Ballot question looks at dental insurance premiums

As far as ballot questions go, proponents say it should be pretty straightforward: Ensure the bulk of dental insurance premium costs find their way into patient's mouths.

Opponents contend the measure, ballot question 21-13, would increase premium costs, reduce consumer choice and block access to dental insurance for the state's most vulnerable residents, especially children.

The question, if the signatures presented to Secretary of State William Galvin on July 6 are certified, would ask voters to approve a measure that would require dental insurers to spend at least 83% of insurance premiums on patient care, and if the money goes unspent, the coverage would be rebated to subscribers.

In Massachusetts, 88% of medical health insurance premiums must be used for treatment, otherwise the money is returned to the subscriber as a rebate. This is called an annual aggregate medical loss ratio.

Extending it to dental insurance just makes sense, proponents of the ballot question claim.

Both sides had it out in the shadow of the State House on July 6 when they championed their cause at a noontime rally.

Dianne Morad, a lobbyist working with the ballot question committee, said during the news conference that some large dental insurance carriers spend as much as 40% of what they collect in premiums on "executive salaries, bonuses and other administrative expenditures" rather than on patient care.

"A yes vote would help fix a broken system in which insurance companies benefit from denying claims and limiting coverage," Morad said.

State Sen. Harriette Chandler, D-Worcester, has proposed a bill that echoes what could be included in the ballot question.

Dental health is essential to overall health, according to the Massachusetts Dental Society.

"Oral health plays a very important role in overall health," with many systemic illnesses indicated by oral health symptoms, the organization says.

Plaque, gum disease, missing teeth – all contribute to other conditions, including lung issues, heart disease and stroke.

Women suffering from gum disease who are pregnant are more likely to deliver prematurely, according to the Massachusetts Dental Society. And low-birth-weight babies are more likely to have breathing problems, anemia, jaundice (yellowing of the skin from liver issues), developmental delays and even congestive heart failure. Issues with teeth and gums can indicate diabetes and osteoporosis, a condition that affects some 10 million Americans, 8 million of them women.

The Massachusetts Dental Society board of trustees has endorsed the ballot question.

"As an advocate for dental care for all Massachusetts residents, the (Massachusetts Dental Society) endorses the Massachusetts Medical Loss Ratios for Dental Insurance Plans Initiative and encourages Massachusetts residents to pass it in November," said Dr. Meredith Bailey, the organization's president. "Patient dollars should be required to be spent in support of their oral health, and patients deserve visibility into how much of their dental insurance premiums are paying for care as opposed to administrative costs."

The measure would require dental insurers to disclose the projected medical loss ratio for their plans. It also would require them to anticipate the base rates and file those charges by July. The measure would put the approval of base rates in the hands of the state Division of Insurance.

The Committee to Protect Access to Quality Dental Care – a coalition of dental plans, health plans, life insurers and trade associations organized in opposition to the ballot question – said it is concerned the measure would drive up health care costs for consumers and small businesses.

"The proponents of this ballot question are not being straight with the voters," the committee said. "What they aren't telling you is that their anti-consumer proposal will increase costs for Massachusetts families and employers – a nearly 40% premium increase in one recent study – and can result in thousands of residents being denied access to much-needed dental care."

A study commissioned by National Association of Dental Plans looking at the costs and benefits of the proposal found that most Massachusetts dental insurers allocate between 60% and 79% of premiums to patient care, depending on the size of the company, with smaller companies allocating fewer dollars while larger companies allocate more.

The remainder of premiums charged is used, in part, for administrative costs.

The study, by the Milliman Research, group found that the proposal would affect companies with a smaller pool of clients. Also, fulfilling the 83% mandate, coupled with the cost of rebates, would tax company revenue.

Opponents contend that a yes vote on the ballot question in November could drive some dental insurance providers out of Massachusetts.

"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," according to a statement by the opposition committee.

The study predicts that premiums could increase by 38%, jumping from $35 per month to $50.

State House News Service contributed to this report.