REGULATION

After the midterms, look to the statehouse for dental policy fights

Congress may have changed hands last week, but a divided government means gridlock in Washington. The statehouses will be where the real action is on dental policy.

Catch up: Democrats flipped the Senate and the House, securing healthy majorities in both chambers. Further down the ballot, Democrats now control the governor's office and both legislative chambers in 23 states, including six new states: Michigan, Minnesota, Nevada, Pennsylvania, Wisconsin, and Arizona, as well as the Texas House for the first time since 2002.

• But don’t forget, President Trump still has his veto pen, and he’s ready to use it. That means any successful legislation will need to have bipartisan support—something that’s not easy to come by in Washington these days.

What it means nationally: Soon-to-be Speaker of the House Hakeem Jeffries said that healthcare will be one of the top priorities for the incoming Congress, specifically reinstating lapsed Affordable Care Act subsidies and reversing the Medicaid cuts tied to the One Big Beautiful Bill Act (OBBB). That’s unlikely to happen, given that it would require overcoming (or avoiding) a presidential veto.

• “It’s important to level-set that changes are likely coming and are likely not going to be delayed or canceled, at least early in 2027,” Manatt Health partner Allison Orris said.

• Some of the rougher edges of the OBBB could be sanded down or implementation delayed, however, through amendments in other spending bills. Chris Rorick, a policy adviser to the Dental Trade Alliance, told DrBicuspid he expects Democrats to try to delay or soften the cuts through appropriations within a year.

The bigger national issue: Oversight powers are where the Democrats will be more free to flex their new congressional powers, and healthcare is likely to face significantly more scrutiny, particularly in areas linked to perceived affordability challenges. That may not capture dentistry, but it’s a risk, particularly for larger DSOs and those linked to private equity. Hearings, investigations, and subpoenas create reputational risks for those targeted.

What it means at the state level: Every state will have to deal with the fallout of OBBB and Medicaid cuts, which is hitting dentistry both because adult dental benefits, optional under federal law, are an easy target for cuts, and because around five million people are expected to lose Medicaid benefits altogether. How they are approaching this varies: 

• Colorado: In his final budget this week, Governor Jared Polis proposed eliminating Medicaid adult dental along with the state's low-income senior dental program.

• Pennsylvania: The state cut most adult Medicaid dental in 2011, and a bill restoring them passed the House in 2023 before stalling in the Senate. Democrats now control that Senate and could try to get that bill passed again. For his part, Governor Josh Shapiro has pledged not to cut Medicaid services.

• Wisconsin: Governor-elect David Crowley ran on making BadgerCare, the state's Medicaid program, cover dental and vision alongside medical care.

• Georgia: Governor-elect Keisha Lance Bottoms says she would expand Medicaid, which covers routine dental already, to more adults.

• Texas: Governor-elect Gina Hinojosa also backed Medicaid expansion, but Texas’ program covers emergency dental only.

What’s next: The most consequential bills introduced in upcoming Congress could be ones that have no real chance of passing. According to the think tank Brookings, prospective Democratic presidential candidates could introduce legislation in an effort to pave the way for their campaigns and set the agenda for 2029.