Artwork: Brendan Lynch/Axios
The digestion of question 2 feels like pulling teeth.
The big picture: When you get past the jargon, the metric that voters will face when they go to the polls on Election Day comes down to how much of our insurance premiums should cover dental procedures and how much insurers should pocket.
A “yes” would force insurers to spend 83 cents of every dollar on patient dental care, a threshold known as the “medical loss rate.”
- That would leave 17 cents of every dollar for administrative costs, taxes, and revenue.
- It would be the first law of its kind in the United States regulating dental plans in the same way as medical plans.
A “no” would impose no threshold on dental insurers.
Details: The proposed dental insurance overhaul would cause the state’s Division of Insurance to block proposals in which insurers pay less than 83% for dental care, according to a report by the Tufts University Center for State Policy Analysis.
- It would also force insurers to give discounts if they fail to meet the 83% standard.
- They would also be required to disclose more financial and operational data, per CSPA.
There are few details on the portion of premiums that typically covers dental care, which is perhaps why the ACPD notes that the voting question is “built on relatively thin information.”
- The report says many dental insurers could easily adapt to an 83% standard, with the exception of “smaller and less efficient health insurers”.
Yes, but: A report by the National Association of Dental Plans indicates that in one scenario, a small insurer would have to increase premiums by 38%, from $35 to $50, and increase claims by 60% to meet the threshold while pocketing enough to maintain the company afloat.
- The CSPA report says insurers could meet the 83% standard in several ways, such as covering a wide range of procedures or letting dentists charge a higher price and pass the costs on to patients.
What they say : “Patient premium money should be spent supporting patient care, and dental patients deserve to know how much of their dental insurance premiums go to their actual care versus insurers’ profits and administrative costs,” said Andrew Tonelli, co-chair of the Massachusetts Dental Society’s Governmental Affairs Committee and former president of the Boston District Dental Society, in a recent press release.
The other side: Former state senator James Welch, representing the Committee to Protect Access to Quality Dental Care, told GBH News’ Jim Braude that the government shouldn’t regulate dental insurance in the same way that it regulates medical insurance, which is compulsory.
- Since dental plans are not mandatory, dental insurers tend to have fewer policyholders than medical insurers. Yet dental insurance companies face the same administrative costs as medical insurers, according to the committee.