Astha Singhal (
Peter Damiano is a professor of preventive and community dentistry and director of the Public Policy Center at the University of Iowa, in Iowa.
Health Aff (Millwood). 2017 Apr 1;36(4):723-732. doi: 10.1377/hlthaff.2016.0877.
Dental coverage for adult enrollees is an optional benefit under Medicaid. Thirty-one states and the District of Columbia have expanded eligibility for Medicaid under the Affordable Care Act. Millions of low-income adults have gained health care coverage and, in states offering dental benefits, oral health coverage as well. Using data for 2010 and 2014 from the Behavioral Risk Factor Surveillance System, we examined the impact of Medicaid adult dental coverage and eligibility expansions on low-income adults' use of dental care. We found that low-income adults in states that provided dental benefits beyond emergency-only coverage were more likely to have had a dental visit in the past year, compared to low-income adults in states without such benefits. Among states that provided dental benefits and expanded their Medicaid program, regression-based estimates suggest that childless adults had a significant increase (1.8 percentage points) in the likelihood of having had a dental visit, while parents had a significant decline (8.1 percentage points). One possible explanation for the disparity is that after expansion, newly enrolled childless adults might have exhausted the limited dental provider capacity that was available to parents before expansion. Additional policy-level efforts may be needed to expand the dental care delivery system's capacity.
医疗补助计划为成年参保人提供牙科保险,这是一项可选福利。在平价医疗法案下,31 个州和哥伦比亚特区扩大了医疗补助计划的资格。数以百万计的低收入成年人获得了医疗保健覆盖范围,而在提供牙科福利的州,口腔健康覆盖范围也扩大了。我们利用 2010 年和 2014 年行为风险因素监测系统的数据,研究了医疗补助计划成年牙科保险覆盖范围和资格扩大对低收入成年人牙科护理使用的影响。我们发现,与没有这种福利的州的低收入成年人相比,在提供牙科福利且扩大其医疗补助计划的州,享受了除紧急情况以外的牙科福利的低收入成年人在过去一年中更有可能进行过牙科就诊。在提供牙科福利并扩大其医疗补助计划的州,基于回归的估计表明,无子女的成年人进行牙科就诊的可能性显著增加(1.8 个百分点),而父母进行牙科就诊的可能性显著下降(8.1 个百分点)。造成这种差异的一个可能原因是,在扩大资格范围后,新纳入的无子女成年人可能已经耗尽了在扩大之前父母可用的有限牙科服务能力。可能需要在政策层面做出更多努力来扩大牙科医疗服务系统的能力。