The proposed rule could give millions of Americans access to the new drugs; it would also put pressure on the federal budget.The Biden administration, in one of its last major policy directives, will propose that Medicare and Medicaid cover obesity medications, a costly and probably popular move that the Trump administration would need to endorse to become official.The proposal would extend access of the drugs to millions of Americans who aren’t covered now.The new obesity drugs, including Wegovy from Novo Nordisk and Zepbound from Eli Lilly, have been shown to improve health in numerous ways, but legislation passed 20 years ago prevents Medicare from covering drugs for “weight loss.”The new proposal sidesteps that restriction, specifying that the drugs would be covered to treat the disease of obesity and prevent its related conditions.“We don’t want to see people having to wait until they have these additional diseases before they get treatment,” said Chiquita Brooks-LaSure, the administrator of the Centers for Medicare and Medicaid Services, or C.M.S., noting the growing medical consensus that obesity is a chronic health condition.The classification would also mean that every state Medicaid program would be required to cover the drugs starting in 2026. Currently, only a handful do.C.M.S. estimates that around 3.4 million more patients in Medicare would become eligible for obesity drugs, and around four million patients in Medicaid would gain coverage, costing the programs billions of dollars. Medicare covers Americans 65 and older; Medicaid covers poor and disabled Americans.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The widespread use and enormous expense of blockbuster drugs like Wegovy are forcing state governments to make painful choices.This month, North Carolina did something enthusiastically that most states have been reluctant to try: It started covering new obesity medicines like Wegovy for its poorest residents as part of its Medicaid program.For Kody Kinsley, the state’s health and human services secretary, the choice was easy. Those poor residents are disproportionately affected by obesity and its related diseases. “From a base-line justice perspective,” he said, “why are we even talking about it?”The reason many people are talking about it is the price tag. Expensive drugs are nothing new in the U.S. health system, but these are an unprecedented type of blockbuster because so many people could benefit: More than a third of American adults meet the clinical definition of obesity. The combination of high prices and high demand is forcing every insurer, public and private, to make tough decisions.Just this spring, the North Carolina state employees’ health plan dropped coverage of the same class of drugs, citing unsustainable costs, ending coverage for nearly 25,000 people who were taking them.That means the civil-service administrators who will be helping the state’s poorest residents get access to Wegovy and its siblings have lost their own employer coverage for the very same drugs.The costs of the drugs, known as GLP-1 agonists, can add up quickly. Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound — the two GLP-1 drugs that have been approved specifically for weight loss — each come with a sticker price over $1,200 a month, and need to be taken long-term for sustained effect. (Ozempic has the same active ingredient as Wegovy, but has been approved for diabetes.)We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Enrollment in plans through the Affordable Care Act’s marketplaces broke last year’s record, with particularly high growth in Florida, Texas and Georgia.WASHINGTON — A record 16.3 million Americans have signed up for health insurance plans through the Affordable Care Act’s marketplaces during this year’s open enrollment period, beating last year’s sign-ups by 13 percent, the Biden administration said on Wednesday.The growing enrollment follows the passage of legislation during the coronavirus pandemic to increase federal subsidies for people buying the plans — substantially lowering prices for nearly every American who buys their own insurance. Around 3.6 million people selected plans in the Obamacare marketplaces who did not receive coverage through them last year. Last year’s total had been the highest in the law’s history.President Biden cheered the development in a statement, saying, “Today, we received further proof that our efforts are delivering record-breaking results.”The Biden administration has taken other steps to encourage enrollment in the plans, including increasing advertising and enrollment assistance and providing a longer window for sign-ups than during President Donald J. Trump’s administration. But it appears the money is mattering more than anything else.