Spending Cuts Could Reduce Pediatric Visits

With a Republican president and majorities in both the House and Senate, conservative lawmakers hope to reduce federal spending on Medicaid and roll back some essential benefits in health plans that currently qualify for consumer tax credits under the Patient Protection and Affordable Care Act (ACA). If they succeed, this could impact adult Medicaid dental benefits that were added in several states through the ACA’s Medicaid expansion funding — and, in particular, reduce dental coverage for children.

According to an analysis by the Urban Institute,1 a Washington, D.C., think tank, Medicaid and the federal Children’s Health Insurance Program (CHIP) collectively cover more than one-third of U.S. children — or nearly 47 million kids. The Urban Institute used the 2016 Health Insurance Policy Simulation Model to estimate what would happen to the number of uninsured children in 2019 under four scenarios.1

  1. With existing ACA provisions in place
  2. With the American Health Care Act (the Republican budget reconciliation bill) that would move Medicaid from its current federal/state matching structure to per capita caps that limit federal spending on a per-enrollee basis
  3. Without the separate CHIP program (funding for which expires at the end of this year)
  4. With the American Health Care Act and ending federal “maintenance of eligibility standards” that prevent states from changing Medicaid eligibility to be more restrictive than what was in place in 2010 when the ACA was passed.

As can be seen in the chart, each scenario leaves additional numbers of children uninsured — with as many as 13.3 million more uninsured kids under the last scenario. Millions more children without dental coverage would certainly impact access to oral health care and likely mean fewer pediatric patients in dental chairs.

It remains to be seen if a decrease in pediatric patients, spurred by reduced federal coverage for children’s oral health care, would create impactful changes in case mix between preventive and restorative treatment. One possible result would be a slowdown in the trend toward more preventive care and less restorative care,2 as cuts in prevention correlate with an increase in dental disease.


  1. Kenney G. The Uncertain Future of Medicaid and CHIP: Implications for Oral Health. Children’s Dental Health Project and Urban Institute webinar. Available at: s3.amazonaws.com/cdhp/dental+coverage/CompleteOral HealthWebinar_03.09.2017.pdf. Accessed March 23, 2017.
  2. Meyerhoefer CD, Panovska I, Manski RJ. Projections of dental care use through 2026: Preventive care to increase while treatment will decline. Health Aff. 2016;35:2183–2189.

From Decisions in Dentistry. April 2017;3(4):60.

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