Rep. Joseph McNamara and  Sen. Hanna Gallo have teamed up to reform how dental insurance in an effort to minimize the bite on the rate payer.

The two legislators are backing the “The Rhode Island Fair Share For Dental Care Act.”

If passed and signed into law, the act requires “carriers offering dental benefit plans to annually submit information which includes the current and projected medical loss ratio for claims for their plans” and in addition, make the medical loss ratio (MLR) 85%.

“For the last 40 years, the caps on patient benefits haven’t increased,” Patrick Sweeney, a public affairs consultant for the Rhode Island Dental Association (RIDA), said in an interview. “In 1962, the cap on dental benefits was basically $1,500. And currently today, the average cap is $1,500, whereas in medical care, you can get as much care as you want, and it doesn’t matter. On dental care – there’s a cap on your benefits, so once you hit that cap, you’re paying cash out of pocket, and most people can’t afford it.”

McNamara said in a February press release that because of this issue, “we’re seeing more and more patients forgo essential oral health treatment,” adding that this bill “will help reduce the out-of-pocket costs for patients, making dental care more affordable” and “encourage more Rhode Islanders to seek the dental care they need, while at the same time attract more oral health care providers to the state.”

The MLR would mean that 85% of patients’ premium dollars would go to patient care, which Sweeney says would “align with” the Affordable Care Act. According to data from a slideshow by RIDA, Delta Dental, Rhode Island’s biggest insurer for dental, had an average of a 79% MLR from 2010 to 2019. In that same chart, the percentages for 2020 and 2021 were 68% and 74%, respectively.

Sweeney also said the bill increases transparency regarding how patients’ money gets spent, citing up to 40% of patient premiums “go to executive compensation, bonuses, corporate profits, and administrative expense instead of being directed to patient care.”

Proponents of this legislation also point to other states implementing similar laws. Massachusetts voters approved a ballot initiative in 2022’s general election with 71.60% of the vote that would implement an 83% MLR for dental. Arizona, Colorado and Nevada also passed bills in 2023 and New Mexico passed one in 2022.

Rhode Island is in the midst of a dental crisis, which includes a range of sub-issues. One of those issues is the lack of dentists practicing in this state. According to data from the American Dental Association’s Health Policy Institute, Rhode Island is last in New England for Dentists per 100,000 population numbers.

Sweeney said the legislation would be “the easiest thing to do” when addressing the state’s dental crisis.

Opposition toward this legislation comes from a combination of unions and Delta Dental. Delta’s concerns were listed in a letter by their Senior Vice President and Chief Financial Officer, Richard A. Fritz,  sent to the House Corporations Committee on April 11. They cited “negative impacts” from Massachusetts’ 83% MLR, which included regulations being “significantly delayed” even with “a mandated January 1, 2024 start date,” and “more than six carriers have announced plans” to end coverage for individuals and small businesses. This letter also cites a study by Millman, Inc., that says the Rhode Island bill would result in a “38% increase in premiums.”

RIDA is also paying for a 30-second ad promoting this bill. Sweeney said the ad is playing on broadcast, over-the-top, digital platforms and on radio. He added the ad, created by Targeted Strategies, began airing last Thursday and will air until June.

Looking ahead, where the House and Senate leadership stand on this bill gives an idea of its chances for passage. “Chairman McNamara’s bill was just heard last week in the House Corporations Committee and we are reviewing the testimony as part of the normal legislative process,” House Speaker K. Joseph Shekarchi said when asked for his thoughts on this bill. “It is apparent that there is conflicting and divergent data presented by the dentists and the insurance companies.”

Senate President Dominick Ruggerio, who praised Gallo for “her strong leadership on this critical issue,” pointed out that “The Senate included this proposal as part of our Rhode Island HEALTH Initiative, a 25-bill package of legislation the Senate unveiled last month to focus on four key pillars of the health care system in our state: consumer protection, provider availability and care quality, cost containment, and health system financial stability.”

Ruggerio continued, “The Health & Human Services Committee conducted a robust hearing on the legislation last month, and we continue to work towards addressing this important issue