How President Biden Can Solve the Rural Oral Health Crisis
by Arielle Kane
The 2020 election confirmed the political divide between rural and urban America has grown deeper. President Joe Biden overwhelmingly won the nation’s metro regions, but former-President Donald Trump made the contest more competitive than expected by rolling up huge margins in rural areas, where 20 percent of Americans live. Determined to start bridging that chasm, Biden has promised to launch a new “rural agenda” aimed at addressing the stark disparities in health, income and opportunity that have fueled populist anger in the nation’s rural communities.
People who live in rural areas are often underserved, lower-income and more likely to die an early death than their urban counterparts. To address these economic and health disparities, Biden is considering appointing a rural “czar” and rolling out policy aimed at restoring vibrant rural communities.
Though Biden has proposed a number of plans to improve quality of life in rural areas, he has neglected to mention one vital component: good oral health. Fortunately, there are three keyways Biden can improve oral health and direct resources where they’re needed most through his existing proposals.
First, the president-elect has proposed to double funding for community health centers. While his policy platform focused on the primary and maternal care community health centers provide, roughly 80 percent of community health center clinics offer free or discounted dental services to people who need them. He should make sure that a portion of the funding is specifically dedicated to improving access to oral health in underserved communities.
Secondly, Biden signed an executive order creating a U.S. Public Health Job Corps to create new jobs and help unserved communities. Specifically, he has outlined how these new community health workers could help address the current Covid-19 pandemic. However, this model could also help underserved communities access oral health services. Sometimes the hurdle to accessing care isn’t a provider shortage or lack of insurance coverage, but the difficulty of finding and navigating existing oral health resources. A Public Health Corps could help people in need by connecting them with already available dental care.
Several states have proven that a new type of health worker, called a community dental health coordinator (CDHC), can help patients better access dental care. Based on the community health worker model, where workers help patients bridge the gap between clinical and community services, CDHCs provide community-based prevention, care coordination and patient navigation to connect people with available services in their community. If the president-elect is interested in investing in a new type of health care workforce, CDHCs would be a great place to start.
Finally, in order to best allocate limited resources, the Health Resources and Services Administration (HRSA) should update and finalize its definition of Federal Health Professional Shortage Areas (HPSA). HPSA designations help the federal government decide how to allocate resources to underserved areas and rural communities. Specifically, there are loan repayment and forgiveness opportunities for medical and dental students who chose to practice in these areas. More than 30 federal programs allocate resources based on HPSA designations, and many states use the definition for state funding as well. But the program does not have enough funding to cover all those seeking funds: in the last cycle it received 7,000 applications and could only award funding to 40 percent of the applicants.
HRSA is currently revising the HPSA designation to make it more useful. The Biden administration should finish the work and establish new criteria that would direct limited resources to the most underserved rural areas and consider all barriers to care.
While increasing funding for community health centers requires congressional approval, the other two policy changes can be done administratively. Poor oral health can limit a person’s employment opportunities, increase the risk of certain cancers, cardiovascular disease, Alzheimer’s disease, premature births and lead to unnecessary emergency department (ED) visits. And in the United States, if you live in a rural area, you are less likely to have dental insurance and access to a dentist, and more likely to have tooth loss. Biden’s administration should prioritize achievable policies that will increase access to oral health services in underserved, rural areas. Our nation’s health, especially for those who have been long underserved, depends on it.