal found that most Massachusetts dental insurers spend about 68% of premiums on patient care. According to the report, small businesses allocate 60% of premiums to patient care; large companies, 77%. The rest of the premiums billed are used, in part, for administrative costs.
The Milliman Research Group study found that the proposal would impact companies with a smaller customer base, as the administrative costs of insuring patients are borne by fewer customers. Additionally, the cost of fulfilling the 83% mandate, coupled with the cost of discounts, would tax the company’s revenue.
Opponents predict jumps in bounties
Opponents argue that a yes vote on the ballot issue in November could drive some dental insurance providers out of Massachusetts.
“With consumer prices reaching all-time highs, the Commonwealth does not need this additional regulation which will only increase costs and reduce patient choice statewide,” a committee statement said. of opposition.
The study predicts that premiums could increase by 38%, from $35 per month to $50.
It would be painful for consumers’ wallets.
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However, Morad said at least one major Massachusetts provider has the same number of millionaires on its board as the state’s largest health insurer; Blue Cross Blue Shield.
“And these insurance providers are designated as nonprofits,” Morad said.
The State House News Service contributed to this report.