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Dentists play hardball, deny access

Empower Wisconsin | Nov. 5, 2019

By M.D. Kittle 

MADISON — A bill that would open the door to dental therapists in Wisconsin may have bipartisan support and the backing of dozens of organizations, but it won’t go anywhere if the Wisconsin Dental Association has its way.

The powerful special interest group has used its lobbying muscle for more than two years in stalling the bill, which would create a license for a dental therapist — similar to a physician’s assistant — that could perform basic oral health procedures. 

Those who have gone up against the WDA and its parent, the American Dental Association, say the well-heeled organizations often get their way because they will use all means necessary to do so. 

And a long-time dentist and member of the WDA asserts dentists around the state have not been forthright about their refusal to serve Wisconsin’s many underserved communities.  

Threats and intimidation

Ruth Ballweg has been fighting with the dental association for years. The feisty former director on the University of Washington School of Medicine’s physician assistant program helped oversee the creation of the school’s DENTEX program for students studying to be dental health aid therapists. She is internationally known as a spokesperson for primary care and as a passionate advocate for dental therapists. 

Ballweg claims the dental association immediately threatened to lobby lawmakers to pull funding from the University of Washington’s dental program if it pursued the dental therapist program. Ballweg said she agreed to take the DT program under the School of Medicine.

Then, Ballweg said, the local dental association began threatening young dental professors and dentists involved in the dental therapy program. 

“The dental program dean told me this woman dentist in Spokane had just called her to hassle her about wanting to know who these (faculty members) were,” Ballweg told Empower Wisconsin. “I pick up the phone and this dentist, she doesn’t say hello, she immediately says, ‘I demand you tell me who these people are!” She’s screaming at me. She goes on and on. She said, ‘You better tell me or I’ll ruin your career, your life, your family.’” 

“I started laughing. She said, ‘Why are you laughing?’ I said, ‘I’m not a dentist, you can’t do shit to me,” the long-time physician’s assistant recalled. 

Despite the intimidation game, the university dental therapist program has been successful by most measures. The program serves a five-state area in the Northwest, including Alaska, where native tribes long ago begged for dental practitioners in their remote villages. Ballweg said there are communities there today where children and young adults boast full, healthy smiles, unlike their parents and grandparents who had no access to dental care. 

The access gap remains a significant problem in urban and rural Wisconsin. According to the federal Health Resources and Services Administration, dental provider shortages exist in 65 of Wisconsin’s 72 counties, affecting 1.5 million Wisconsinites. Only one-third of poor children covered by Medicaid saw a dentist in 2016, according to the U.S. Department of Health and Human Services.

Minnesota experienced the same problems in 2011 when the state launched its dental therapist program. The Legislature met resistance from the dental association, but the therapist program at least in part has helped close the Gopher State’s access gap. 

’No symphathy’

The Wisconsin Dental Association and Marquette University, which houses the state’s only dental school, have fought the dental therapist bill tooth and nail. WDA lobbyists have complained the legislation doesn’t require dental therapists to work in underserved areas or take Medicaid patients.

Such complaints ring hollow to a northern Wisconsin dentist and longtime WDA member, who spoke to Empower Wisconsin on condition he not be identified in the article. 

The dentist says he has “no sympathy” for the WDA’s position, asserting dental professionals opened the door to the need for dental therapists by rejecting Medicaid patients. While he agrees Medicaid reimbursement rates for dental care in Wisconsin are frustratingly low, dental practitioners have too often been motivated by greed. 

In a letter to the WDA, the dentist said his policy has been to treat one BadgerCare (Wisconsin’s Medicaid program) patient per day, plus any adult emergencies or pediatric BadgerCare patients. 

“The most embarrassing case that I can remember from our profession came when a local dentist refused treatment to a family, who had been regular patients of his for 25 years, when the father lost his job and the family went on BadgerCare. They were told to ‘go see (the dentist who took Medicaid patients) — he sees people like you.’ How humiliating for the family. How humiliating for our profession,” the dentist wrote. 

He takes issue with the WDA’s stance against dental therapists. 

“I say that they (dental therapists), at least, are standing up for thousands of our citizens, many of who are in pain — something which dentistry should have done years ago,” he wrote. “There are over 60 groups who are going to weigh in on the side of our citizens who need dental care, and all that the WDA and Marquette can come up with to counter is to continue their worn-out whine about reimbursement levels.” 

‘Posturing until the clock runs out’

The WDA has told lawmakers that dentists should have a seat at the table in crafting legislation that has an impact on them. State Rep. Mary Felzkowski (R-Irma), co-author of the dental therapist bill, said the authors have attempted to include the association in discussions. They have stalled and have been unwilling to have “a real conversation” about “how to improve this bill.” 

WDA lobbyist Matt Rossetto, following a legislative hearing on the bill in August, in an email told Felzkowski that his members do not feel the legislation is “something that they can get behind.”  

“I have always had a sincere interest in hearing what you and the dentists have to say, but I have absolutely no interest in posturing until the clock runs out,” Felzkowski said in an email dated Aug. 22. “Every day that passes is another day we could have moved closer to truly improving access to care.”

The lawmaker said the measure is expected to receive an Assembly hearing next month. At every turn, dental therapist legislation has failed to move before session’s end. Will the bill ultimately die at the hands of a powerful special interest group and their legislative allies?

“It’s frustrating when you have bipartisan legislation … and 62 groups have signed on to support it, yet one group has the power to stop this,” Felzkowski said. “This is what everybody hates about politics.”

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1 thought on “Dentists play hardball, deny access

  • I am a dentist and oppose the Dental Therapist bill. I was a participating Medicaid Provider until I retired and now volunteer at a free health care clinic in my city as well as having provided pro bono care in my former office. Reimbursement for services at 30 cents for a dollar’s worth of care is not sustainable. The actual overhead costs of these services averages 60-70 cents. So as Republicans often say “the market will decide” and it has. The introduction of a new provider level requiring funding to establish educational facilities, tuition support and eventual physical buildout when the payback is 30 cents on the dollar does not seem a wise investment. Much better to use those funds to expand the reimbursement for services to all counties within the state and provider great support to those clinics in the state where dentists like me provide care by donating their time and talents.

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