Maryland Bill SB511 Engross aims to create the Task Force related to the oral health of Maryland residents. The Task Force will explore the possibility of improving access to dental services for all people of the state, first of all, identifying areas where a substantial number of inhabitants do not receive it (“Maryland Senate Bill 511”, 2020). In particular, the most focus will be on the population affected by disability, poverty, or aging (“Maryland Senate Bill 511”, 2020). At the same time, a distinction will be made between adult and child communities (“Maryland Senate Bill 511”, 2020). The research group will concentrate on analyzing the current barriers to accessing these services and assessing options for addressing them (“Maryland Senate Bill 511”, 2020). Finally, the Task Force will provide effective guidance on various methods of expanding access to dental attendance.
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The bill was first to read in January 2020, while the second hearing is scheduled for February 2021. No later than December 2021, the Task Force must submit its final recommendations and findings report to the Governor of Maryland, the House Health, the Senate Health, Education, Environmental Affairs Committee, and the Government Operations Committee (“Maryland Senate Bill 511”, 2020). It will be in effect for two years, while at the end of June 2022, without any action required by the General Assembly, it will be canceled. This piece of legislation will have a significant impact on ensuring more comprehensive access to oral health care services for the state population, the work of health care providers, and organizations.
Social, Political, and Economic Impact on Health Care Organizations, Providers, and Consumers
The lack of access for poor Americans to dental care is a long-standing problem, despite widespread recognition of its significant impact on overall health. In particular, according to the Healthy People 2020 report, a sound oral cavity is an important part of overall human health, while universal access to dental services is paramount to maintaining it (Bersell, 2017). Government funding policy for dental reimbursement is frequently limited in volume or absent for the adult population. For instance, Medicare, the U.S. government health insurance program for people 65-years-old and upward, provides 22 preventive examinations but does not include oral hygiene services (U.S. Department of Health Oral Health Coordinating Committee, 2016). Twenty years ago, the United States’ general surgeon declared the oral disease an epidemic, which is not as overtly occurring as rest, since this issue is receiving less attention (Kim, 2019). However, poor oral health is inextricably linked with increased inflammatory factors and exposure to bacteria (U.S. Department of Health Oral Health Coordinating Committee, 2016). It can lead to health consequences such as cardiovascular diseases, diabetes, poor pregnancy outcomes, and even death if dental infections are not treated.
At the same time, less threatening, but still significant problems consist of affecting oral diseases the psychological, physical, economic, and social well-being and health of a person. It happened as a result of impairment of functions, pain, and a decrease in the quality of life (U.S. Department of Health Oral Health Coordinating Committee, 2016). The consequences of poor oral health negatively affect growth, speech, and social development. In addition, missing teeth, infections, and hurt from oral diseases can impair nutrition by restricting food choices (U.S. Department of Health Oral Health Coordinating Committee, 2016). The pain caused by caries can also lead to decreased performance in school and work and absenteeism. Thus, changes in appearance as a result of dental problems can contribute to loss of self-esteem, lower wages, and social isolation.
The situation with dental diseases and access to treatment in Maryland is disappointing, along with the country’s general. Maryland offered full dental coverage in the Medicaid program, which helps pay medical costs for people with limited resources and incomes and offers benefits that Medicare does not cover, until 1976 (Kim, 2019). Further, state legislators decided to cancel it due to too high costs (Kim, 2019). In 2007, after the death of Deamonte Driver, the state government offered a Medicaid program newly (Kim, 2019). This boy died because of an infection from a dental abscess, which has not been treated and spread to the brain (Kim, 2019). However, according to the DentaQuest study, from 2013 to 2016, 15 people died in Maryland after being hospitalized with identified severe diseases of the oral cavity (Kim, 2019). As a consequence, oral health is vital not only to well-being and overall health but also to the life of people.
In Maryland, a considerable problem exists with the provision of oral health care. The Medicaid program does not allow the supply of dental services to the entire population in need (Kim, 2019). This state is one of 15 in the US, which does not cover the cost of dental care for 21- year-old adults and older on the health insurance Medicaid program for low-income people (Kim, 2019). In 2018, the Maryland government launched a pilot program to reach a small number of adults regarding dental insurance provided to them, but substantial actions are still required (Burger, 2018). Therefore, a researched piece of legislation, aimed at finding ways to expand access to dental services for low-income people, will have a significant social and economic impact on health oral care consumers.
Currently, due to a lack of necessary funds and insurance to pay for expensive dental treatments and address them directly to dental clinics, people of Maryland go to emergency departments. These separations are equipped with only antibiotics and pain relievers to reduce pain (Kim, 2019). Staff is not trained to perform other procedures, such as tooth extractions or filling a cavity (Burger, 2018). As a consequence, most of the diseases of the dental cavity could be prevented if residents had access to routine dental care, where more appropriate and cost-effective treatment could be provided.
