By Sasha Ray
Boston University Statehouse Program
A ballot question initiated by a Somerville orthodontist will either result in better dental health for an estimated 25% of Massachusetts residents without dental insurance – or result in higher premiums and prompt employers to drop coverage for their workers.
Question 2 on the Nov. 8 ballot would “regulate dental insurance rates by requiring companies to spend at least 83% of premiums on member dental expenses and quality improvements instead of administrative expenses and by making other changes to dental insurance regulations.” Furthermore, insurers would be required to disclose where those premiums are being spent.
Under state law, Massachusetts residents are required to have health insurance. The Massachusetts Health Insurance Survey found the 2021 uninsurance rate was 2.4%, compared to the national rate of 9.2%. Health insurers are required to allocate 88% of premiums to coverage. The proposed measure to amend dental insurance was designed as an effort to mirror medical coverage for patients across the commonwealth.
In contrast, a 2017 survey estimated one-in-four state residents who have health coverage lack any insurance for dental health. In Massachusetts, 16.6% of all residents reported an unmet need for dental care due to cost in 2019.
“Even though dental insurance is cheaper on a monthly basis, the number and types of claims that come in on a typical year don’t require the staff work that health care does,” said Chris Keohan, co-founder of Shawmut Strategies Group, which has worked in support of Question 2.
“Health care is clearly much more complicated when it comes to testing and trying to actually try and find the problem and the different treatments. There’s a wide range of care. With dental, it’s pretty standard pricing across the board.”
Supporters say the passage of Question 2 would provide a decrease in both premiums and denials of service while covering more of patients’ annual costs. Patients would also know how their premiums are being spent – information that is not currently made public to those paying hefty sums in dental coverage.
Under Question 2, fewer patients would be put in an “emergency” status in order to afford their dental care, something Rep. Jon Santiago, D-Boston, sees on a regular basis as an emergency room physician at Boston Medical Center.
“For someone with an abscess in their mouth, if they wait too long, it gets infected. It could have been something that was fixed if they’d gone to the dentist but is now to the point where they have to go to the ER for medication and services,” he has said. This happens more commonly because, once in an “emergency” state, a patient’s health insurance covers the cost.
“Really, it’s very simple: it’s important to make sure that the people who are paying premiums for dental insurance, that the money goes to dental care, and as little of it goes to overhead as possible,” Rep. Steven Owens, D-Watertown, said in a phone interview. This has not been the case for nearly as long as dental insurance has existed.
Question 2 is backed by the Massachusetts Dental Society and 13 Massachusetts lawmakers.
Dental insurers oppose the question.
Opponents warn that premiums could go up by as much as 38%, and thousands of Massachusetts residents may lose dental coverage as a result. The study that projected this price increase was commissioned and funded by a trade group for dental insurers.
“You will most likely see some carriers leave the market and some carriers offer less in terms of benefits,” Jim Welch, a former state legislator and spokesman for the “No on 2” campaign told WBUR. “When carriers leave the market and benefits get decreased, access goes down, quality goes down, and, unfortunately, in the end, costs will go up.”
Welch said the measure, if it passes, would disproportionately hurt people who can least afford it: “This ballot question would really negatively affect the smaller insurance carriers, the ones that probably provide dental insurance to employers, smaller mom and pop type organizations.”
Kyle Sullivan, a spokesperson for the Committee to Protect Access to Quality Dental Care, voiced similar concerns.
“Question 2 will increase costs for Massachusetts families and employers and can result in denying thousands of residents access to much-needed dental care. With consumer prices soaring to all-time highs, the commonwealth doesn’t need this added regulation that will only increase costs and decrease choice for patients across the state,” Sullivan said in a statement on behalf of the committee.
Dental coverage is a voluntary benefit, leaving far fewer residents with coverage compared to mandated medical insurance. Dental plans must then distribute costs among fewer policyholders, Sullivan said, yet, dental plans have similar fixed administrative costs as medical plans, such as credentialing and monitoring fraud, waste, and abuse.
“Dental insurers have fewer dollars and fewer policyholders to cover the administrative expenses,” Sullivan said, “and thus these expenses comprise a larger portion of dental premiums than medical premiums.”
Delta Dental, the state’s largest insurer, has been relatively quiet, referring questions to a spokesperson, But they have also been a leader in voicing its opposition monetarily.
The company has contributed the bulk of the cash, putting over $4 million toward the effort, according to data from the Massachusetts Office of Campaign and Political Finance through Oct. 1, WBUR reported.
The Massachusetts Dental Society had contributed over $200,000 to the “Yes on 2” campaign, and the American Dental Association had pledged $5 million. Mouhab Rizkallah, the Somerville orthodontist, is the biggest individual donor, contributing over $2 million. Many dozens of donations have come from individual dentists, mostly of amounts in the low hundreds.