What to know about the Mass. dental insurance ballot question

Illustration: Brendan Lynch/Axios

Digesting Question 2 feels like pulling teeth.

The big picture: When you get past the jargon, the measure that voters will face at the ballot on Election Day comes down to how much of our insurance premiums should cover dental procedures and how much insurers should pocket.

A “yes” vote would require insurers to spend 83 cents of every dollar on patients’ dental work, a threshold known as the “medical loss ratio.”

• That would leave 17 cents of every dollar for administrative costs, taxes and revenue.
• It would be the first law of its kind in the U.S. regulating dental plans similarly to medical plans.

A “no” vote would impose no threshold for dental insurers.

Details: The proposed dental insurance overhaul would make the state Division of Insurance block proposals in which insurers pay out less than the 83% for dental work, per a report from the Tufts University Center for State Policy Analysis.

• It would also make insurers issue rebates if they don’t meet the 83% standard.
• They would also be required to divulge more financial and operating data, per CSPA.

There are few details about what share of premiums usually covers dental work, which is perhaps why the CSPA notes the ballot question is “built on relatively thin information.”

• The report says many dental insurers could easily adjust to an 83% standard, except for “smaller, less efficient health insurers.”

Yes, but: A report from the National Association of Dental Plans says in one scenario a small carrier would have to raise premiums by 38%, from $35 to $50, and increase claims by 60% to meet the threshold while pocketing enough to keep the business afloat.

• The CSPA report says insurers could meet the 83% standard in several ways, such as covering a wide range of procedures or by letting dentists charge a higher price and pass costs onto patients.

What they’re saying: “Patient premium dollars should be spent in support of patient care, and dental patients deserve to know how much of their dental insurance premiums go toward their actual care versus profits and administrative costs for insurers,” said Andrew Tonelli, co-chair of the Massachusetts Dental Society’s government affairs committee and former chair of the Boston District Dental Society, in a recent press release.

The other side: Former state Sen. James Welch, representing the Committee to Protect Access to Quality Dental Care, told GBH News’ Jim Braude the government shouldn’t regulate dental insurance the same way it regulates medical insurance, which is mandated.

• Because dental plans aren’t mandated, dental insurers tend to have fewer policy holders than medical insurers. Yet dental insurance companies face the same administrative costs as medical insurers, per the committee.

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