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C. Everett Koop, the avuncular doctor with a fluffy white beard who served as the U.S. surgeon general during the Reagan administration, was famous for his work as an innovative pediatric surgeon and the attention he paid to the HIV-AIDS crisis.

As dentistry scholars, we believe Koop also deserves credit for something else. To help make the medical profession pay more attention to the importance of healthy teeth and gums, he’d often say: “You are not healthy without good oral health.”

Yet, more than three decades after Koop’s surgeon general stint ended in 1989, millions of Americans don’t get even the most basic dental services, such as checkups, tooth cleanings and fillings.

Americans who rely on the traditional Medicare program for their health insurance get no help from that program with paying their dental bills aside from some narrow exceptions. This group includes some 24 million people over 65 – about half of all the people who rely on Medicare for their health insurance.

When the Medicare program was established in 1965, almost all dental services were excluded due to the expense and vigorous opposition from associations that represent dentists out of fear that reimbursement rates would be markedly low compared to traditional insurance plans or out-of-pocket payment.

However, interest in including dental benefits in Medicare is on the rise at the Centers for Medicare and Medicaid Services, the federal agency responsible for the Medicare program, as well as many organizations that seek to provide dental benefits to all members of society.

The Biden administration initially considered the addition of comprehensive Medicare dental coverage as part of its proposed Build Back Better legislation, a broad US$1.8 trillion legislative package designed to fix problems ranging from child care costs to climate change, but failed to get enough support in Congress.

Dental coverage was eliminated from the version of the bill the House passed in 2021, in part due to cost concerns and resistance from organized dentistry due to the low reimbursement rates for medical care for patients with Medicare benefits.

In 2022, after the broader package was blocked in the Senate, the federal government added coverage for dental treatment that was designated as “medically necessary” for people with Medicare.

The list of circumstances that would lead patients to be eligible is short. Some examples include patients scheduled for organ transplants or who have cancer treatment requiring radiation of their jaws.

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