[Congressional Record Volume 170, Number 9 (Wednesday, January 17, 2024)]
[Senate]
[Pages S149-S150]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
By Mr. DURBIN (for himself and Mr. Marshall):
S. 3597. A bill to reauthorize programs relating to oral health
promotion and disease prevention; to the Committee on Health,
Education, Labor, and Pensions.
Mr. DURBIN. Madam President, last week, we received remarkable news
about a milestone in America's healthcare: A record 20 million
Americans are now covered by health insurance under the Affordable Care
Act.
This is a sign of progress as we improve the quality of life and
healthcare protections under President Biden.
Having quality, affordable healthcare coverage means having peace of
mind if you get a diagnosis, an accident, or if you need access to care
and are facing medical debt.
I know this story. I have been there. I was a law student at
Georgetown when my wife and I were blessed with the birth of our first
child, a baby girl born with a serious medical condition. As a young
father without insurance, I can tell you, there is no greater feeling
of helplessness.
That is why Democrats have been committed to expanding health
insurance to millions more Americans and ensuring it contains
protections for patients with preexisting conditions.
But even with these successes, there are serious gaps in America's
healthcare system, gaps which are unimaginable until you learn
specifically what I mean.
I want to focus on one of them: access to dental care.
I spent the August recess last year visiting small towns in Southern
Illinois. I met with the new mayor of Carbondale, IL, Carolin Harvey.
I asked her: OK. You have a U.S. Senator in your office, Mayor. What
is your ask? What do you want?
Her answer: pediatric dentistry, of all things. I couldn't imagine
that. I thought it would be a sewer line or a street or something for
law enforcement--pediatric dentistry. She said: Senator, we just don't
have enough dentists for kids in Southern Illinois. In fact, there are
10 rural counties in the State that have only 1 dentist to serve their
community. In Lawrence County, there is 1 dentist for 15,000 people.
That ratio--a local ratio--is 11 times worse than the national average.
What is the result of a shortage of dentists, particularly for kids?
Patients' conditions worsen as they face delays to getting an
examination.
My office was recently contacted about a child in Southern Illinois
who was found to have tooth decay in her 18-month checkup. The patient
is covered by Medicaid, and her parents had a hard time finding a
dentist who would even see her.
Imagine this for a minute as I tell you this story, that you are a
father or mother of a child who is 18 months old and has tooth decay
and pain. After nearly a year, the patient was finally treated for
severe tooth decay, erosion of the upper incisor teeth, and a large
tooth abscess, but her condition did not improve after multiple rounds
of antibiotics so her dentist called around to find a specialist to see
her.
They were told by the specialist that ``unfortunately, we have over
200 patients on our [waiting] list, so we really cannot help [her].''
This child is going to have to develop a much worse condition known as
facial cellulitis, then she can be sent to an emergency room and then
``we can see her.''
Listen to what I just said. You have a child who is a year and a half
old, who has already been treated by a dentist, who has complications,
who is trying to find her way back to the dentist and is being told:
Sorry. There is a waiting list here of 200 people. Get to the end of
the line, and wait.
Perhaps, though, there is a way out. If this child's condition
worsens or is complicated, then maybe we can qualify under a new code
under Medicaid to finally see her and treat her. In other words, this
toddler had to develop deep-tissue infection--putting her at risk of
sepsis, jaw damage, and other life-threatening illnesses--to get her
decayed teeth pulled.
Imagine that as a parent, would you. Think about that for a minute.
Her dentist called a specialist in a neighboring State. Thankfully,
they were able to perform emergency surgery to remove the decayed teeth
but not before risking life-threatening illnesses.
That is the reality for people in the United States of America and in
the State of Illinois today. That is unacceptable. In fact, it is
embarrassing. So what are we going to do about it in Washington, with
all our money and all our power?
