By: Deesha Bhaumik, PhD, and Marko Vujicic, PhD

The American Dental Association Health Policy Institute (HPI) is a thought leader for critical policy knowledge about the U.S. dental care system.¹ We are a group of health economists, statisticians, and health services researchers dedicated to being the premier source for credible data and research on critical issues facing the dental care system. Our data is used to inform dental policymakers at the federal and state levels. Here, we highlight three recent initiatives showcasing how HPI’s data has impacted state and federal policy related to oral health.

MEDICAID POLICY
The passage of the One Big Beautiful Bill Act represents a pivotal moment for health care access in the U.S. This bill is estimated to reduce Medicaid spending by $1 trillion nationally, which would result in 12 million people becoming uninsured.² The reduced funding will put pressure on states to determine how to manage benefits with a smaller Medicaid budget. Adult dental benefits, which are optional under Medicaid, are at risk of being reduced or cut completely. This represents a significant setback, jeopardizing years of progress states have made in expanding adult dental benefits for Medicaid recipients. HPI’s recent brief, ‘What Happens if the Adult Medicaid Dental Benefit Goes Away?’³ estimates the one-year cost of eliminating adult Medicaid dental benefits at $1.9 billion in additional health care spending, resulting from increased emergency department visits for dental conditions and unmet periodontal needs among pregnant beneficiaries and beneficiaries with diabetes and coronary artery disease. The states with the two highest estimated one-year costs are California ($400 million) and New York ($256 million). Our data is intended to be used by the dental profession to advocate for preserving and expanding adult Medicaid dental benefits in their state.

Recently, following a state budget shortfall of $1.2 billion, the Colorado Dental Association (CDA) successfully used HPI’s data to leverage against proposed rate cuts to Medicaid dental benefits as well as an annual spending cap on adult dental benefits.⁴ CDA also secured an increase of 1.6% for all Medicaid rates, including dental rates. HPI is thrilled that our data was used to guide policymakers’ efforts to expand services that improve public health outcomes and lower economic costs.

COMMUNITY WATER FLUORIDATION POLICY
Community water fluoridation (CWF) is currently at risk of being removed from many community water systems in the United States.⁵ Fluoride, a naturally occurring mineral found in water, strengthens teeth and prevents decay through remineralization of the tooth enamel.^6,7 CWF, a public health measure implemented 80 years ago, ensures that the U.S. population has equitable access to the benefits of fluoride.⁸ Currently, fluoride is administered at an optimal level of 0.7 mg/L in community water systems.8 Due to growing distrust of scientific evidence and concerns of consumer autonomy,^9,10 fluoride has recently been banned from community water systems for the first time in two states: Utah and Florida.¹¹ Several other states have begun motions to ban the mineral as well.^12,13 In an effort to help preserve CWF and illustrate its benefit in preventing costs related to dental decay, HPI published a brief ‘State-Level Costs of Removing Fluoride from Community Water Systems.’¹⁴ Our brief projects each state’s total five-year cost of increased dental treatment if fluoride is removed from their community water systems. We estimate the national five-year cost at $46 billion, with the two highest state-level costs being for California ($4.8 billion) and Texas ($4.4 billion).

In addition, the U.S. Food and Drug Administration announced that prescription fluoride supplements will be pulled from the market effective October 2025 following a safety review.¹⁵ The ADA recently submitted comments in response to FDA’s request for input on the use of orally ingestible unapproved prescription drug products containing fluoride among children.¹⁶ In this six-part letter, HPI provided data on fluoride supplement prescription trends among dentists. Nearly two out of three dentists participating in HPI’s quarterly panel of U.S. dentists reported that they prescribe fluoride supplements to their patients.¹⁷ Among dentists who prescribe supplements and see both children and adults, 84% prescribe high-concentration fluoride toothpaste. Eliminating dentists’ ability to prescribe fluoride supplements would be a violation of providers’ clinical autonomy and greatly affect the dental health of their patients.

We hope our data can be a tool for state and national policymakers aiming to preserve CWF. The removal of fluoride from community water sources, coupled with a fluoride supplement ban, would leave all communities, but especially rural and low-income communities, vulnerable to tooth decay and its associated health complications.

ECONOMIC POLICIES AFFECTING DENTAL PRACTICES
In early June, the U.S. House of Representatives passed its reconciliation package, which included a provision that would remove the pass-through entity taxes (PTET) deduction.^18,19 Designating small businesses as pass-through entities and taxing them differently than larger corporations helps to create a sustainable and competitive financial model, particularly for dental and medical practices in rural or underserved communities. The removal of the PTET deduction would result in increased taxes on dental practice owners operating as pass-through entities. To help the ADA’s lobbying efforts, HPI provided a comprehensive analysis of dental practice employment, dentist wages and the financial structure of dental practices. Our data showed that nationally, nine out of ten dental practices are structured as pass-through entities that could be impacted by any PTET policy changes.²⁰ This data was broken down to the state level, directly informing members of Congress on how this issue affects their constituents and stakeholders. The removal of PTET would put financial strain on dental practices, possibly leading to reduced services or practice closures that would harm both dentists and the populations they serve.¹⁸ The ADA organized a broad coalition of 31 health care groups, coordinated cross‑industry advocacy for affected pass‑through entities and leveraged HPI data to make their case to Congress. A grassroots effort resulted in more than 11,000 letters being sent to Congress from ADA members in support of the PTET deduction.²¹ In July, the ADA secured the restoration of the PTET deduction in the Senate bill, avoiding a nearly five percent tax increase on S-Corporations and partnerships and preserving tax parity with other pass-through entities.²¹

LEVERAGING DATA IN YOUR STATE
HPI offers a variety of state-level resources that health organizations, policymakers, dentists and other stakeholders can use to inform their policy decisions.²² We encourage interested readers to explore the depth of data we can offer to advocate for access to care. Contact HPI at hpi@ada.org or visit us at ada.org/hpi.

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Deesha Bhaumik Ph.D., M.S., is the Senior Health Policy Analyst at the Health Policy Institute (HPI) of the American Dental Association (ADA). At HPI, she leads both research and advocacy for various projects focused on dental policy. She is responsible for both quantitative and qualitative analysis and keeps HPI informed and up to date on new oral health policy issues, particularly in Medicaid, Medicare and the Affordable Care Act.

Marko Vujicic, Ph.D., currently serves as Chief Economist and Vice President of the Health Policy Institute (HPI) as well as Chief of International Relations at the American Dental Association (ADA). In his role as Chief Economist, he oversees a comprehensive research program focusing on oral health policy issues in the U.S. health care system. In his role as Chief of International Relations, he oversees all global initiatives within the Association.