Steve Rosenblum has been making crafts with inlaid wood for decades, earning a living with the intricate designs, but not enough to pay for dental care.
"I've had dental insurance and taken care of my teeth all of my life, until recently when I can't really afford to do it," Rosenblum said.
He's self-employed, so he buys regular health insurance on his own. But Rosenblum says paying for that puts dental insurance out of reach. He hopes the new health exchange will make paying for health insurance easier. But even if he qualifies for health subsidies, dental care is not part of Vermont's exchange or the federal Affordable Care Act, also known as Obamacare.
"At one point we sold off some land six years ago, and we probably spent $7,500 on getting our teeth fixed up, and so it's really a difficult problem," Rosenblum said.
"So, you have private insurance which is expensive and limited," said Sen. Bernie Sanders, I-Vermont.
Sanders is sponsoring a bill to expand dental coverage to underserved patients. It would let people use federal health care subsidies through the Affordable Care Act to pay for dental plans. It also requires Medicaid to cover dental; it is optional for states now. It would have the VA provide dental services for vets even if the problem is unrelated to their service. It also would start training programs for dental therapists to offer basic dental services where there are few dentists.
"We have a very excellent team right now to provide that exact care," said Robert Faiella, the president of the American Dental Association.
The ADA supports expanding coverage to more patients, but does not support the idea of training dental therapists.
"It's not so much that we need more providers to treat dental disease, we need more education prevention efforts to stop the rate of the disease from increasing and then use our current system to make up for the shortfall," Faiella said.
The ADA says already short resources should go to help people pay for dental visits and that a growing number of state studies show there are enough dentists to go around.
"You can have plenty of dentists, but if they're all located on Park Ave. and upper income areas throughout America and not in rural America-- rural Vermont-- or in urban areas, then you haven't solved the problem," Sanders said. "I think in some ways they probably don't want the competition from non-dentists who can do many procedures."
"We're not so much protecting our territory," Faiella said. "We want to engage provision of that care for the people that desperately need it. And we are willing to do that with a properly funded public health system."
Sanders says under his bill, the therapists would treat patients with supervision from dentists. As for the price tag Sanders says it will be expensive and he has no total available. But he argues it could end up cutting some costs if patients can skip a trip to the emergency room and get regular dental visits instead.
"We have people who cannot get jobs in this economy. You know why? Because someone is not going to hire them when they don't have teeth in their mouth. We have people who are getting sick when they cannot adequately digest their food. So, if you are asking me in the long run as an economy and as a society are we going to save money by providing good dental care, I believe that we do," Sanders said.
The bill is being sponsored in the House by Representative Elijah Cummings of Maryland, a Democrat. But with Congress preoccupied with spending bills, it is not expected to see action in the near future.