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The Affordable Care Act and Dentistry

By David Campbell, DDS | December 07, 2016

by David Campbell, DDS

Has the Affordable Care Act (ACA) affected dentistry in any way? This question has arisen many times from my medical colleagues. They are changing practice structures, plan participation and patient selection, while some are hurrying retirement plans based on changes or coming changes in medical coverage. None would say their professional judgements are conditional to coverage. We care for all people with the Lord’s image in mind. Our higher calling to treat all our patients with generosity and excellence is manifested as we dedicate ourselves to sanctification. ACA can never interfere with our sanctification and dedication to serve the Lord with all we have and with our best in all efforts.

As with our unique knitting in our mother’s womb, our professional lives do not have identical expressions of our faith either. Practice management is a discipline that addresses the struggle against the thorns of the land. The curse of Adam upon mankind includes scant resources and limits our opportunities to serve all. We present options for services that include less resource allocations, especially in dentistry, where simple options, such as implants and partials, have obvious variances. The variance in functionality and cosmetic results may not address desirable concerns for many of our patients who express content with less elaborate selections. And there are always some who forgo services. Dentition is really not necessary for survival. But, these options in delivery of care are basic economics of dentistry. We struggle with our patients to be generous and responsible. Some dentists are able to treat all as family members without limitation, and some of us in the middle of a community perspective have to view our resource allocations as adequately doled out by a simple fee schedule. Those of us who can set our own fees may express our faith with sliding fees or by foregoing fees based on generous exceptions. Prayer and wisdom balance our lives, professionally and personally. 

Yet, has ACA affected dentistry? Certainly, some of us who have hospital privileges and engage with medical coding for oral conditions have had similar choices to medical professionals. But the majority of private practice dentists have very little concern for the ramifications of national policy. For most of us, our selection of insurance plan participation and patient choices was built into our professional calling years ago. We know our community preferences. Some want elaborate ideal care, while others settle for the resource allocations of less functional or cosmetic care. Whether they delay care to wait for the best or they opt for easier lower costs dental care, our dental care is not usually driven by plan changes from ACA. We are making arrangements based on individual patient resources. 

However, ACA may affect our dental practice in other ways. The original promise allowed our communities to save themselves from the increases in medical costs. The savings from the decrease in medical costs could provide our patients with more resources for dental care. Very few have seen their medical expenses decrease, although the slowing of increases may have occurred, only the Lord knows.

In a few practices, the ACA has been a wonderful resource for dental care. Few dentists have noticed the burgeoning Federally Qualified Health Centers (FQHC) delivering dental care. They have grown from merely provision of rescue dental care to covering nearly 50 percent of the poorer populations, especially children. This is especially true in the major cities. My practice was started in poor communities. As a dentist dedicated to serving whole communities in poverty, instead of part of a community in poverty, the effects of ACA have been dramatic. The older welfare system has been squeezed by state budget shortfalls, leaving practices weaker and weaker until they must abandon participation or be sold to those who abandon welfare dental plans. Meanwhile, federal resources are burgeoning. Most dentists may not know the size of the FQHC movement. Many of us in urban Christian missions have seen the expansion first hand. The movement has controls that currently keep these clinics from serving communities who earn greater than 200 percent of poverty. But this limitation is arbitrary. The measure of poverty changes with politics. Thus, the wild growth of FQHC dental care is robust, but only the Lord knows if it’s enduring.

How, then, shall we pray? Many of us haven’t seen the FQHC movement, and those involved have not seen retraction in generosity, so let us stay alert. The present times have shown some balance from a generous political environment and fiscal policy. Some would say the deficit is a real concern, while others of faith see tax relief as virtually necessary. We cannot see our world of fortunes and failings from our various perspectives, identically. There are joys and tears in all affairs. Let us stay alert. Prayer and wisdom need to balance our lives.

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