It’s clear that the COVID-19 pandemic has impacted more than our health. For thousands of Americans, the pandemic has left them jobless – and as a result, without health insurance from their employer. Although there are some indications of our country’s economic recovery, another 406,000 people filed for unemployment last week. Women have been greatly affected by this job loss, and as COVID-19 cases have shown, the pandemic has disproportionally impacted Black and Brown populations.
There is no preordained reason why health insurance should be tied to employment. America is unique in its use of employer-sponsored healthcare. About half of all Americans have health insurance through their employer. In addition, the United States remains the only country in the developed world without a system of universal healthcare. Unfortunately, many Americans view health insurance – and thus access to health care – as a privilege earned through employment, rather than a fundamental right. Attempts to alter this system of health coverage have been met with intractable resistance.
Our country’s history of employer-based healthcare stems back to World War II when workers were scarce and competition for talent was high. To control competition for workers, the U.S. government limited employers from raising workers’ wages. Instead, employers began offering workers health benefits as incentives. Insurance companies learned that insuring workers was a powerful and financially smart way to guarantee that they would sell their policies to a relatively fit, capable, and young population.
By the 1950s, major medical plans evolved and included vision and dental benefits. Of course, employer-based healthcare keeps the insurers expenses low and profits high with tactics like limiting benefits to relatively healthy young adults and limiting the dental benefits to an inadequate dollar amount, preventing optimal care. But relying on employment for healthcare leaves retirees, the elderly, the unemployed, those who cannot work, and children without insurance.
Government-run programs like Medicare, Medicaid, and the Children’s Health Insurance Program were created for those groups left behind. The Affordable Care Act, which was designed to expand Medicaid eligibility to low-income Americans, has helped many, but not all. There remains a pending explosion of oral health conditions and diseases that are still not addressed with these programs for far too many Americans. About 74 million Americans today still find themselves with no dental insurance.
This is a problem for adults in particular who are out of work or retired and relying on Medicare. Nearly two-thirds of Medicare beneficiaries – 37 million people – have no oral health insurance. The disparity in oral health once again follows racial and economic lines with Black, Latinx, and low-income adults experiencing the highest levels of periodontitis, dental caries and oral cancer.
We now know that oral health affects more than your teeth – it alters your overall health and well-being. Research also shows that the appearance of your mouth and teeth can influence hiring practices and affect employee earnings. For Americans who were having difficulty accessing health care before COVID-19, the pandemic has made oral health even worse as thousands of Americans continue struggling to find work.
UCSF and other academic health systems with dental schools commonly act as safety nets for the uninsured and vulnerable populations that are left behind. We compassionately treat all individuals. But the question remains: Is this our responsibility alone or should it be shared? The economic benefits of universal health care for oral health will far outweigh the costs, as stated by the World Health Organization this month.
Our government can promote oral health by increasing support for academic dental centers. If we want a healthy and well-employed America, we also need to expand Medicare, Medicaid and private health insurance coverage to include dental services that will move with individuals throughout their lifespan.