Thankfully, there is a Federal program that can help. It is called
the National Health Service Corps. It provides a scholarship and loan
repayment to dental, medical, and mental health providers who work in
rural and urban areas in need. It is the primary Federal program
intended to build a pipeline of healthcare providers and address
shortages such as the one I just described to you. Nationwide, there
are 20,000 professionals serving in the National Health Service Corps,
treating 21 million patients.
But $310 million in mandatory funding for this program will expire at
the end of this month. We cannot allow this to happen. Senator Marco
Rubio--a Republican from Florida--and I have a bipartisan measure to
extend this program and nearly triple its funding. It is supported by
more than 65 leading medical organizations. They know the reality on
the ground for poor people in America, particularly in rural areas and
urban areas in need.
The Senate HELP Committee passed a major bipartisan package last fall
that included significant new funding for this program. I urge my
Republican colleagues to join and support it.
But there is a lot more we need to do. For example, in Illinois, only
one-quarter of practicing dentists accepts Medicaid. Think about that.
Only one-quarter of practicing dentists accepts Medicaid. Since so few
dentists take Medicaid patients, it means that kids in Illinois, with
private insurance, are six times more likely to get a dental
appointment than those who have Medicaid. In other words, if you are
poor, that child complaining of a toothache is just going to have to
take it. That, unfortunately, in my State and in many States, is
reality.
Low reimbursement rates and arbitrary practices by companies that
administer dental benefits under Medicaid contribute to this. So I
recently sent a letter to the three major insurance providers--
DentaQuest, Avesis, and Envolve--to understand their tactics and their
corporate strategies and ensure they are not putting unnecessary
barriers up for basic dental treatment.
I am also working with stakeholders to bring in Federal dollars to
expand dental residency training programs, fund mobile clinics that
drive into rural areas, and expand surgical capacity.
I might just say this as an aside. I am often asked the question: Why
in the world do we treat dentistry as anything other than a medical
specialty? It certainly is. If you have got a sore
[[Page S150]]
tooth or a decayed tooth or a problem in your mouth, you want help, and
you want it now; and you want a professional to provide it. They go
through years and years of training. Yet, instead of being treated like
a medical specialty like orthopedics or cardio, they are in a different
category altogether. It makes no sense.
Today, I am announcing a new bill that I am introducing with Senator
Roger Marshall of Kansas. Our bipartisan legislation will authorize
funding for the Centers for Disease Control and Prevention to enhance
public health activities to improve dental care across America. It will
support education, data collection, sealant treatments in schools,
water fluoridation efforts, the development of the dental workforce,
and community outreach efforts, such as the distribution of
toothbrushes--the basics--to new parents and children.
Illinois has not received funding for this important work in nearly
20 years due to a lack of funding. I want to change that. If we improve
the health of Americans, especially kids, then we must invest in
preventing cavities, tooth decay, and infections. We must also ensure
that patients have access to treatment, regardless of their ZIP Codes.
I appreciate the partnership of my colleague Senator Marshall, and I
will be working to pass this bipartisan legislation quickly.
I want to say, just in closing, to the mayor, Carolin Harvey of
Carbondale, IL, that you shocked me when you suggested pediatric
dentistry was your ask. It told me a lot about you, your heart, and
your caring for kids. Now that we know the reality of kids waiting for
months and months and even years for basic dental treatment, let's do
something about it, not just in Illinois but across this country. This
is fundamental and basic, good health, and we need to make sure it is
included in all healthcare coverage.
Madam President, I ask unanimous consent that the text of the bill be
printed in the Record.
There being no objection, the text of the bill was ordere to be
printed in the Record, as follows:
S. 3597
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Promoting Dental Health
Act''.
SEC. 2. REAUTHORIZATION OF PROGRAMS.
Section 317M of the Public Health Service Act (42 U.S.C.
247b-14) is amended--
(1) in subsection (d)(2), by striking ``2010 through 2014''
and inserting ``2024 through 2028''; and
(2) in subsection (f), by striking ``2001 through 2005''
and inserting ``2024 through 2028''.
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