Dentists worry Canada’s dental plan may entice businesses to cancel employees’ private dental benefits, thus threatening to overwhelm the new program.
“This has already been going on… many have already eliminated those plans,” said Dr. Robert Wolanski, president of the British Columbia Dental Association.
This is a problem referred to as the risk of de-insurance, says Wolanski. Employers who wish to cut costs could save money by eliminating their staff’s private dental insurance.
The risk of de-insurance is “huge,” said Dr. Jenny Doerksen, president of the Alberta Dental Association.
The Canadian Dental Care Plan was designed for the current one-third of Canadians who do not have access to private dental insurance. Dental associations have criticized the public plan for low coverage rates and the high administrative burden it places on already short-staffed dental clinics, Canadian Affairs recently reported.
If millions more Canadians are added to Canada’s dental plan, it would aggravate the burden on dentists and jeopardize dental operations, says Jeff D’Andrea, media relations specialist for the Canadian Dental Association.
“The pool of eligible persons has the potential to grow from the estimated nine million to approximately 17 million. This would be destabilizing for the oral health care system,” D’Andrea said.
It would also significantly inflate the cost of Ottawa’s dental plan, which is estimated to cost $10.1 billion over five years.
Many dentists have cold feet on whether to join clinics participating in the public plan. If many choose not to participate, patients will have fewer clinics to choose from, and many could be left with nowhere to go for dental care.
“It has to be sustainable,” said Doerksen. “Without dentists, this program will fail.”
‘Increasingly tempting’
This year, Canada’s dental plan is available for eligible minors, seniors and individuals living with a disability. When all eligible Canadians can participate in the plan in 2025, “we will see the full scale of the free-loading that could potentially happen,” said David Macdonald, senior economist at the research institute Canadian Centre for Policy Alternatives.
Canada’s dental plan is not meant to replace current private benefits packages, said Anne Génier, senior media relations advisor at Health Canada and the Public Health Agency of Canada, in a statement. In its responses to frequently asked questions about its plan, Health Canada says that “private businesses should not be cancelling their dental plans.”
But there will “absolutely be businesses that will attempt” to cancel their employees’ dental coverage, said Macdonald. “Employers [could] simply remove their dental insurance coverage and give their workers a link to the [government] website where they can apply for the federal program.”
Last week was the first time a large Canadian business with a global presence asked if it should drop dental coverage for some employees, said Adam Mitchell, CEO at Mitch Insurance Brokers, an insurance brokerage with offices across Canada.
As more businesses renew their annual employee benefits packages, “it will become increasingly tempting” for companies to weigh their options on whether cutting private insurance is beneficial, he said.
“I could see a lot of startup businesses and very small businesses opting out of this cost,” he said. Businesses might also choose to have “different tiers” of benefit coverage, with select employees being offered private dental plans.
Attract and retain
But cutting benefits packages for employees could have repercussions for businesses.
To be eligible for Ottawa’s dental plan, family net income — the sum of both spouses’ or common law partners’ pay — must be less than $90,000.
Companies may not know their employees’ spouses’ income to determine if their workers would be eligible for the public plan. For example, a common law or married couple making $45,000 each would be ineligible for Canada’s dental plan.
Cancelling private benefits could leave workers and their families with no dental coverage. “Workers take pretty badly to having key benefits like [dental care] canceled on them,” said Macdonald.
Businesses could also have a harder time attracting and retaining employees if they cut dental benefits. If a business offers better coverage than the public plan — such as braces for their employees’ kids or coverage of major dental work — it would give it a competitive advantage in scoring great talent, said Mitchell.
Only if a company’s private insurance offered less coverage than the public plan would employees wish to end their benefits, said Christina Santini, director of national affairs at the Canadian Federation of Independent Business, a non-profit agency representing small and mid-size businesses.
“[T]he government program is looking like a minimum standard sort of social safety net, more than it is a comprehensive, wonderful benefit,” said Mitchell.
Dentists agree. Canada’s dental plan “coverage and care will be less than what any normalized dental plan provides,” said Wolanski. “There are exceptions, but overall the public plan is worse than private.”
Ottawa’s dental plan is not a medicare plan. It does not attempt to provide free dental coverage for all Canadians, only improve accessibility, says MacDonald.
Health Canada announced they will work with “industry partners and provincial and territorial governments to put in place mitigation solutions that avoid displacement of existing dental plans.”
The statement Health Canada sent to Canadian Affairs did not say what those solutions are.
Difficult to enforce
One way to prevent businesses from cancelling employee dental insurance would be to require businesses with more than a certain number of employees to provide private coverage, says Macdonald.
But that would be difficult to enforce given insurance coverage is provided on a federal level.
“The problem with that is most workers aren’t under… federal jurisdiction,” said Macdonald. “They are under provincial-level labour law, which is to say the provinces each individually would have to implement some sort of change to their own labour legislation.”
Provinces and territories also offer some dental coverage. It is unclear how the federal plan will affect those existing programs, said Doerksen.
Ottawa’s dental plan is unique in that it is a Canada-wide, federal insurance plan. “I have some people in my life that this will likely benefit. It’s nice to know we’re going in this direction,” said Mitchell. He expects the public program to improve over time.
“I think this is Version 1 and nothing is going to be perfect on your first try,” said Mitchell. “Will there be problems? Yes. Is it still moving towards the North Star of a noble cause? Yes, I believe so.”