“The No. 1 reason the Affordable Care Act has worked — and is now working better — is it is affordable,” said Peter V. Lee, a senior scholar at Stanford University who ran California’s marketplace for a decade. “Affordability is the biggest thing.”Health Care in the United StatesOmnibus Bill: The giant spending bill passed by Congress in December kept the government open. But it also quietly rewrote huge areas of health policy.Obamacare: A decade after the Affordable Care Act’s federal health insurance marketplace was created, its outsize and improbable popularity persists in the unlikeliest of places: South Florida.Drug Costs: Medicare reforms embedded in the Inflation Reduction Act will bring savings to seniors this year. But some lawmakers are already aiming to repeal the changes.Medical Debt: To address the high cost of health care, local governments are turning to the American Rescue Plan to wipe out residents’ medical debt. Experts caution that it is a short-term solution.There was ample evidence during Obamacare’s earlier years that the price of health plans remained a major barrier for Americans. People qualified for subsidies on a sliding scale according to their income, and under the original formula, the remaining premiums proved a barrier for many low-income households.For a family of four earning more than around $110,000, there was no federal assistance available at all, saddling many with extremely high insurance prices. The cheapest plans also often came with high deductibles and a limited selection of doctors.Frustrations with the cost of coverage helped fuel a political backlash to the Affordable Care Act that culminated with an effort by Mr. Trump and congressional Republicans to repeal the law in 2017. But Republican lawmakers were unable to agree on a program to replace the law that could win majority support in the Senate.Under the new policies enacted during the pandemic, which were renewed through 2025 in the climate, tax and health care bill passed last year, subsidies increased at every level of income.Americans earning less than 150 percent of the federal poverty level — around $42,000 for a family of four — are eligible for free health plans that come with low deductibles and co-payments. Before the change, many such people could get free plans on the Obamacare marketplaces, but only with very high deductibles. This year, there were particularly large increases in sign-ups in Texas, Florida, Georgia and North Carolina — states with large low-income populations that have not expanded Medicaid, suggesting the new subsidies are driving the change..css-1v2n82w{max-width:600px;width:calc(100% – 40px);margin-top:20px;margin-bottom:25px;height:auto;margin-left:auto;margin-right:auto;font-family:nyt-franklin;color:var(–color-content-secondary,#363636);}@media only screen and (max-width:480px){.css-1v2n82w{margin-left:20px;margin-right:20px;}}@media only screen and (min-width:1024px){.css-1v2n82w{width:600px;}}.css-161d8zr{width:40px;margin-bottom:18px;text-align:left;margin-left:0;color:var(–color-content-primary,#121212);border:1px solid var(–color-content-primary,#121212);}@media only screen and (max-width:480px){.css-161d8zr{width:30px;margin-bottom:15px;}}.css-tjtq43{line-height:25px;}@media only screen and (max-width:480px){.css-tjtq43{line-height:24px;}}.css-x1k33h{font-family:nyt-cheltenham;font-size:19px;font-weight:700;line-height:25px;}.css-1hvpcve{font-size:17px;font-weight:300;line-height:25px;}.css-1hvpcve em{font-style:italic;}.css-1hvpcve strong{font-weight:bold;}.css-1hvpcve a{font-weight:500;color:var(–color-content-secondary,#363636);}.css-1c013uz{margin-top:18px;margin-bottom:22px;}@media only screen and (max-width:480px){.css-1c013uz{font-size:14px;margin-top:15px;margin-bottom:20px;}}.css-1c013uz a{color:var(–color-signal-editorial,#326891);-webkit-text-decoration:underline;text-decoration:underline;font-weight:500;font-size:16px;}@media only screen and (max-width:480px){.css-1c013uz a{font-size:13px;}}.css-1c013uz a:hover{-webkit-text-decoration:none;text-decoration:none;}How Times reporters cover politics. We rely on our journalists to be independent observers. So while Times staff members may vote, they are not allowed to endorse or campaign for candidates or political causes. This includes participating in marches or rallies in support of a movement or giving money to, or raising money for, any political candidate or election cause.Learn more about our process.