Closing Pitch: Passion for Policy

As executive director of the Children’s Dental Health Project (CDHP), Meg Booth, MPH, advocates tirelessly for children and their oral health. The mission of this independent Washington, D.C.-based nonprofit is simple: eliminate the early childhood caries (ECC) epidemic. And Booth is leading that charge, recognizing the urgent need for change in the oral health care system.

A self-proclaimed farm girl from Iowa, Booth has always pursued grand ideals. Her passion for health issues, specifically those pertaining to pregnant women and children, ignited during her collegiate studies, but it was during her employment at a state health department that Booth met her mentor who encouraged her to pursue a career that would allow her passions to have a far-reaching impact: changing the systems that have been established to support families.

This advice was a pivoting point for Booth and marked the beginning of her interest in policy. Mentor recently talked to this policy influencer, who shared some of CDHP’s biggest wins as it celebrates its 20th anniversary of advocacy on Capitol Hill.

How has CDHP made an impact on oral health since its inception in 1997?

When CDHP began, our goal was to ensure that states opted to include dental benefits in their new Children’s Health Insurance Program (CHIP). In 2009, when we secured a federal guarantee of dental coverage in CHIP, we had already been exploring how to make Medicaid work better for families, and immediately started working on dental benefits in what was then a new health care reform debate (which led to the Affordable Care Act). Our work has been a big contributor to increasing the number of children with dental insurance to 90%. Those are the most dramatic numbers that reflect the impact of our work. However, we are always working behind the scenes to build the evidence base and identify options for policymakers to expand access to oral health services for families.

What remains the biggest obstacle to ensuring that every child has access to oral health care?

We have made great strides in reducing ECC overall and unmet dental needs, but those gains have not been equally shared across racial and economic groups. Affluent white kids continue to fair substantially better than their less affluent peers and many nonwhite peers. That’s not good enough for us. ECC is preventable, so it’s possible to put children on the same trajectory for good oral health. The current structure of dental benefits in public or private programs has little incentive or flexibility to identify children with the greatest risk for dental caries. We need system-level changes that support the family in preventing decay or managing ECC over time, reducing their risk of very complex problems down the road.

How does state and federal health policy intersect with the work of dental sales reps?

As many sales reps know, the greatest growth in dental coverage, especially for children, continues to be in public coverage (Medicaid and CHIP). The stability and expansion of these programs directly contributes to dental offices’ productivity. Right now, 74 million adults and children utilize public coverage. In collaboration with the American Dental Association’s Health Policy Institute, we found that for every 1,000 people who lose dental coverage, $10,837 less is spent on dental supplies. If 13 million people lose health insurance next year, that could mean $140 million of lost revenue for dental supplies. It is incumbent on all of us to analyze what lawmakers are proposing and to understand the trends and opportunities to stabilize the market.

Your leadership and advocacy have seen the number of children with dental insurance raise from 71% to 90% between 1996 and 2015. What is CDHP doing to secure coverage for that last 10%?

In recent months, we have had to “play defense” to protect these gains. Preserving this progress and building on it requires a variety of strategies. One strategy is to identify partners that extend beyond the dental world, including medical groups, hospitals, insurers, and children’s and health advocates who know that dental coverage is a crucial foundation for good health, ability to learn, and future opportunities. So, while we will look more closely at the commonalities of the 10% and what may be keeping them from accessing coverage, right now we really need to focus on keeping that 90% covered.

What keeps you up at night?

The fact that our society values straight, white teeth — so much that people can’t get good jobs and promotions without them — but we can’t agree that preventing caries or averting pain and infection is for the greater good. Knowing that the lack of attention to oral health fuels societal inequities. That disconnect keeps me focused each day.

From MENTOR. January 2018;9(1): 42.

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