Medicare is the government-funded health coverage plan that is specifically designed to assist older adults. It includes numerous elements intended to target elders’ general medical needs. However, Medicare often does not involve the coverage of oral care (Macek et al., 2017). Incorporating dental care with universal health care will help study the outcomes of preserving dental health. Moreover, research explains that individuals with access to medical and dental coverage have better physical health and oral health–related life quality (Chávez et al., 2017). Thus, the bill asking Congress to include dental care in Medicare would enlarge the possibility of improved dental health outcomes for all senior citizens. The purpose of this policy analysis is to discover the bill’s information, which will help develop the SWOT analysis, comprehend the bill’s effects on various levels, and prepare nurse leaders to take appropriate actions.
Information about the Bill
Bill Title and Area of Concern
Bill HJM 4014 – 2019-20: Asking Congress to include dental care in Medicare. Bill HJM 4014 – 2019-20 aims to have dental care added to Medicare, as it is the primary provider of healthcare for nearly sixty million Americans (Asking Congress, 2020). The low-income elderly, in particular, are vulnerable, as many do not have access to any dental care. Lack of proper oral care can result in more significant health issues if left untreated. Thereby, expanding Medicare to include dental care would improve the well-being of Medicare recipients while possibly reducing costs, as proper oral health, can offset more severe conditions. The main aim of the bill is to get Congress to include dental care in Medicare coverage.
Background of the Issue
Medicare is the primary source of healthcare for many Americans, particularly the elderly and the disabled. In Washington State, more than one million residents rely on Medicare for their healthcare. As a result, almost thirty-nine percent of Washington State residents do not have any form of oral health insurance (Asking Congress, 2020). Seniors are particularly affected, as twenty-eight percent of Washington State seniors suffer from severe tooth loss, measured as having lost six or more teeth. In comparison, ten percent suffer from total tooth loss. Low-income elderly are similarly affected, as one fourth suffer from total tooth loss (Asking Congress, 2020). This oral damage is not evenly distributed by race; the non-white elderly are more likely to suffer from tooth damage than white seniors (Asking Congress, 2020). The quality of dental health has a direct effect on the general health, as poor oral health is positively linked to heart disease and diabetes. Access to oral healthcare could allow these conditions to be preemptively limited.
Stakeholders and Their Position
The direct stakeholders regarding this bill are individuals on Medicare, as this bill would give them access to dental care. The elderly and the disabled, in particular, are direct stakeholders. Dental healthcare providers are also direct stakeholders, as this bill would influence the number of clients seeking dental care. Indirect stakeholders include the Federal Government, which will have to allocate more resources towards Medicare to cover the cost of dental healthcare. General healthcare providers are also indirect stakeholders, as the long term effects of more oral health may influence their work.
The SWOT Analysis
Evaluation of Bill’s Effect
Institutional: Fighting Inequalities
The bill proposes the inclusion of affordable dental care in Medicare health insurance. The study conducted by Lutfiyya et al. (2019) discovered the sufficient level of inequalities among citizens receiving dental care. The disparities were predominant among males, residents of rural areas, and individuals with yearly income less than $50,000 (Lutfiyya et al. 2019). The similar disadvantages were visible among Black and Non-Hispanic residents as well as individuals with severe dental problems and current-smokers (Lutfiyya et al. 2019). The inequalities are especially noticeable because legally, “state Medicaid programs can decide whether dental services should be covered for adults and to what extent” (Willink et al., 2016, p. 2241). Therefore, the lack of appropriate dental care within the frameworks of Medicare leads to institutional inequalities in society. Thus, including oral health services in Medicare can positively influence institutional changes, which will benefit stakeholders that cannot have immediate access to dental specialists.
Local: Improving Overall Well-Being of the Stakeholders
Local stakeholders of all backgrounds might benefit from the bill, as improved dental health leads to the advancement of the overall well-being. Numerous studies suggest that dental health is linked to the quality of physical and mental health. Frequent preventive oral care examination can identify the origin of multiple illnesses, including cancer (Willink et al., 2016). Moreover, the proper dental condition is recognized as a significant determinant of an individual’s quality of health. Thus, the study shows a correlation between dental health and “cardiovascular disease, premature or low birth weight babies, depression, asthma, and chronic obstructive pulmonary disease” (Lutfiyya et al. 2019, p. 1). Besides physical health issues, individuals can suffer mentally, as it affects the quality of social life. Poor dentition can reduce the likelihood of societal inclusion, as it leads to a lack of self-esteem. Timely oral care can effectively prevent various dental problems, including tooth decay and more. Thus, the bill will positively affect stakeholders on a local level by improving their physical and mental well-being.
