Just like the Affordable Care Act brought fairness to medical care, Washington can lead the way in bringing equity to dental care. Requiring dental insurance companies to spend 85% of premiums on patient care – just like what’s required in medical insurance – will ensure more money goes to actual care instead of corporate profits, improving access for all.

It’s time to make the dental insurance system work for everyone, not just the corporations that dominate it.

Dental insurance is actually very different from medical insurance. Dental plans are really prepaid benefits programs, where a percentage of premium dollars can be accessed up to a set limit each year. Recognizing this fact will help address and correct the limitations and inefficiencies that currently burden patients and providers alike.

To earn the business of large corporations and government entities, insurance companies offer their most generous benefit plans to the employees of these major employers.  But after paying the same or higher premiums, consumers who get their dental insurance from small business plans or on the individual market receive less generous benefits.  Without a minimum standard for the percentage of premiums paid out in claims – known as the Dental Loss Ratio (DLR) – this form of subsidization will continue.

Large insurance companies – especially Delta Dental of Washington (DDWA), which enjoys a virtual monopoly in some markets in the state – can prevent patients from fully accessing their benefits. Delta has approximately 90% of Washington dentists in their network, and 97% of the patients they cover use one of those dentists. But they still feel the need to punish patients who choose to be cared for by one of the other 10%. They pay less than half of the “usual and customary” fees for such care.

Paying less for care at some dental offices is just one way DDWA reduces benefits for patients. Other problems:

- Their claims payments don’t come close to keeping up with inflation.

- They can refuse to pay for some covered treatments if more than one is performed on a single day – even if that’s what’s best for the patient.

- They can deny claims for procedures deemed necessary by the licensed dentist who is actually treating that patient, without ever examining the patient. 

These efforts to reduce claim expenses increases Delta’s profits and leads to bigger bonuses for company executives.

According to IRS filings and DDWA public reporting, over the decade from 2013 to 2022, the number of subscribers Delta covered increased by 62.5%, while CEO compensation grew nearly four times as fast, up 230%. More than half of that compensation comes from a bonus program tied to financial metrics – metrics that improve when the amount they pay in claims shrinks.

Total pay for the top three corporate officers was up 138%; for the board chair, it was up 153%; and for the rest of the board, it was up 132%.

In the last five years for which IRS data are available*, DDWA reported approximately $22.35 million in charitable donations, while paying their directors and executive team a total of $58.90 million – more than twice as much.

*Form 990 filings, 2018-2022