For millions of Americans, the promise of affordable healthcare stops at the neck. While life-threatening medical emergencies are often covered, necessary dental care is routinely denied, forcing individuals to live with chronic pain, shame, and mounting debt. This crisis highlights a deep divide in the U.S. healthcare system, where basic oral health is treated as a luxury rather than a fundamental component of well-being.
The stories of individuals like Jackie Duda, Harold Krieg, and Betty Lowe—all struggling to afford essential dental procedures—underscore the devastating financial and emotional fallout of this systemic failure.
The Insurance Illusion: Where Medical Coverage Ends
Jackie Duda, a 61-year-old freelance health journalist from Maryland, survived a life-threatening case of sepsis and chronic illness, accumulating over $250,000 in hospital bills that her medical insurance largely covered. Yet, she faces an insurmountable obstacle with her teeth.
Duda needs dental implants to replace three teeth damaged by illness, a procedure her Medicaid insurance refuses to cover. Even with a discounted rate from a university dental school, she is short $6,000. Her only recourse is a high-interest Care Credit medical card, adding to her existing credit card debt.
“Who has that kind of money just lying around?” Duda questioned. “At least hospitals will work with you on costs… but all the dental providers I’ve ever encountered never do.”
Since the Affordable Care Act (ACA) was passed, millions gained subsidized medical insurance and expanded Medicaid. However, the federal law does not mandate adult dental insurance, leaving vast numbers of people routinely excluded from necessary care.
Furthermore, even having dental insurance offers little financial security for extensive needs. Many plans cap annual coverage, forcing patients to bear substantial out-of-pocket costs after routine cleanings. As incoming American Dental Association (ADA) leader Brett H. Kessler noted, «That’s the ridiculousness of the dental insurance model… After a certain range or a few thousand dollars of service, the plans stop covering patients.»
The Ethical Barrier: Businesses First, Patients Second
The ethical dilemma for patients begins with the stark legal distinction between hospitals and dental practices:
- Hospitals are legally required to assess and stabilize all patients in an emergency, regardless of their ability to pay.
- Dental practices operate as independent businesses and are not bound by such mandates. They can, and often do, reject patients who cannot afford care.
Dentists face their own financial pressures, including recovering high operating costs and managing significant educational debt—2023 dental school graduates owed an average of $296,500 in student loans, surpassing medical doctors.
While dentists provide substantial charity—the ADA estimated $1.6 billion in free care in 2018—they stress that their capacity is limited by overwhelming unmet oral health needs. «We can’t give away everything for free,» Kessler affirmed.
Desperate Measures: The Human Cost of Neglect
The lack of systemic coverage has led to tragic and painful realities for patients in need:
- Chronic Pain and Shame: Harold Krieg, a 62-year-old Las Vegas resident, lives in constant pain from untreated dental disease exacerbated by severe acid reflux and diabetes. He needs $35,000 for full extractions and implants but is shut out of the system. In a desperate act, he said he contemplated seeking a deadly diagnosis because Medicare covers some dental procedures for cancer patients before chemotherapy. «You literally have to pray to get something deadly in order to get your teeth done,» Krieg said.
- The Medicaid Trap: Betty Lowe of Tennessee lost her newly expanded Medicaid dental coverage mid-treatment due to eligibility checks. After a dentist pulled her molars, she couldn’t afford the remaining $2,700 for extractions and dentures. She is now left with a dozen broken, infected teeth in the front of her mouth. Her dentist, Timothy Gansore—one of only two in a 25-mile region who accepts Medicaid—is inundated with low-income patients but must limit bookings because Medicaid reimbursement is too low to keep his business afloat.
Legislative Efforts and the Path Forward
Senator Bernie Sanders (I-Vt.) has called the U.S. dental care system «in crisis,» noting that nearly 69 million U.S. adults lacked dental insurance or access to routine care last year. Sanders’ bill aims to expand dental coverage through Medicare, Medicaid, and the Veterans Administration while increasing the number of dentists nationwide.
The Biden administration is also pushing a rule to allow states to opt into adult dental coverage under the ACA.
However, any significant legislative change will face an uphill battle against rising federal deficits and political opposition. Carlos S. Smith, a dental professor at Virginia Commonwealth University, argues the profession must undergo a foundational self-evaluation, questioning whether organized dentistry prioritizes an «ethical decision-making model» or one that supports «office profits.»
Until systemic change is enacted, millions of Americans like Duda, Krieg, and Lowe will continue to live in a state of dental emergency, forced to choose between crippling debt, relentless pain, or dangerous financial schemes like high-interest medical credit cards.
#Dental #access #American #crisis #vulnerable #shut
