Will States Take the Lead on Healthcare?

by Naomi Lopez
March 14, 2018

At a time of seemingly intractable partisan acrimony over healthcare in Congress, prospects for comprehensive reform remain dim. But, when it comes to delivering on healthcare access and affordability, there are some bright spots in the states.

One state to watch is Arizona where lawmakers are inching closer to delivering on a significant reform that promises more accessible and affordable dental care. Somewhat like nurse practitioners, SB 1377 would allow for mid-level dental providers. This effort is an urgent priority as the state faces a severe dental crisis.

Of Arizona’s 7 million residents, 4.6 million are living in “dental health professional shortage areas” with one or fewer dentists per 5,000 people. Significant areas of all fifteen counties fall under this designation with five counties falling entirely under it. And remember that living near a dentist doesn’t mean that the provider is taking new patients or that a current patient can obtain an appointment in the near future.

Allowing for mid-level dental providers is an idea that enjoys strong, bipartisan political support. A 2016 national poll found that 79 percent of all voters were in favor. More important, this idea was consistently supported no matter one’s political label with 77 percent of Republicans, 79 percent of independents and 80 percent of Democrats in support.

In Arizona, this bipartisan voter support is reflected in the coalition supporting this legislative effort. Dental Care for Arizona is represented by groups spanning the ideological spectrum including Americans for Tax Reform, Navajo Nation, the Inter-Tribal Association of Arizona, the Pew Charitable Trusts, and my own organization, the Goldwater Institute.

These diverse groups are unified behind the goals of increasing dental access and affordability – doing so by removing the government barriers that prevent mid-level dental providers from practicing at the top of their education and dental training – without imposing additional costs on taxpayers.

While some are opposing this common-sense, free-market solution on the basis that it would threaten patient safety, the evidence affirming the safety of dental therapy is long and well documented. Dental therapists have been providing care for decades in more than 50 countries around the world and in a growing number of states in the U.S.

In addition to the 1,000 studies from around the world attesting to the safety and quality of dental therapy, a recent study published in the Journal of Public Health Dentistry last month further attests to Alaska’s positive outcomes with dental therapy.

Researchers at the University of School of Dentistry at the University of Washington examined communities both with and without dental therapists in communities of 58 Native Alaska tribes between 2006 and 2015 where dental therapists are allowed to practice on tribal lands.

Using data from 13 dental therapists who provided the equivalent of 9,012 days of treatment in those communities, the authors found that the increased dental therapy treatment days were associated with more preventive care, fewer tooth extractions for children under age 3, and fewer permanent tooth extractions for adults.

The authors concluded that: “There appear to be clinically meaningful differences between communities with no Dental Therapists and communities with the highest number of Dental Therapist treatment days, with the latter communities exhibiting utilization patterns consistent with improved outcomes (e.g., more preventive care, fewer extractions, less general anesthesia).”

Arizona lawmakers have an opportunity to put patients above politics, setting an example for lawmakers in Congress and the multiple states considering similar proposals to foster greater access to affordable dental care.

Naomi Lopez is director of healthcare policy at the Goldwater Institute.