Access to a healthy mouth and smile shouldn’t depend on our income, our race or where we live. Yet here in Washington, that is precisely what is happening. Wealthier white people with private insurance can easily get an appointment to see a dentist in their community, while the opposite is true for lower-income people of color who either have Medicaid (called Apple Health in Washington) or no health insurance.
How do we know this? Because we hear it all the time. Every other summer, my organization — Statewide Poverty Action Network — travels to communities across the state to hear from people impacted by economic and racial injustice about what they’re facing day to day and their visions for change. What we hear informs the policies we advocate for during the state’s legislative session. What we hear time and time again, even when not asked, is that people all over Washington are not able to get the dental care they need. People face the brutal decision to suffer the pain and risk losing their teeth or take on medical debt to get dental treatment. We consistently hear stories of people delaying care and ending up losing their smile in order to afford other needs like rent, bills and expenses to care for their children.
Indeed, data from the Health Care Authority shows that less than 25 percent of Medicaid enrollees over age 21 can find a dental provider. That number is better for kids, at 53 percent, but the idea that barely half of our kids can see a dentist isn’t exactly a ringing endorsement of our current oral health care system.
This should not be acceptable. For something that is such an obvious (and often painful!) need, it is unsettling that our state legislature has not made oral health access a top priority. While there are many solutions to improving access to dental care for everyone in Washington, only one remains evidence based yet vehemently opposed by the Washington State Dental Association (WSDA): dental therapy. Dental therapy is backed by years of research and is already being practiced in 12 other states and on tribal land in Washington. In addition to advancing care, it creates a more affordable pathway to quality employment in the health care field so that dental therapists can provide care to the community in which they grew up.
We have fought for years to both protect and increase funding for adult dental care through Medicaid so that more dentists accept patients insured through Apple Health. At the same time, we support expanding dental therapy to every community in the state. But for years, the WSDA has used its influence and political action committee to spread misinformation and fear among our lawmakers to obstruct dental therapy. The success of these efforts continues to block better access to care for Black and Brown children, and leaves adults in our state to suffer more pain and entirely preventable oral health disease.
For years, legislators have called for all sides of the issue to come to the table for a full discussion. That finally happened. In the 2021 legislative session, the state legislature created a task force to examine bringing dental therapy to every community in Washington. I was invited to join the Dental Therapy Task Force alongside other members with a range of expertise and experience to review the research and hear from practicing dental therapists, oral health experts and dentists who supervise dental therapists.
My experience on the task force was as frustrating as it was informative and inspiring. I read mountains of research pointing to the effectiveness of dental therapy in improving access to care. I heard deeply touching stories about Indigenous dental therapists speaking their native languages to children receiving care for the first time. I heard about improved oral health outcomes for communities and a sense of pride in having a homegrown provider who stayed in their community.
And I watched the representatives of a large, well-funded and well-organized association resort to stalling, distracting, name-calling and questioning the integrity and experience of practicing dental therapists and their supervisors working on tribal lands.
But in the end, what matters is whether or not those tactics will actually work. Whether the antics of the WSDA will continue to prevent lawmakers from passing an anti-racist, anti-poverty policy that has a proven track record of increasing access to care is all up to our legislators. Will they choose a path of fear and misinformation, or will they follow the lead of tribes in our state and authorize dental therapy for everyone in Washington?
The choice is clear to me. Legislators should review the task force report, stand in solidarity with their constituents who need access to oral health care and authorize statewide dental therapy in the 2022 legislative session.
Marcy Bowers has been Executive Director of the Statewide Poverty Action Network since 2011. The Statewide Poverty Action Network is an antipoverty advocacy organization based in Seattle. Bowers also serves as chair of the Washington State Oral Health Coalition board.