“It speaks to the power of free, but also free plans that are actually attractive,” said Cynthia Cox, who directs the Kaiser Family Foundation’s program on the Affordable Care Act. The foundation has been tracking the millions of low-income Americans who were eligible for coverage under the law but remained uninsured. Last year, that number fell substantially, and Ms. Cox said it would most likely fall again once new data on the uninsured rate is published.Americans with incomes higher than four times the poverty level became eligible for subsidies for the first time as a result of the pandemic stimulus bill that Mr. Biden signed into law in 2021. Though this higher-earning group, often made up of the self-employed and early retirees, represented a relatively small share of the nation’s uninsured population, there is evidence that they represent a growing share of those covered by Obamacare plans.The strong enrollment and improved political stability of the Affordable Care Act have helped make the marketplaces a more attractive place for insurance companies to do business. Several years ago, many insurers pulled out of the markets, but since Republicans tried and failed to repeal the Affordable Care Act in 2017, the plans have largely come back. More than 90 percent of people who signed up for this year had a choice among at least three insurance companies, according to the Centers for Medicare and Medicaid Services.“That really has become an important and much more stable market,” said Matt Eyles, the president and chief executive of America’s Health Insurance Plans, the insurance industry’s largest trade group.Last year, the Biden administration eliminated a longstanding barrier to subsidies for the family members of Americans who get insurance at work for themselves but not for their relatives. The change was estimated to affect more than five million Americans, a vast majority of whom were already insured through other means.But while some of the enrollment in Affordable Care Act plans may reflect people shifting from other types of coverage, it appears that many of the new enrollees had no insurance before. The uninsured rate declined last year amid increased Obamacare enrollment, though a pandemic policy that requires extended Medicaid coverage by states probably also played a significant role.The end of that policy is coming, and Mr. Lee said the robust sign-ups and the Biden administration’s stewardship of the marketplaces made him confident that many of the people who would lose coverage when their Medicaid plans expire would be able to transition into marketplace plans later this year, a shift that could increase enrollment even further.The numbers announced on Wednesday are not final. Some states that run their own marketplaces are continuing to let consumers sign up for plans for this year. Some people also drop their insurance after initially signing up, so it will take a few months for final enrollment numbers to become clear.Reed Abelson

The bill stands to benefit millions of Americans with diabetes, but to become law, it will need to attract at least 10 Republican votes in the SenateWASHINGTON — A bill to limit the cost of insulin to $35 a month for most Americans who depend on it passed the House on Thursday, raising Democrats’ hopes that the party could take at least one step toward fulfilling its promise of lowering drug costs.The bill attracted unanimous support from Democrats who voted, as well as from 12 Republicans, making it a rare piece of bipartisan policy legislation.To become law, the bill will need to attract at least 10 Republican votes in the Senate to overcome a filibuster. Some lawmakers involved in the effort have expressed optimism that such a coalition might be possible, but few Republican senators have publicly endorsed the bill yet. Senator Susan Collins, Republican of Maine, has been working with Senator Jeanne Shaheen, Democrat of New Hampshire, on a broader bill related to insulin prices.The bill would have substantial benefits for many of the nearly 30 million Americans who live with diabetes. Insulin, a lifesaving drug that is typically taken daily, has grown increasingly expensive in recent years, and many diabetes patients ration their medicines or discontinue them because of the cost. About one in five Americans who take insulin would save money under the proposal, according to a recent analysis from the Kaiser Family Foundation.But the insulin bill represents a substantial scaling back of Democratic ambitions to tackle high drug prices for all Americans. A broader prescription drug package, written as part of the $2.2 trillion social spending and climate bill that has stalled in the Senate, would limit price increases on all prescription drugs, improve the generosity of Medicare’s drug coverage, and allow the government to negotiate directly on the price of some drugs used by Medicare patients, while also limiting insulin co-payments.Other parts of the broader bill would expand health insurance coverage, extending insulin coverage to diabetes patients who are uninsured. The bill that passed the House on Thursday would not improve the affordability of insulin for people who lack health insurance.The insulin bill may be the Democrats’ best chance of passing part of their popular prescription drug agenda, as the future of the larger package remains unclear.“If the effort to address drug prices ends with this plan to cap out-of-pocket costs for insulin, it will amount to crumbs compared to Democrats’ initial ambitions to allow the government to negotiate drug prices,” said Larry Levitt, the executive vice president for health policy at the Kaiser Family Foundation, a health research group.On the House floor, several Republicans expressed their opposition to the measure.