Under a budget veto by Gov. Mike Dunleavy that eliminated Medicaid dental coverage for adults from the state operating budget, some Alaskans are going without teeth and others may become more likely to lose them, dental providers and health advocates warn.
Michael Shelden, a 50-year-old Chugiak resident, was expecting to have a mouth full of teeth by now. Shelden, who had been dealing with chronic dental pain, had all 16 of his remaining teeth pulled last month. His plan was to replace them four weeks later with dentures.
One of the 182 line items Dunleavy vetoed from the budget passed by the Alaska Legislature, however, was $27 million in Medicaid coverage for adult preventive dental care. The plan covered services like regular cleanings, fillings and, as Shelden found out too late, dentures.
The veto left Shelden unable to afford the second half of his procedure, just one day before he was scheduled to be fitted for his new teeth.
Unable to pay the $2,000 expense out of pocket and unable to work because of multiple disabilities, he’s limited his diet to soft foods like baked potatoes, rice, soup and taco meat. He sometimes eats just one meal a day, and he turned down a friend’s invitation to visit Texas because, he said, he couldn’t bear to go if he couldn’t eat barbecue. Anchorage television station KTUU initially reported on Shelden’s plight.
Dental providers, who have criticized the veto as “shortsighted,” warn that Shelden may be among the first of many people to see their dental care suffer because of it.
Tammy Green, CEO of Anchorage Neighborhood Health Center, said her clinic has already seen a handful of people who are in the same boat as Shelden — they had teeth pulled before the vetoes, but can’t afford to replace them now.
“You can imagine as a provider how awful that feels,” Green said.
The chief dental officer at Anchorage Neighborhood Health Center has even scaled back on that particular procedure, fearing her patients might become stuck in that same toothless limbo, Green said.
Without cleanings and other preventive care, though, even people who still have all their teeth will likely see long-term health consequences, dentists warn.
“If someone has not been having preventative health and they have cavities or things like that, they can get inflammation, and that inflammation can exacerbate other chronic conditions,” Green said.
That can affect everything from your kidneys to your heart, said David Logan, executive director of the Alaska Dental Society.
Barring preventive dental care, Logan said, all Medicaid will cover is emergency care, which usually means a tooth extraction. And because of what he called a “domino effect,” people who lose one tooth are more likely to lose additional teeth.
He said under Dunleavy’s veto, Medicaid patients will likely delay treatment until they have no choice but to go to hospital emergency departments, which are often not equipped to provide dental care.
In the end, that means much higher medical bills and teeth lost that could have been saved, he said.
“Small problems are going to go untreated until they become big problems, and big problems are going to be dealt with by extraction,” Logan said.
Because of that, some providers encouraged their patients to have as much work done before July 1 as they could, Logan said.
That’s bought the dental community some time, but given another month or two, community clinics like Anchorage Neighborhood Health Center — one of few providers in Southcentral Alaska that offers a sliding pay scale — may soon be stretched thin.
“Our hope is that we will stand together and do whatever we can to try to serve our patients, but there will be a limit to what we can do with our current and internal resources,” said Green.
Some providers are already feeling the squeeze. Royann Royer, who runs dental clinics at two Anchorage nursing homes, pays for most of her operating expenses through Medicaid.
“It’s going to be devastating for us,” Royer said.
About 95% of the patients she sees rely on Medicaid for their dental coverage, which means the cut may leave her unable to care for her patients all together.
That’s a social problem for many of the patients Royer sees, some of whom refused to come out of their rooms to interact with others until their teeth had been restored. It’s especially problematic, though, for medically vulnerable patients who, given an infection, could aspirate the bacteria into their lungs and trigger pneumonia, she said.
For Royer, the loss would be a personal one. Her organization, Healthy Smiles Forever, has been treating patients at Prestige Care & Rehabilitation Center for three years, but it opened the clinic at Pioneer Home just last month.
“It’s just so sad, especially when we were just making a positive effect," Royer said.
With few other options, Royer, like many providers, said she’s hoping for a solution from the Legislature. Although lawmakers failed to override the vetoes before last week’s deadline, legislators in Juneau have introduced a bill to restore the $444 million back to the budget.
Shelden, the Chugiak man whose coverage lapsed before he could be fitted for dentures, said after trying to call his representative and getting nowhere, he’s not holding his breath.
“There’s too many people squabbling for power at the top to care about the people at the bottom,” he said.