Opinion: Let’s Put Some Teeth into Veterans’ Healthcare Coverage
The U.S. Department of Veterans Affairs provides veterans with coverage for medical care, but routine dental care only garners partial coverage, being available only to those veterans on 100% disability or with oral health problems related their service. The lack of full dental care from both the Department of Veterans Affairs, Medicare and Medicaid causes issues for veterans in need. Research supports the provision of dental as well as general health care, given that gum disease and systemic conditions are strongly correlated. Type 2 diabetes mellitus, cardiovascular disease, and osteoporosis have all been linked to oral issues, with strokes and depression potentially also related. The risk factors for these diseases are increasingly higher for the older population of Vietnam and Korean War veterans, and as nearly half of the 20m US veterans are over the age of 65, the problems will continue to worsen without intervention. For senior citizens, seven in ten have gum disease; one in five have untreated cavities, and almost one in five have no teeth remaining. Despite these facts, only 28 states offer adult dental benefits through Medicaid, and even this coverage only covers particular services, with few providers willing to offer them. As it stands, 70% of seniors do not have dental insurance, and low-income seniors generally go without basic care for their oral health.

By Shelley Lyford

When Brian parachuted onto the Korean Peninsula with the 187th Airborne in September of 1950, his teeth were the last thing he worried about. His primary concerns were, first, that his chute would open, second, that he wouldn’t get shot out of the sky by the enemy or tangled up with one of the thousands of other paratroopers jumping out of the “Flying Boxcar” transport planes, third, that he’d land in the jump zone clearing and not in the trees, and fourth, that he wouldn’t break his leg or become separated from his company once he landed.

Brian managed to survive that jump, as well as months of fierce combat against Chinese and North Korean troops during the freezing winter of 1951. But sixty years later, he literally didn’t have a leg to stand on. Like a lot of paratroopers, Brian had developed osteoarthritis in his knees as a result of the repeated impact of parachute landings with a heavy pack and rifle bag strapped to his body.

Brian was a good candidate for double knee replacement which would allow him to walk again, and would relieve the pain of the degenerative arthritis that had wrecked his joints. And since his disability was directly related to his wartime service, it was covered by his veteran’s benefits — which was good news indeed, because Brian was flat broke by then and just getting by on Social Security. For years after his service, Brian owned a successful restaurant in downtown San Diego. But he fell on hard times, lost his business and couldn’t keep up with his bills.

While the U.S. Department of Veterans Affairs continued to cover his medical care, routine dental care is generally only covered for veterans on 100% disability or with service-related dental problems, so he couldn’t keep up with his basic dental needs. Ten years of going without dental care had taken their toll on his mouth. Most of his teeth were rotted and his gums were badly infected. So badly, that the orthopedic surgeon couldn’t operate on his knees, for fear Brian’s gum infection might spread through his bloodstream to his knee joints during surgery. So his knee replacement had to be put on hold until he could get his mouth treated. Brian didn’t have coverage for the thousands of dollars’ worth of dental work he needed to extract his rotten teeth and treat his infected gums. And because of the patchwork nature of dental coverage for seniors in California and in most states, he didn’t qualify for coverage under Medicaid, while Medicare doesn’t cover dental care.

These kinds of coverage gaps in veterans’ healthcare are all too common. It’s unconscionable that our lawmakers have failed to take care of our Veterans’ needs by ensuring they receive basic dental care.

In the past decade, we’ve come to understand that the mouth is not only the gateway to the body, but also the gateway to chronic disease. Research has uncovered consistent and strong associations between gum disease and systemic conditions such as cardiovascular disease, type 2 diabetes mellitus, and osteoporosis — and it’s suspected to cause many other serious conditions including stroke and depression.

While gum disease is more often a byproduct of old age, poverty and oral healthcare neglect than of battlefield injuries, those risk factors are increasingly common among the aging population of Korean and Vietnam War veterans. Almost half of our country’s 20 million veterans are over the age of 65. California is home to more vets than any other state: 1.8 million, and more than 800,000 of them are over 65.

Here are the hard facts about the oral health of our seniors overall:

7 in 10 suffer from gum disease

1 in 5 have untreated cavities

Nearly 1 in 5 have no teeth at all

Only 28 states include adult dental benefits under Medicaid, and those benefits cover only certain services and finding a dentist to treat a Medicaid patient can be extremely difficult, if not impossible. In 2009, facing a severe budget shortfall, California eliminated its adult dental care benefit. The state restored some of the benefit in 2014, but Denti-Cal payments are so limited that most dentists don’t see Medicaid patients. And since 70 percent of seniors have no dental insurance, low-income seniors are mostly going without basic dental care.

For seniors like Brian, “going without” can have far-reaching consequences. Fortunately, caseworkers at the VA were eventually able to get him the dental care he needed to proceed with his knee replacement surgery.

Veterans like Brian can’t wait for legislators to provide more funding to the VA and Medicaid so they can get critically needed dental care. His story shows how important it is for the whole community to step up and bridge the gaps in veteran’s care. That includes the public and the private sector, as well as private philanthropy.

I’m the Chair of the Board of the Gary and Mary West Senior Dental Center in downtown San Diego, an integrated, community-based model of care tailored to the special needs of seniors. In the year since it opened, our clinic has hosted more than 4,200 dental visits from low-income seniors, who also receive a spectrum of coordinated medical and social supports services under one roof.

All seniors should be able to age with dignity, and oral health is a big part of that equation. Without healthy teeth, seniors can’t eat a nutritious diet, or even engage in everyday social interaction. Our clinic has tapped into an enormous pent-up demand for affordable dental care for seniors, including veterans. Meanwhile, tens of thousands of other seniors, including veterans, are still “going without” dental care.

In addition to Gary and Mary West, visionary philanthropists and dentists in other communities have begun to create model programs to assist veterans. Aspen Dental has 450 offices across the country that have provided free dental care to more than 17,000 veterans and people in need since 2014. Meanwhile, a retired periodontist in Washington state, Theresa Cheng, was inspired by the story of a local Iraq veteran, gravely injured by an IED, to start Everyone for Veterans, a nonprofit that now works with 300 dentists to provide free dental care to veterans in need.

By working together in our communities — in coordination with state and federal agencies — for-profits and nonprofits can close the gaps in healthcare funding for veterans. It’s the least we can do to repay our debt to the brave men and women who have put their lives on the line in defense of our nation. Veterans like Brian deserve a special measure of gratitude and care. Not just today, but every day.

Shelley Lyford is President and CEO of San Diego-based West Health and the Gary and Mary West Foundation, nonprofit organizations that enables seniors to successfully age in place with access to high-quality healthcare and supportive services.