State: Shortage of Medical Specialists
The bill will encourage individuals to visit dental care professionals more often, as it will become more accessible, which might lead to an immediate shortage of personal short-term. The 2019 study discovered that adults residing in states with the smallest quantity of practicing dentists per hundred thousand residents had visited dentist professionals much less in the past year (Lutfiyya et al. 2019). Thus, some states do not have an appropriate capacity to satisfy the expected demand for dental care professionals after the bill is introduced. Moreover, the research on the topic of Medicaid revealed that the introduction of dental coverage doubled the number of patients visiting the Emergency Department for oral care purposes (Baicker et al., 2018). Therefore, it is reasonable to assume that similar changes to Medicare will lead to a rise of interest in dental services. Thus, on the state level, stakeholders might be affected negatively, as they might face the shortage of medical personal, at least shortly after the bill.
Nurse Leader as an Agent of Change
A Change Agent
The Essentials of Master’s Education in Nursing proposes various essentials that guide nurse leaders’ actions. The Essential IV, which stands for the incorporation of scholarship into medical practice, suggests that Master’s education prepares nurses to apply the research on practice (American Association of Colleges of Nursing, 2011). This means that a qualified nurse should have the ability to resolve problems and work as a change agent. Therefore, the nurse can conduct research connected to the effectiveness of dental care, which can be used in practice by a wide range of medical professionals and policy-makers. Overall, nurses should be ready to implement quality principles within various organizations to act as competent change agents.
A Policy Contributor and an Advocate
Moreover, qualified nurses can influence policy-making and should advocate for high-quality healthcare. The Essential VI, which covers the topics of health policy development and advocacy, suggests that Master’s Education enables nurses to engage in the policy-making process (AACN, 2011). Additionally, qualified professionals should apply advocacy tactics to impact and shape the overall healthcare setting. Thus, the nurses can advocate for the bill’s acceptance, as it aligns with the core values of the entire healthcare setting. The decision to include dental care into Medicare will make healthcare more affordable and accessible. Therefore, nurses should cooperate with different professionals within the field to support the system’s improvement.
Conclusion
Bill HJM 4014 – 2019-20: Asking Congress to include dental care in Medicare aims to provide American citizens with affordable oral health treatment. The need for accessible dental care is essential, as various residents do not have the opportunity to appropriately address problems with their teeth. The main stakeholders of the bill are the people using Medicare, in particular the elderly and disabled. The SWOT analysis helped determine the helpful and harmful effects of the bill both externally and internally, including lower medical expenses and possible reasons for lack of public support. The bill’s implementation will affect stakeholders within institutional, local, and state levels. The Essentials of Master’s Education in Nursing provide ideas for ways qualified professionals can be change agents and advocates.
References
American Association of Colleges of Nursing (2011). The essentials of Master’s education in nursing. Web.
Asking Congress to include dental care in Medicare, HJM 4014. (2020). Web.
Baicker, K., Allen, H. L., Wright, B. J., Taubman, S. L., & Finkelstein, A. N. (2018). The effect of Medicaid on dental care of poor adults: Evidence from the Oregon health insurance experiment. Health Services Research, 53(4), 2147–2164. Web.
Chávez, E. M., Calvo, J. M., & Jones, J. A. (2017). Dental homes for older Americans: The Santa Fe group call for removal of the dental exclusion in Medicare. American Journal of Public Health, 107(S1), S41–S43. Web.
Lutfiyya, M. N., Gross, A. J., Soffe, B., & Lipsky, M. S. (2019). Dental care utilization: Examining the associations between health services deficits and not having a dental visit in past 12 months. BMC Public Health, 19(1), 265. Web.
Macek, M. D., Atchison, K. A., Wells, W., Haynes, D., Parker, R. M., & Chen, H. (2017). Did you know Medicare does not usually include a dental benefit? Findings from a multisite investigation of oral health literacy. Journal of Public Health Dentistry, 77(2), 95–98. Web.
Willink, A., Schoen, C., & Davis, K. (2016). Dental care and Medicare beneficiaries: Access gaps, cost burdens, and policy options. Health affairs (Project Hope), 35(12), 2241–2248. Web.