“We all share the goal of reducing the cost of insulin,” said Representative Cathy McMorris Rodgers of Washington, the top Republican on the House Energy and Commerce Committee. “This bill, however, is not the right answer.”The pharmaceutical industry opposed the drug price regulations in the social spending and climate legislation, but it has not vocally opposed the insulin bill. While the bill would lower costs for many individual patients who take insulin, it would do nothing to reduce the prices paid to the companies that make it. Instead, insurance companies would simply pay a larger share of the price. The Congressional Budget Office estimated that the bill would increase government spending, since health insurers, including Medicare, would be responsible for a greater share of insulin costs.But consumer insulin costs have emerged as a politically potent problem, given how widespread diabetes is in the United States, and one that is relatively easier to solve than the prices for prescription drugs overall. At a White House event in December, President Biden centered a speech about prescription drugs around the cost of insulin.“I think it’s safe to say that all of us, all of us, whatever our background, our age, where we live, we can agree that prescription drugs are outrageously expensive in this country,” Mr. Biden said at the event, where patients with diabetes told their stories of struggles to afford the medicine.Debate on the broader legislation has slowed, but has not died. Senator Joe Manchin III, Democrat of West Virginia and a key centrist holdout, has expressed support for the prescription drug provisions in the bill, even as he has been more skeptical about other parts of the package.At her weekly news conference on Thursday, Speaker Nancy Pelosi of California tried to cast the passage of the insulin bill as progress toward the party’s broader drug-pricing agenda. She described insulin prices as a “kitchen-table issue.”“It is for us a step in the direction of the secretary being able to negotiate for lower drug prices beyond insulin,” she added, referring to the secretary of the Department of Health and Human Services.Senator Patty Murray, Democrat of Washington and the chairwoman of the Senate’s Health, Education, Labor and Pensions Committee, is a co-sponsor of similar insulin legislation in her chamber. She said she remained committed to passing a full suite of prescription drug price reforms, but that she viewed the insulin issue as particularly urgent.“We’re focused on insulin, because it affects so many Americans in so many specific ways,” she said.Emily Cochrane

In the large budget bill now in Congress, supporters of the measure see a rare opportunity to advance a popular policy.Tens of millions of older Americans who cannot afford dental care — with severe consequences for their overall health, what they eat and even when they smile — may soon get help as Democrats maneuver to add dental benefits to Medicare for the first time in its history.The proposal, part of the large budget bill moving through Congress, would be among the largest changes to Medicare since its creation in 1965 but would require overcoming resistance from dentists themselves, who are worried that it would pay them too little.The impact could be enormous for people like Natalie Hayes, 69. Ms. Hayes worked in restaurants, raised a son and managed her health as best she could within her limited means. As she lost her teeth — most of them many years ago and her remaining front ones last fall — she simply lived with it.“I had a lot of pneumonia,” she said, at a recent visit to the Northern Counties Dental Center in Hardwick, Vt. “Not a lot of good dental care.”For Ms. Hayes, the top set of dentures she was there to get will mean the difference between smiling and not smiling — and a wider choice of food. But financially, this would never be an option if her two sisters had not pooled funds to help her. Though Medicare, the federal program primarily for people 65 and older, helped pay for her pneumonia hospitalizations and recent shoulder surgery, it does not cover dental care.For reference, she showed Colleen Mercier, a dental assistant, an old photograph.