The Medicare Dental Benefit Act of 2019 Research Paper

Introduction

• Dental care services are not included in the Medicare program. This denies the vulnerable aged population access to oral health care services (Macek et al., 2017)
• This bill seeks to amend the Social Security Act Title XVIII, which does not cover dental service under the Medicare program
• The congress will decide whether to include dental care in Medicare
• I chose the bill because it will improve population oral health if enacted

Overview of the Bill

• The bill was first introduced by Ms. Barragán, on May 23, 2019, in the116^th Congress (2019–2021).
• The rule number is H. R. 2951 and it is titled “Medicare Dental Benefit Act of 2019”.
• The bill was first mentioned in the house of congress, it was later referred to the Committee on Energy and Commerce (Willink et al., 2016).
• A definition of dental and oral health service has been made in the bill. In addition, areas of Medicare coverage, Payment and limit specification, as well as coverage of routine diagnostic preventive care and services have been discussed.

Direct and indirect stakeholders

• Hospital and dental schools (Indirect)
• Service recipients, and their caregivers (direct)
• Policymakers (indirect)
• Oral foundations, patients advocacy groups, and oral coalitions (indirect)
• Oral health primary care, dentist, and their professional associations( direct)
• .Pharmaceuticals and insurance companies (direct), these stakeholders are not supporting the bill

SWOT Analysis of the Bill

Strengths

The bill aims at improving access to oral healthcare service by the old people in the community, who are more vulnerable to dental problems.

The bill has support from various advocacy group or coalitions, dental physicians, and caretakers.

Weakness

There is overdependence in private pharmaceutical and insurance companies.

These firms are in business, they maximize profit at the expense of the citizens and the government.

Reimbursement rates, Prospective Payment System (PPS) rates, and billing for multiple encounters.

Congress voters are easily influenced by some firms and organizations.

Opportunity

Adoption of a differential PPS rate (Maserat et al., 2020).

There is a lack of awareness of the importance of routine daily care in society.

The majority of the population, in the US, are approaching 65 years. This is the eligible age to join Medicare. There is room for dental coverage expansion.

Threats

Lack of health promotion program for preventive care.

Deficiencies in public health.

Health care disparities across populations due to socioeconomic status.

Lack of sufficient knowledge on the importance of oral health care for the elderly among the policymakers.

Effects of the Bill on Stakeholders

• The profit margin gained by pharmaceuticals and insurance companies will reduce significantly (Slavkin et al., 2017). This is because the bill will regulate prices for covered individuals.
• Oral health care in the U.S population will improve because access to dental services for patients will reduce.
• Payment and limits for dental and oral health services imposed by the bill will affect government expenditure. This is because the addition of dental service in Medicare may increase the expense per capita.

Masters Prepared Nurse Leader Contribution to the Policy

• They can advocate for the inclusion of oral health with primary care by influencing policymakers opinions through campaigns.
• They can conduct research showing the importance of insured dental services on the health of U.S populations. Their findings may be used to justify the need for inclusion of oral dental services in Medicare that will form a basis for voting.

Conclusion

• This paper shows the strengths, weaknesses, opportunities, and threats linked to Medicare Dental Benefit Act of 2019
• The bill will augment the affordable care act (Moss, 2017).
• Providing comprehensive patient care in the community is the greatest strength for dental service inclusion in Medicare. It will have a huge impact on solving health disparities across the state.

References

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.

Maserat, E., Davoodi, S., & Mohammadzadeh, Z. (2020). Analysis of strengths, weaknesses, opportunities, and threats of electronic dental and oral records in clinics of School of Dentistry, Tehran University of Medical Sciences, Iran: A qualitative study. Journal of Oral Health and Oral Epidemiology, 9(1), 24-31.

Moss, M. E. (2017). Integrating oral health care services within Medicare. North Carolina Medical Journal, 78(6), 402-405.

Slavkin, H. C., Abel, S., Alfano, M., Dolan, T., DuBois, P., Fox, C. E., & Kleinman, D. (2017). A national imperative: oral health services in Medicare. The Journal of the American Dental Association, 148(5), 281-283.

Willink, A., Schoen, C., & Davis, K. (2016). Dental care and Medicare beneficiaries: access gaps, cost burdens, and policy options. Health Affairs, 35(12), 2241-2248.