Funded Projects

(SDAS) Effect of the Affordable Care Act on Pediatric Dental Coverage and Utilization

Grantee: RAND Corporation, The
Principal Investigator: Ashley Kranz
Project Number: R40MC29442
Project Date: 04/01/2016

Age group(s)

• Toddlerhood (13-35 months)
• Early Childhood (3-5 years)
• Middle Childhood (6-11 years)
• Adolescence (12-18 years)

Targeted/Underserved Population

• African American
• Asian/Pacific Islander
• Hispanic/Latino

Abstract

Dental caries, commonly referred to as tooth decay, is a preventable disease affecting more than half of U.S. school-aged children in the U.S. Promoting oral health is important because untreated dental caries is painful, contributes to missed days of school, and is costly to treat, yet national surveys report that most children do not visit a dentist in a given year. Children with dental coverage are more likely to receive dental care and less likely to have an unmet dental need. Dental coverage is provided to all publicly insured children, but less common for other children. The Affordable Care Act (ACA) seeks to increase the number of children with dental coverage through its inclusion of pediatric dental care as one of the essential health benefits (EHB) covered by plans sold on the individual and small group insurance markets, however the effect of this provision is uncertain because families are not required to purchase dental coverage. In response to the R40 MCH Secondary Data Analysis Studies funding opportunity announcement (HRSA-16-029), this secondary analysis of the National Health Interview Survey (NHIS) will examine whether the ACA's pediatric dental care EHB increased dental coverage and utilization among children. Using six years of NHIS data (2010 to 2015), we will estimate regression-adjusted difference-in-differences models comparing results in 2014 and 2015 with results from the time period prior to the implementation of the ACA's EHB package (2010 to 2013) among children affected by the pediatric dental care EHB and children unaffected by it. Aim 1 of this project will determine whether the ACA increased rates of dental coverage and dental visits for children affected by the pediatric dental care EHB. Because a few states required families using the insurance marketplaces to purchase pediatric dental coverage, Aim 2 will determine the extent to which this requirement increased dental coverage and dental visits for children overall and for historically underserved groups, defined by race/ethnicity and income. This study will address two MCH Block Grant National Performance Priority Areas, specifically oral health and adequate insurance coverage. Additionally, this study is attentive to several MCHB Strategic Research Issues because we will evaluate the effect of a policy on the healthcare system (Strategic Research Issue #I), examine the policy's effect on reducing disparities in access to care (Strategic Research Issue #II), and explore how this policy can promote use of dental care and thus the healthy development of children (Strategic Research Issue #IV).