The emergency rooms are overcrowded with residents who come due to problems with toothache. Researchers of the nonprofit group DentaQuest Institute at the request of the General Assembly conducted a study in emergency departments (Kim, 2019). They found that the total cost of more than 42,000 dental visits in 2016 was $ 22 million (Kim, 2019). Most of these patients returned with a similar complaint to the emergency department within 15 days (Kim, 2019). As a consequence, the government is spending unnecessary facilities to fund the provision of these types of services. It could be much more effective if this staff was properly trained in dental care. In addition, the Medicaid program could save $ 4 million a year in this case (Kim, 2019). Thus, the application of Maryland Bill SB511 Engross, which contains clauses on expanding education to study dental therapy, will have a significant social and economic impact on health oral care organizations and providers.
The bill influences the political system by involvement in the Task Force, its research, and making recommendations of many members of political organizations related to the health care system. Specifically, the Deputy Secretary for Health Care Financing, the Director of the Office of Oral Health in Maryland, and the Dental Director of Maryland Healthy Smiles Dental Program is presented in the Task Force (“Maryland Senate Bill 511”, 2020). Apart from it, the Task Force includes the Dean of the University of Maryland School of Dentistry, the Secretary of the Maryland Higher Education Commission, and the Maryland Association of Community Colleges (“Maryland Senate Bill 511”, 2020). In addition, the Task Force has one representative each from the Maryland Developmental Disabilities Council, Advocates for Children and Youth, Maryland Alliance for the Poor, and others. The presence of such a number of essential organizations provides a high probability of a solution to the long-standing problem of poor Americans’ lack of access to dental care and reorganizing the dental care system.
Since the spectrum of Maryland Bill SB511 Engross is primarily democratic, it will impact voters by building commitment to the Democratic Party. It will influence the health care system’s politicians through the expansion of current initiatives and programs, such as community dental health coordinators statewide (“Maryland Senate Bill 511”, 2020). In addition, it will affect policy by creating ways to re-establish the government’s adult Medicaid dental program mentioned earlier.
Benefits and Problems Associated With the Implementation of the Statute
Among the undoubted benefits associated with the bill’s implementation, first of all, creating a more integrated and focused comprehensive health care delivery system of dental services can be mentioned. As discussed above, the Task Force aims to identify and resolve barriers to oral health services in areas of the state where significant numbers of residents do not receive them. Specifically, it designates issues such as the high cost of services and lack of insurance or dental coverage under Medicaid (“Maryland Senate Bill 511”, 2020). According to the US Senate Subcommittee on Primary Health and Aging (USPHA), children and the elderly experience the most difficulties accessing dental care (Larson et al., 2016). The Task Force highlights ways to remove these barriers, such as methods to facilitate dental care for children and the elderly, especially those in assisted nursing and living homes, and to restore Medicaid for adults (“Maryland Senate Bill 511”, 2020). There is no doubt that these measures are necessary for the general well-being of the state’s entire population and the improvement of its oral health.
At the same time, problems may arise due to the lack of a definition of the specific services, which Medicaid for adults will cover. In particular, an essential procedure for people with advanced dental diseases will be not only their extraction but also the insertion of dentures (Kim, 2019). Failure to consider it can be a significant gap, as according to dentists, replacing missing teeth can help a patient eat, smile, and improve in health (Kim, 2019). Therefore, additional amendments are needed relating to the specificity of the dental services to which access will expand.
Among the benefits connected with the implementation of the bill can also be called increased literacy of the population in the field of oral hygiene (OHL). In particular, OHL is identified in research as the primary internal barrier to medical care (Bersell, 2017). The Task Force focuses in addition to the high cost of services on obstacles associated with OHL. They comprise the impact of low literacy in oral hygiene, lack of understanding of the relationship between oral health and overall well-being, cultural and language barriers (“Maryland Senate Bill 511”, 2020). Moreover, factors related to fear and anxiety about dental procedures and dental treatment are also considered (“Maryland Senate Bill 511”, 2020). Only 3% of Medicare or Medicaid recipients and 12% of the general population are ranked as oral health literate (Bersell, 2017). Such a low level of OHL is associated in part with an increase in the use of emergency services and a decrease in preventive dental services.
The bill identifies expanding educational programs in schools to spread awareness of the need for preventive dental services and initiatives related to community oral health coordinators across the state as options to remove barriers. These measures are sufficient to increase the OHL of the population and reduce the burden on emergency services, thus providing benefits associated with implementing the statute. Nevertheless, in the bill, aspects of cultural competence in disseminating OHL are overlooked, which can create problems in the future. In addition, it can lead to ethical outcomes associated with the violation of the principle of nonmaleficence, presupposing the impossibility of causing any kind of harm. As a consequence, additional amendments are needed relating to the culturally competent spread of OHL.
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Another benefit associated with the statute’s implementation is the correct allocation of dentists and the solution to the problem of shortage of specialists. The Task Force identifies dental office locations as barriers to accessing oral care services (“Maryland Senate Bill 511”, 2020). Medicaid recipients can be difficult to find, according to government officials and lawyers (Kim, 2019). Actually, a sufficient number of low-income people live in geographically isolated regions with a limited amount of Medicaid providers and an uneven distribution of dentists.
