Universal health care must expand to include our teeth

April is Oral Health Month, and 6.4 million people have signed up for the Canadian Dental Care Plan (CDCP). Anyone who has had a toothache knows that this is a reason to celebrate, but after one year of the program being fully implemented, it is worth looking at where Canadians are left with respect to access to dental care.

We should care about access to dental care because it is an integral part of our overall health. Poor oral health has been associated with cardiovascular disease, diabetes, low-birth-weight infants, aspiration pneumonia, erectile dysfunction, osteoporosis, metabolic syndrome and stroke. Having missing front teeth and visible decay can affect employability and self-esteem. Lacking access to dental care traps people in a cycle of poor health and poverty that is difficult to escape.

The CDCP sought to help increase access to care by providing public dental insurance to people who do not have private insurance, and have a family income of less than $90,000 per year. While not perfect, the coverage through the CDCP is far more extensive than all of the public provincial programs that mainly focused on extracting teeth and making dentures.

When first announced in 2023, we were told that there would be no co-payments for those making less than $70,000 per year. After pushback from organized dentistry, the Liberals caved and allowed balance billing, which means those patients face an average co-payment of 15 per cent. People with a family income between $70,000-90,000 have a 40-60 per cent co-payment, plus the additional 15 per cent for balance billing. While helpful, clearly CDCP recipients are still having to pay a lot out of pocket.

There was also confusion for many seniors as to whether they were eligible for the CDCP. At first, the eligibility criteria said that you are not eligible if you have private insurance, but that changed to access to private insurance. Effectively, this meant that seniors that were offered to keep their work-related insurance when they retire, which usually coincided with a drop in coverage and increase in cost, were forced to pay into this private plan rather than choosing the superior government program.

While it is great that 6.4 million people have signed up for the CDCP, we were originally promised 9 million. The gap is created by the many hurdles in the registration process. People have to prove their family income to sign up, which is not possible if you have not filed your tax return. Many immigrants who pay taxes in Canada have been denied coverage because their spouses reside in another country. People also have to be aware of the program and sign-up months before being able to use their coverage.

We at the Coalition for Dentalcare worry that this gap will continue to grow for two reasons. First, since the CDCP was announced in 2022, the income cutoffs have not gone up with inflation. This means the program is being cut, as the purchasing power of those incomes decrease. Second, the program does not have auto-renewal and people have to re-apply each year, creating an opportunity for more people to fall through the cracks. 

While the CDCP is undoubtedly a step in the right direction, we must not become complacent in thinking that it should be our end point. It is the largest investment in public dental care in Canadian history, but that is also because our starting point is so poor. Close to 9 million Canadians still lack dental insurance, and plenty of insured people still struggle to make their co-payments. We need to harness the momentum of the CDCP and finish Tommy Douglas’s dream of expanding our universal health care system to include our teeth.