Five decades later, Medicare could cover dental care

However, research is increasingly showing how closely dental health is related to overall health. Dental problems, and the inflammation and bacteria that come with it, can make other chronic conditions like diabetes and heart disease worse. And missing or sore teeth can make eating a healthy diet difficult. Dental infections can be painful – they are a leading cause of emergency rooms – and, in rare cases, life-threatening.

"Dental care is preventative health, and dental care must be part of any serious health program in the United States," said Senator Sanders.

Health insurance would allow elderly and disabled patients to pay for their treatment, but there is no guarantee that dentists everywhere would accept it. Almost every doctor and hospital in the country takes Medicare, but dentists have built their business without relying on the program for the past 50 years. Many private dentists are refusing Medicaid because of underpayment and bureaucracy.

"If you provide someone with an insured benefit and they have no place to go, it's pointless," said Tess Kuenning, president of the Bistate Primary Care Association, a group for community health centers in Vermont and New Hampshire. Ms. Kuenning called on the legislature to offer dentists attractive remuneration rates and investments in public health dentists such as Dr. Rulon, who would be more inclined to treat Medicare patients than private-practice dentists.

However, optimists see Medicare dental insurance as something that could do more than just improve affordability for beneficiaries. It could also change the long-standing norms about what health insurance should cover. In the past, health plans have tended to ignore health problems "in the head": dental insurance, visual performance, hearing aids and mental health have all been left out. Congress began calling for mental illness coverage about 15 years ago, starting with Medicare and then expanding to other types of plans. Access to mental health care is still uneven, but in a broader sense it is understood as part of health care.

"When Medicare moves, everyone else moves," said Michael Costa, the C.E.O. with Northern Counties Health Care and former top Vermont health officer.

Meanwhile, Medicare patients treated at Hardwick continue to make difficult choices. When Gina Brown, 66, recently came to clean her teeth, Dr. Rulon created a cavity near a root – one that could quickly cost it the tooth. She sat in the chair again that afternoon for a filling. She has had comprehensive health insurance through her work as a caregiver for developmentally disabled adults, she said, but her dental benefits are "very limited". She could afford to fix that ailing front tooth, but could not afford a partial denture to replace the molar teeth she had lost years ago when money was tight and dental care was out of reach.