Massachusetts ballot question pits dentists against insurers

Question 2 on the Nov. 8 ballot would "regulate dental insurance rates by requiring companies to spend at least 83% of premiums on member dental expenses and quality improvements instead of administrative expenses and by making other changes to dental insurance regulations." Furthermore, insurers would be required to disclose where those premiums are being spent.

Under state law, Massachusetts residents are required to have health insurance. The Massachusetts Health Insurance Survey found the 2021 non-insured rate was 2.4%, compared to the national rate of 9.2%. Health insurers are required to allocate 88% of premiums to coverage. The proposed measure to amend dental insurance was designed as an effort to mirror medical coverage for patients across the commonwealth.

In contrast, a 2017 survey estimated one-in-four state residents who have health coverage lack any dental insurance. In 2019, 16.6% of state residents reported an unmet need for dental care due to cost.

"Even though dental insurance is cheaper on a monthly basis, the number and types of claims that come in on a typical year don't require the staff work that health care does," said Chris Keohan, co-founder of Shawmut Strategies Group, which has worked in support of Question 2.

"Health care is clearly much more complicated when it comes to testing and trying to actually try and find the problem and the different treatments. There's a wide range of care. With dental, it's pretty standard pricing across the board."

Supporters say the passage of Question 2 would decrease both premiums and denials of service, while covering more of patients' annual costs. Patients would also know how their premiums are being spent — information that is not currently made public to those paying sometime hefty sums in dental coverage.

Under Question 2, fewer patients would be put in "emergency" status in order to afford their dental care, something state Rep. Jon Santiago, D-Boston, sees regularly as an emergency room physician at Boston Medical Center.

"For someone with an abscess in their mouth, if they wait too long, it gets infected. It could have been something that was fixed if they'd gone to the dentist but is now to the point where they have to go to the ER for medication and services," he said. This happens more commonly because, once in an "emergency" state, a patient's health insurance covers the cost.

"Really, it's very simple: it's important to make sure that the people who are paying premiums for dental insurance, that the money goes to dental care, and as little of it goes to overhead as possible," state Rep. Steven Owens, D-Watertown, said in a phone interview.

Question 2 is backed by the Massachusetts Dental Society and 13 Massachusetts lawmakers, including state Sen. Paul Feeney, D-Foxboro, who is running for re-election in the Bristol and Norfolk District, and state Rep. Ted Philips, D-Sharon, who represents Precinct 4 in Mansfield.

Feeney said he's heard from area dentists and constituents who support it as he campaigns.

"From my point of view, anytime we can ensure better quality care by putting money back in the hands of consumers and providers, not insurance executives, that's a good thing, and that's why I will be voting Yes on Question 2," he said.

Dr. Kevin Eagan, who works at Nichols Family Dentistry in Foxboro, is convinced that Question 2 would help his patients.

"Patients are always very surprised to find out their insurance only covers a small part"" of their dental care, he said.

Eagan, who holds both a dental degree and a master's in public health from Columbia University, formerly worked for the Department of Veterans Affairs. There, he said, there was never a question of cost in providing timely care for those who need it.

But for his patients in private practice, things are different.

"These are people in middle class communities who otherwise assume they would have their health needs taken care of," Eagan said. "But they find they can't budget for unexpected (dental care) issues. They feel angry and betrayed by the insurance companies."

Eagan said he finds himself stretching out treatments for patients so they don't go over the limits of their coverage.

"The plans are opaque," he added. "They deny coverage for reasons we don't understand."

"People are losing teeth" because they delay treatments they think they can't afford, he said.

Eagan, 30, a graduate of Foxboro High, is living at his parents' home while he pays off his student loans. He said dentists are not expecting to get rich off of Question 2's change in how money is allocated.

But, he added, "dentists stand to benefit because more patients will accept treatments that are recommended."

Insurers oppose

Dental insurers oppose the ballot question.

They warn that premiums could go up by as much as 38%, and thousands of Massachusetts residents may lose dental coverage as a result. The study that projected this price increase was commissioned and funded by a trade group for dental insurers.

"You will most likely see some carriers leave the market and some carriers offer less in terms of benefits," Jim Welch, a former state legislator and spokesman for the "No on 2" campaign told WBUR radio in Boston. "When carriers leave the market and benefits get decreased, access goes down, quality goes down and, unfortunately, in the end costs will go up."

Welch said the measure, if it passes, would disproportionately hurt people who can least afford it.

"This ballot question would really negatively affect the smaller insurance carriers, the ones that probably provide dental insurance to employers, smaller mom and pop type organizations," he said.

Kyle Sullivan, a spokesperson for the Committee to Protect Access to Quality Dental Care, voiced similar concerns.

"Question 2 will increase costs for Massachusetts families and employers and can result in denying thousands of residents access to much needed dental care. 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," Sullivan said in a statement on behalf of the committee.

Dental coverage is a voluntary benefit, leaving far fewer residents with coverage compared to mandated medical insurance. Dental plans must then distribute costs among fewer policyholders. Yet dental plans have similar fixed administrative costs as medical plans, such as credentialing and monitoring fraud, waste, and abuse, Sullivan said.

"Dental insurers have fewer dollars and fewer policyholders to cover the administrative expenses," he said, "and thus these expenses comprise a larger portion of dental premiums than medical premiums."

Delta Dental, the state's largest insurer, has been relatively quiet, referring questions to a spokesperson. But they have also been a leader in voicing its opposition monetarily.

WBUR reported that, through Oct. 1, the company contributed the bulk of the cash, over $4 million, toward the effort, according to data from the Massachusetts Office of Campaign and Political Finance.

The Massachusetts Dental Society had contributed over $200,000 to the "Yes on 2" campaign, and the American Dental Association had pledged $5 million. Mouhab Rizkallah, the Somerville orthodontist, is the biggest individual donor, contributing over $2 million. Many dozens of donations have come from individual dentists, mostly of amounts in the low hundreds.

(Staff writer Tom Reilly contributed to this report.)