But research increasingly shows how closely dental health is connected to overall health. Dental problems, and their accompanying inflammation and bacteria, can worsen other chronic conditions, like diabetes and heart disease. And missing or sore teeth can make it hard to eat a healthy diet. Dental infections can be painful — they are a major cause of emergency room visits — and, in rare cases, life-threatening.
“Dental care is health care, and dental care must be part of any serious health care program in the United States,” Senator Sanders said.
Medicare coverage would give older and disabled patients a way to pay for their care, yet there is no guarantee that dentists everywhere would accept it. Nearly every doctor and hospital in the country takes Medicare, but dentists have built their businesses over the last 50 years without relying on the program. Many dentists in private practice refuse to accept Medicaid, saying that payments are too low and the red tape burden too high.
“If you provide somebody with a covered benefit and they have no place to go, then that’s feckless,” said Tess Kuenning, the president of Bistate Primary Care Association, a group for community health centers in Vermont and New Hampshire. Ms. Kuenning urged lawmakers to ensure payment rates that would be enticing to dentists, and investments in public health dentists like Dr. Rulon, who would be more inclined than dentists in private practices to treat Medicare patients.
But optimists see Medicare dental coverage as something that might do more than just improve affordability for beneficiaries. It could also shift longstanding norms about what health insurance should cover. Historically, health plans have tended to ignore health problems “in your head”: omitting dental coverage, vision benefits, hearing aids and mental health. Congress began requiring mental health coverage about 15 years ago, starting in Medicare, and then expanding to other types of plans. Mental health care access is still uneven, but has become more broadly understood to be a part of health care.
“When Medicare moves, everyone else moves,” said Michael Costa, the C.E.O. at Northern Counties Health Care and a former top health policy official for Vermont.
In the meantime, Medicare patients treated in Hardwick continue to make tough choices. When Gina Brown, 66, came in recently for a teeth cleaning, Dr. Rulon discovered a cavity near a root — one that could quickly cost her the tooth. She was back in the chair for a filling that afternoon. She had comprehensive health coverage through her job caring for developmentally disabled adults, she said, but her dental benefit was “very limited.” She could afford to fix this ailing front tooth, but not a partial denture to replace the molars she had lost years ago, when money was tight and dental care out of reach.