Forcing dental insurers to spend more of the premiums they collect on actual patient care would be a step in the right direction.
Not many people like going to the dentist. There are the blindingly bright lights, the invasive metal tools, the odd tasting toothpaste — and that’s for a routine cleaning. But for many Americans, what makes visiting the dentist so unpleasant has nothing to do with the work that’s done while they’re sitting in the dentist’s chair; it’s the fact that they have to deal with what is far too often inadequate dental insurance, if they even have insurance in the first place.
That’s what’s at the heart of Question 2, the abstruse ballot measure that seeks to impose stricter regulations on dental insurers so that more of the money they collect in premiums is spent on patient care. While the polls aren’t the wisest venue to pass complex industry regulations (more on that later), Massachusetts voters should seize this opportunity to improve dental coverage in the state by voting yes on Question 2.
It doesn’t take much to see how poorly dental insurers are serving people under the current system. More than half of Americans delay getting medical care — or avoid it altogether — because of burdensome costs, and the most frequently skipped form of care is dental work. That’s not surprising. According to the American Dental Association, 45.1 percent of all spending on dental care in the United States comes from out-of-pocket expenses, while that figure for total health care spending is 13.8 percent. In Massachusetts, a quarter of residents don’t have dental insurance, and 16.6 percent have not gotten necessary dental work because they could not afford it.
This needs to change, and passing this ballot measure is the first step.
The proposed law would establish what is known as a medical loss ratio — that is, the portion of revenue from premiums that is spent on patient care vs. administrative costs — for dental insurers. By requiring that a minimum share of premium dollars be spent on patient care, which in this case would be 83 percent, dental insurers would be given a meaningful incentive to expand the number of procedures they cover or reduce out-of-pocket expenses if their medical loss ratio is below that threshold. Otherwise, they’d have to reimburse their clients.
While this would make Massachusetts the first state in the country to adopt this standard for dentistry, it’s not exactly unprecedented: The Affordable Care Act did the same for medical insurers. And given how much more coverage people get from their medical insurance than they do from dental, it’s clear that setting some baseline for how premium dollars are spent ultimately benefits consumers.
The Affordable Care Act precedent also shows that a medical loss ratio is not the kind of major burden on insurers that the opposition campaign will have you believe. Medical insurers in Massachusetts are required to have a medical loss ratio of up to 88 percent — higher than the federal standard under the ACA — and insurers in the state have managed just fine.
One point of concern about this ballot measure has been that premiums might go up. While this is certainly a possibility, the opposition campaign is likely exaggerating that claim. First of all, the proposed law would require that premium increases be reviewed by the Division of Insurance, which would be charged with disapproving any rate increases that are “excessive, inadequate, or unreasonable in relation to the benefits charged.”
Second, according to one study, dental insurers in Massachusetts spend, on average, 13 percent of their premium dollars on administrative costs. Large insurers spend about 9 percent. Even if their administrative costs increase, a medical loss ratio of 83 percent gives insurers more than enough breathing room to maintain a reasonable profit margin, and it’s difficult to foresee how a major spike in premiums would be justified.
None of this is to say that the yes campaign has run a particularly upfront campaign. While one of the ballot measure’s chief proponents, Somerville-based orthodontist Mouhab Rizkallah, told the Globe editorial board that this ballot measure was “right for humanity,” it’s also likely good for his and his colleagues’ pocketbooks. He said so himself: “Dentists are going to make more money. How do you like that? That’s just a fact.” He contends that it’s because dentists will have more patients because of better coverage. But it’s also because if insurers are required to spend more money on patient care, they would likely allow dentists to charge higher prices in order to meet that threshold, essentially transferring some share of dental care profits from insurers to dentists. (Rizkallah has spent $2 million of his own money on this campaign.)
Given the amount of time and money that’s needed to run a successful ballot measure campaign, monied interests and major industries can use it as a vehicle to write their own regulations. The complexity of these sorts of laws all but guarantees that voters won’t be well-informed about what they are voting on. That’s not a good standard for lawmaking, and that’s precisely why regulations of this kind should generally happen in legislatures, not the ballot box.
That this made it onto the ballot points to a failure from Beacon Hill. This issue has come before the Legislature a number of times in the past decade, but lawmakers failed to act — including on the bare minimum of requiring more transparency from dental insurers. That’s ultimately why voters should vote yes: to put pressure on lawmakers to finally take on the very real failures of the dental insurance industry to properly serve consumers.
This ballot measure is only a start. And if it passes, the Legislature must tinker with it over the coming years in order to find the right balance. Is a medical loss ratio of 83 percent, for example, the exact formula that produces the best outcome? (Small insurers in the state have higher administrative costs than large ones, and the Legislature might want to make some accommodations for them.) Perhaps the most important aspect of Question 2 is that it would require more transparency from insurers about how they spend their money. And as more data becomes available, regulations can improve in order to deliver better care for consumers while ensuring that insurers are not overburdened.
Dental insurers, who have been exempt from certain Affordable Care Act regulations, ought to be held to a higher standard. Passing this ballot measure will finally get the ball rolling on Beacon Hill — and make visiting the dentist a little less daunting.