“You have a pretty smile,” Ms. Mercier saidNearly half of Americans 65 and over didn’t visit a dentist in the last year, and nearly one in five have lost all their natural teeth, according to the Centers for Disease Control and Prevention. There’s growing evidence that dental problems can worsen other health conditions that Medicare does cover.Bernie Sanders, the Vermont independent who is the chairman of the Senate Budget Committee, has played a crucial role in advancing the measure. He recalled living as a young man in Vermont’s Northeast Kingdom, five miles from the clinic where Ms. Hayes received her care, and learning that many residents lacked access to dentists. “A child who lived nearby, his teeth were literally rotting in his mouth,” he said.Since then, the situation in Vermont has improved. Community health centers serve about a quarter of the state’s population. The state’s Medicaid program pays for preventive care and for up to $1,000 a year in other treatment for children and poor adults. But it does not pay for dentures, which can run into the thousands of dollars. Nationwide, around half of Americans 65 and older lack any source of dental insurance.The patient, Natalie Hayes, brought in an old photo of her smile to help dentists recreate it.Kelly Burgess for The New York TimesWith so many uninsured older patients, dentists like Dr. Adrienne Rulon, who treated Ms. Hayes, practice triage. Certain teeth — like the eye teeth and first molars — are more important to save. Filling a cavity in one tooth is less expensive than a root canal in another. Sometimes, patients will come in for an exam, learn about more expensive problems, then disappear for months while they save money for the procedure. “People are having to pick and choose,” she said. “It’s a huge untreated population.”.css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-w739ur{font-size:1.25rem;line-height:1.4375rem;}}.css-9s9ecg{margin-bottom:15px;}.css-uf1ume{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;}.css-wxi1cx{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-self:flex-end;-ms-flex-item-align:end;align-self:flex-end;}.css-12vbvwq{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-12vbvwq{padding:20px;width:100%;}}.css-12vbvwq:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-12vbvwq{border:none;padding:10px 0 0;border-top:2px solid #121212;}.css-12vbvwq[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-12vbvwq[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-12vbvwq[data-truncated] .css-5gimkt:after{content:’See more’;}.css-12vbvwq[data-truncated] .css-6mllg9{opacity:1;}.css-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}Ms. Hayes was also making such judgments. A top set of dentures would give her a smile back. But she had also lost most of her bottom molars. Without a partial set of bottom dentures, she still will be unable to chew many hard foods.Poor adults in other states have even fewer resources. Medicaid is not required to cover adult dental services, and many states do not pay for any services at all, while others cover only emergency treatments, like tooth extractions. Vermont’s program is among the most generous in the nation.On Capitol Hill, the proposal to add a Medicare dental benefit has near-universal support among Democrats, and many health industry and consumer groups back it, too. The main opposition comes from dentists. With the Democrats’ large policy ambitions but narrow majority, its passage is not assured.The American Dental Association, which fought to keep dental care out of the original Medicare program in 1965, supports a limited government benefit for older Americans. The association, whose leaders say they want Congress to concentrate scarce resources on the patients who struggle the most, wants Medicare dental benefits to be offered only to poorer patients, to be offered by private insurers, and to be included in its own special part of Medicare. “Our focus is on the people who don’t go to the dentist at all,” said Michael Graham, the senior vice president for government and public affairs at the association, adding that many Medicare-eligible patients with higher incomes can already get dental care now.Medicare would most likely pay lower prices than older patients who can now afford to pay for care themselves, a potential hit to dental income. It’s possible some providers would refuse to accept Medicare.Groups that have been pushing for the provision describe this as a rare opportunity to advance a popular policy. In one recent poll, 84 percent of Americans, including more than three-quarters of Republicans, supported adding dental, vision and hearing to Medicare. While Democratic lawmakers have tended for years to embrace the idea of dental benefits, they have not made it a priority. When passing the Affordable Care Act in 2010, they chose to focus federal resources on expanding health coverage.But the $3.5 trillion package now being considered has a big enough budget for a variety of long-stalled priorities. Lawmakers hope to add not just dental benefits to Medicare, but vision and hearing coverage as well. They intend to offer Medicaid to poor adults in states that have not expanded it. They plan to extend subsidies that make Obamacare insurance less expensive for people who buy their own insurance. And they aim to broaden investments in loan repayments for health care providers who choose to practice in underserved areas like rural Vermont.The provision still faces challenges. So far, no Republicans have signed onto the plan, and negotiations are still underway among Democratic lawmakers about its size and contours. Among the various health care priorities, the dental benefit is relatively expensive — the cost estimate for a version passed by the House in 2019 was $238 billion over five years. But Melissa Burroughs, an associate director at the consumer group Families USA, who has been leading a coalition pushing for the measure, says she’s been struck by how every lawmaker she talks to wants dental coverage in the package.