Correction: On Jan. 1 all non-grandfathered insurance plans will require coverage of the 10 essential health benefits under the Affordable Care Act, which include pediatric dental and eye care. Non-grandfathered plans were created after March 23, 2010, and have not substantially changed. This article misidentified the type of plan created after March 23, 2010.
Wendi Cheatham’s daughter was having trouble reading in third grade. A trip to the eye doctor revealed that her eyes weren’t properly tracking words and objects.
After some treatment, her daughter went from being on grade level or just below in her school studies to above grade level by the end of the school year, Cheatham said.
“You have to read for comprehension, and if you are struggling to get through a page, you have trouble remembering what the content is,” Cheatham said. “Once she started building her eye strength, she was more confident. The constant tears over reading assignments were gone.”
Pediatric dental and eye care are together considered one of the 10 essential health benefits under the federal Patient Protection and Affordable Care Act. On Jan. 1, all private insurance plans that haven’t been grandfathered in must cover those essential services. (Grandfathered-in plans were created after March 23, 2010, and won’t substantially change).
Health policies not purchased from the state insurance exchange will cover vision and dental care for children. However, health policies purchased on the insurance exchange willcover vision but not dental. The exchange will offer dental-care policies separately, and people are not required to buy them.
THE STATISTICS
Roger Jordan, federal relations chairman for the American Optometric Association, said 10 million children nationally are projected to be positively affected by the required eye-care coverage.
“You are going to see kids get treated who have had their eyes and vision ignored,” Jordan said.
The National Commission on Vision and Health has released a fact sheet statingthat undetected and untreated eye disorders can result in delayed reading and poorer outcomes in schools.
“One in four school-age children suffers from vision problems that could have been treated if the child had been properly screened upon entering school,” the sheet states.
The sheet states that 25 percent of children ages 5-17 have vision problems and that nearly 79 percent of children have not been to an eye-care provider in the past year. Thirty-five percent have never seen an eye-care professional, and 40 percent who fail initial vision screenings do not receive follow-up care.
Uninsured children who need glasses are three times more likely to not get them, the report states.
A Prevent Blindness America report states that the national economic cost of eye problems and vision loss is $139 billion annually. It goes on to estimate the annual loss for Arkansas at $1.3 billion. The estimate includes medical expenses, school screenings, federal assistance, education, lost productivity, lost tax revenue and longtime care.
“Over the years you are going to see a definite increase in school performance,” Jordan said, referring to the vision-care requirement. “The workforce will get better, because kids will perform better.”
Cheatham, who is from Rogers, said she is fortunate that she can provide insurance and resources for herchildren. However, she said, her insurance did not cover the treatment needed to strengthen her daughter’s eyes. The initial visit that determined the need for therapy was covered by her insurance.
“If that initial visit is covered, at least you would know,” Cheatham said. “It is important. We want to let them [kids] have the best possible chance they can get.”
Centerton Family Eyecare is where Cheatham takes her daughter for eye care.
Regan Skye Petty owns the business with his wife. He said nearly 15 percent of his patients do not have insurance. They pay everything out-of-pocket. He said he expects to see an increase in patients after the Affordable Care Act is fully implemented.
He said there are a number of eye problems that can hinder a child in school if left untreated. The sooner eye problems are detected, the easier it is to treat them, he said. Some conditions, if left untreated, can become permanent. He said there are vision tests that doctors can use to test children as young as 6 months old.
DENTAL PLANS
Paul Reggiardo, chairman and former president of the American Academy of Pediatric Dentistry, said dental coverage for children is often not included in employee benefits, and it can be hard to find coverage on the individual market.
Children are much more likely to visit the dentist if dental coverage is among their parents’ work benefits, Reggiardo said. “If the employer didn’t provide dental insurance, then they did not have [such] insurance. Dental decay in a child will progress to where they experience dental pain. Kids who experience pain do not sleep well. They don’t focus. It interferes with their socialization, eating, nutrition and school.”
Students who have tooth pain are four times more likely to have low gradepoint averages, according to a study by the Ostrow School of Dentistry of the University of Southern California. The study also states that poor oral health causes students to miss school.
The National Institute of Dental and Craniofacial Research reports that 117 hours of school are missed annually per 100 children because of oral disease.
A report by the American Dental Association says 2.9 million children nationally could acquire dental insurance through the health insurance exchanges by 2018 because of the Affordable Care Act. The report also states that another 2.5 million could get coverage through workplace plans.
More than 29,000 children in Arkansas could receive access to dental insurance through the exchange by 2018, and another 23,000 could receive the coverage through employee benefits, the report states.
However, those figures may be high. The research for the report was done before a federal government ruling that individuals would not be required to buy the dental policies. In arriving at its figures, the researchers had assumed that pediatric dental coverage would be required justas it is for the other essential benefits.
Melissa Masingill, Delta Dental vice president of public affairs, said there also is some financial concern about not requiring people to buy pediatric dental coverage.
“By mandating the purchase of pediatric dental coverage in the private market, yet leaving it an optional purchase on the marketplace or exchange, you create an adverse risk pool, and the unintended consequences is potentially higher premiums for consumers purchasing dental benefits on the exchange,” Masingill said.
The Affordable Care Act provides subsidies for individuals and families that purchase insurance in the marketplace if their incomes are less than 400 percent of the poverty level.
The subsidies will be used first to pay for a health insurance plan. If there are funds left over, the individual may use that money to buy a dental plan, Masingill said. She said it is not likely that an individual will have any funds left over for dental coverage.
“The lack of tax subsidies for dental premiums could discourage the purchase of dental coverage for children, particularly among lower-income families where available subsides are applied toward much higher medical premiums” Masingill said. Many child-advocacy groups, members of Congress and dental-health advocates arerequesting that the Internal Revenue Service reconsider its interpretation of the subsidies allowed under the Affordable Care Act, she said.
Northwest Arkansas, Pages 15 on 12/22/2013