Public transport is frequently lacking in rural areas, making it difficult for the population to access dental services. Compared to residents of metropolitan areas, the population of rural areas has a higher prevalence of tooth loss and caries (Bersell, 2017). Apart from it, the latter has a lower degree of availability of dental insurance for treatment in private institutions and limited access to public services (Bersell, 2017). As a consequence, people who need the help of dentists the most tend to get it less often. Among the options for removing barriers, the bill provides financial support to professionals who have agreed to provide oral health care in underserved areas, which will facilitate the proper distribution of dentists.
As far as the shortage of specialists is concerned, the Task Force outlines methods to overcome it, such as assessing educational opportunities for learning dental therapy. Moreover, the Task Force highlights the appraisal of mid-level professionals’ benefits and the expansion of their responsibilities (“Maryland Senate Bill 511”, 2020). One of the proponents of mid-level provider implementation, David Nash, M.D., conducted a study, which proved the safety, value, and quality of their care (Bersell, 2017). In practice, mid-level dentists are also successfully extending access to services for underserved and vulnerable populations. Some of the largest countries are using this model to reach and help millions of children who would otherwise be left untreated (Bersell, 2017). The project related to adding mid-level providers to the dental care system started in five states: New Mexico, Kansas, Vermont, Ohio, and Washington (Bersell, 2017). Its efforts are gaining momentum as several dozen more states also have expressed interest.
Proponents and Opponents of the Statute
The bill was unanimously adopted in the third reading, and both representatives of the Democratic and Republican parties expressed their agreement with its provisions. Proponents of the statute include Senators Malcolm L. Augustine, Jack Bailey, Pamela G. Beidle, Joanne C. Benson, and others (“Maryland Senate Bill 511”, 2020). The reasons for their support consist of the presence of a comprehensive study of the problems of access to dental care and effective actions to prevent it. While there has been fierce debate over the rise in costs regarding adopting the U.S. Patient Protection and Affordable Care Act (PPACA) in 2010, there are no opponents of this statute (U.S. Department of Health Oral Health Coordinating Committee, 2016). It is explained by the urgency regarding dental needs, which are critical currently.
Alternative Strategies to Amend the Statute
The strategy to amend the statute is the introduction of a broader interprofessional education clause across the state as an option to remove barriers to general access. The separation in education leads to a lack of acceptance and use of codes for dental diagnostics, separate payment, insurance systems, and treatment delivery. Collaborative students’ practice can help improve patient-centered care in all health service systems, including dental.
At the same time, another proposed improvement concerns the addition of aspects of cultural competence aspects in OHL dissemination. This process requires the provision of materials, which are simple to understand, use, and work for many nations. As a consequence, the spread of information should be convenient for users of all nationalities, concentrate on all life phases, including all forms of technology and media, and be widely available.
Finally, among the strategies to amend the statute, the specificity of the dental services to which access will expand can be mentioned. In particular, comprehensive dental care should be extended to such a superlative extent as possible. As a consequence, it should include not only removing diseased teeth but other restorative and diagnostic services, including a thorough oral examination, cavity cleaning, filling and inserting dentures.
Maryland Bill SB511 Engross will significantly impact the work of health care organizations and providers and ensure wider access of consumers to dental services. The current federal and local health policy, which shapes health oral care financing, regulation, and delivery, is not fully effective since the lack of access for poor Americans to dental care is a long-standing problem. The research piece of legislation considers socioeconomic and health issues and trends and demonstrates a comprehensive examination of the barriers to expanding this access and practical actions to prevent them. The benefits associated with the implementation of the statute constitute extending access for healthy oral care consumers and increasing their oral health literacy. In addition, the bill implies an increase in the number of mid-level providers and the correct distribution of dentists. Simultaneously, strategies to amend this piece of legislation are the introduction of a clause on broader interprofessional education across the state and the addition of information on aspects of cultural competence in disseminating OHL. Finally, the specificity of the dental services within the framework of access expansion can also be included in the bill. All of it will help overcome inequalities in dental care and achieve social justice.
Bersell, C. H. (2017). Access to oral health care: A national crisis and call for reform. American Dental Hygienists’ Association, 91(1), 6-14.
Burger, D. (2018). Maryland bill authorizes Medicaid adult dental coverage pilot program. American Dental Association. Web.
Kim, J. (2019). Maryland’s new dental insurance program for low-income residents pays to remove teeth — but not replace them. The Baltimore Sun. Web.
Larson, K., Cull, W. L., Racine, A. D., & Olson, L. M. (2016). Trends in access to health care services for US children: 2000–2014. Pediatrics, 138(6), 1-9.
Maryland Senate Bill 511. (2020). LegiScan.
U.S. Department of Health and Human Services Oral Health Coordinating Committee (2016). U.S. Department of Health and Human Services Oral Health Strategic Framework, 2014-2017. Public Health Reports, 131(2), 242–257.