“It’s highly unusual,” she said. “We’ve gotten from, ‘Oh this would be good,’ to, ‘Oh this is important, and let’s take action now.’”.css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-w739ur{font-size:1.25rem;line-height:1.4375rem;}}.css-9s9ecg{margin-bottom:15px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}.css-uf1ume{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;}.css-wxi1cx{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-self:flex-end;-ms-flex-item-align:end;align-self:flex-end;}.css-12vbvwq{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-12vbvwq{padding:20px;width:100%;}}.css-12vbvwq:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-12vbvwq{border:none;padding:10px 0 0;border-top:2px solid #121212;}.css-12vbvwq[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-12vbvwq[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-12vbvwq[data-truncated] .css-5gimkt:after{content:’See more’;}.css-12vbvwq[data-truncated] .css-6mllg9{opacity:1;}.css-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}For centuries, care of the mouth has been divided from care of the rest of the body. Dentists train at different schools than doctors, they accept different insurance, and the vast majority practice in private clinics where they must run their own business, not in hospitals or health centers.Northern Counties Dental Center in Hardwick, Vt. Community health centers like Northern Counties Health Care, which runs this clinic, serve about a quarter of the state’s population.Kelly Burgess for The New York TimesBut research increasingly shows how closely dental health is connected to overall health. Dental problems, and their accompanying inflammation and bacteria, can worsen other chronic conditions, like diabetes and heart disease. And missing or sore teeth can make it hard to eat a healthy diet. Dental infections can be painful — they are a major cause of emergency room visits — and, in rare cases, life-threatening.“Dental care is health care, and dental care must be part of any serious health care program in the United States,” Senator Sanders said.Medicare coverage would give older and disabled patients a way to pay for their care, yet there is no guarantee that dentists everywhere would accept it. Nearly every doctor and hospital in the country takes Medicare, but dentists have built their businesses over the last 50 years without relying on the program. Many dentists in private practice refuse to accept Medicaid, saying that payments are too low and the red tape burden too high.“If you provide somebody with a covered benefit and they have no place to go, then that’s feckless,” said Tess Kuenning, the president of Bistate Primary Care Association, a group for community health centers in Vermont and New Hampshire. Ms. Kuenning urged lawmakers to ensure payment rates that would be enticing to dentists, and investments in public health dentists like Dr. Rulon, who would be more inclined than dentists in private practices to treat Medicare patients.But optimists see Medicare dental coverage as something that might do more than just improve affordability for beneficiaries. It could also shift longstanding norms about what health insurance should cover. Historically, health plans have tended to ignore health problems “in your head”: omitting dental coverage, vision benefits, hearing aids and mental health. Congress began requiring mental health coverage about 15 years ago, starting in Medicare, and then expanding to other types of plans. Mental health care access is still uneven, but has become more broadly understood to be a part of health care.“When Medicare moves, everyone else moves,” said Michael Costa, the C.E.O. at Northern Counties Health Care and a former top health policy official for Vermont.In the meantime, Medicare patients treated in Hardwick continue to make tough choices. When Gina Brown, 66, came in recently for a teeth cleaning, Dr. Rulon discovered a cavity near a root — one that could quickly cost her the tooth. She was back in the chair for a filling that afternoon. She had comprehensive health coverage through her job caring for developmentally disabled adults, she said, but her dental benefit was “very limited.” She could afford to fix this ailing front tooth, but not a partial denture to replace the molars she had lost years ago, when money was tight and dental care out of reach.“Maybe if I had some dental insurance, I might think about getting a partial,” she said, as she waited for the Novocain to kick in.

