ADA puts money where its mouth is on insurance reform

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The ADA has committed $5 million to support a medical loss ratio (MLR) ballot initiative in Massachusetts that would require dental insurance companies to operate at a minimum MLR. The funding, announced by ADA President Dr. Cesar R. Sabates to members in a September 15 email blast, signals a new emphasis on insurance reform.

The reform measure, called Question 2, will be taken directly to voters in the upcoming November 8 election. If passed, it will require dental insurance companies not only to report their MLRs but also to operate minimally at an 83% MLR.

That means that dental insurers would have to spend at least 83% of their revenue on patients, dental expenses, and quality improvements. The state already has similar provisions in place for medical insurers.

"The ADA is proud to join with the Massachusetts Dental Society to help support this measure, and we are asking for your support as well," Sabates said in the email blast.

A grassroots approach

The voter initiative to reform the dental insurance industry in Massachusetts was generated by the grassroots activist organization the Committee on Dental Insurance Quality (CDIQ), which is composed of 10 members: five dentists and five members of the public.

Dr. Michael W. Davis.Dr. Michael W. Davis.

In a May 7 letter to the Massachusetts Dental Society (MDS), the CDIQ recognized the dental society's lengthy but futile struggles to reform dental insurance in the state. Dr. Mouhab Rizkallah, president of CDIQ, empathized with the well-intended efforts of the MDS, noting that multiple reform bills had gone through the legislative committee process only to be watered down by industry lobbyists.

The CDIQ instead advocated taking legislatures out of the equation and going directly to voters. Subsequently, the MDS threw its support behind the state ballot question advocated by the CDIQ. Other supporters of the initiative followed suit, including:

  • The Alliance of Independent Dentists, Massachusetts
  • The Association of Independent Dentists
  • The Massachusetts Association of Orthodontists
  • The Massachusetts Society of Oral and Maxillofacial Surgeons
  • The Medicaid Orthodontists of Massachusetts Association
  • The Massachusetts Nurses Association

Linda Gendall, a nondentist and treasurer of the CDIQ, joined the committee because she chose to have a tooth extracted rather than fixed because of the high insurance copay for a crown and root canal. When she reviewed her insurance company's not-for-profit tax form filed with the IRS, she was stunned.

"They literally gave away $291 million the same year they only covered $177 million in patient care," Gendall said. "That money belonged to my family and your family, and they had no right to just give that away and call themselves not for profit."

Insurance heavyweights oppose Question 2

The ballot measure has drawn big spending from dental insurance companies that largely oppose the bill. Before the ADA contribution, funding in support of the ballot initiative fell short of $900,000, of which Rizkallah personally contributed more than half. Meanwhile, the opposition has raised $5 million, more than five times the amount that supporters have raised. The largest contributor was Delta Dental of Massachusetts at $4.5 million.

The opposing Committee to Protect Access to Quality Dental Care (CPAQDC) argues that Question 2 will actually raise dental insurance costs in the states. The organization is composed of insurance industry heavyweights, including the Dental Service of Massachusetts (Delta Dental of Massachusetts), Metropolitan Life Insurance, Principal Life Insurance, Sun Life Financial (DentaQuest), and United Concordia Companies.

"The proponents of this ballot question are not being straight with the voters," the CPAQDC states in its messaging. "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."

Notably absent in opposition to Question 2 is Massachusetts' second largest dental insurance carrier, Blue Cross Blue Shield of Massachusetts (Blue Cross). Reasons for its absence may relate to its value-based dental programs, which shift risks onto providers and reduce loss risks from the insurance company.

Why the ADA stance matters

In addition to leveling the funding playing field, the ADA contribution signals the association is willing to put its money where its mouth is when it comes to addressing dental insurance reforms.

After pressure from dentists for decades, the ADA announced in April that dental insurance reform topped its advocacy priorities for 2022. Other areas of focus include student loan reform, improving Medicaid, and improving health equity.

The ADA's attention on insurance reform has led to real-world changes. At least eight states passed new laws addressing dental insurance, according to the ADA. With the contribution in support of Question 2 in Massachusetts, the ADA is seeking to add another win to its victory lap.

"If we win in Massachusetts, it will be a watershed moment for patients and dentistry, setting a precedent that could herald future change for dental insurance across the country," Sabates said in the email.

Dr. Michael W. Davis practices general dentistry in Santa Fe, NM. He also provides attorney clients with legal expert witness work and consultation. Davis currently chairs the Santa Fe District Dental Society Peer Review Committee. He can be reached at [email protected] or

The comments and observations expressed herein do not necessarily reflect the opinions of, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

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