Just how much Covid was spreading behind closed doors last year? Quite a lot, as a new study with a simple yet creative approach found out.A study found a connection between birthdays in 2020 and increased Covid risk.Meghan Dhaliwal for The New York TimesAt the height of the pandemic, it was easy to worry that strangers would give you the virus. But a new study of what happened after people’s birthdays suggests that people we trust were also a common source of viral spread.Private gatherings have been harder for researchers to measure than big public events — they’re private, after all. And there has been a fierce debate for months among epidemiologists about just how big a factor they have been in how coronavirus moved from person to person.But a team of Harvard researchers used a creative method for finding them: Using health insurance claims data, they looked at the Covid rates of families in the two weeks after one of them had a birthday. Overall, their paper, published in Jama Internal Medicine, found that a recent family birthday increased Covid risk by nearly a third.Their theory is that the increased risk is almost certainly explained by birthday parties. Though the insurance claims don’t show whether any individual Covid patient had actually held a birthday party, several aspects of the data strongly suggest a connection. For one, when researchers looked at other days of the year by randomly assigning birthdays instead of using actual birthdays, or examined diagnoses in weeks before birthdays, they found no such pattern. But, perhaps more significantly, they found the biggest infection risk in the weeks after the birthday of a child.“My wife and I, we certainly didn’t see the need to gather indoors for our birthdays,” said Anupam Jena, a professor of health policy at Harvard Medical School and one of the paper’s co-authors, who said the study was inspired by his own daughter’s birthday. “Our kids might be more disappointed.”Birthday parties, of course, often involve groups huddling in close quarters, perhaps to watch a child blow out candles on a cake.Because birthdays occur all over the country and are spread throughout the calendar year, the researchers were able to look at the effects in places where Covid was widespread and places where it was more rare. Across the board, birthdays were followed by more infections.The study considered data from last year, when Covid was much more common and fewer Americans were vaccinated. But its conclusions are still relevant for Americans who are unvaccinated today — a group that includes all children under 12. That may be especially true as the new, more contagious Delta variant begins to circulate in more states.Many political debates about managing the pandemic have centered on what to do about public spaces — like whether restaurants should be allowed to open, or whether masks should be required. Public officials have had a harder time policing people’s behavior at home. They’ve also struggled to measure its effects.K.J. Seung, the chief of strategy and policy for Partners in Health’s Massachusetts Covid response, who helped set up the contact tracing system, said it has been hard for contact tracers to clearly demonstrate that people were contracting the virus in small private gatherings. Public exposures, like at a factory or a wedding, were easier for them to track. Individuals often didn’t share the nights they had a cousin over for dinner or drove a friend home from work, whether out of shame or forgetfulness — and if they did, they were reluctant to name names.“Small social gatherings are the most difficult locations to trace,” he said. Yet “when we talked to contact tracers around the country, they were like: Yeah, people are getting infected at these small gatherings.”So much behavior around the pandemic — including mask use and the uptake of vaccines — appears to differ by people’s political party. But the study found that birthdays led to increased Covid infections by similar levels in Republican and Democratic areas of the country. This suggests that although Democratic-leaning households may have been more likely to wear a mask while walking the dog, they may have differed less than Republicans in their comfort having a trusted friend over to visit.“There was definitely this element of your home is a safe place and therefore when you have your friends and family over in your home, it just doesn’t feel risky,” said Dr. Ashish Jha, the dean of the School of Public Health at Brown University, who described the paper as “creative” for finding an unusual way of capturing disease transmission that is otherwise hard to measure.For many Americans, birthday parties have gotten much safer in recent months. The Centers for Disease Control and Prevention says it’s safe for fully vaccinated people to gather indoors without wearing face coverings. But for those who remain unvaccinated, the study is a reminder that even activities that feel the most safe pose a threat of infection. In many parts of the country, unvaccinated people are clustered by region or social group, meaning that birthday parties — and other such festive, private occasions — can still be risky.