The easy passage of the first bill to make it through the Legislature this year showed little of the controversy that has dogged the issue for years at the Capitol.
Senate Bill 5079 seeks to improve oral health on reservations by allowing tribes access to federal dollars when using midlevel dental care providers, known as dental therapists. Dental therapists provide preventative care and procedures, such as oral exams, X-rays and crowns.
Though dental therapists aren’t legal in the state, tribes — as sovereign nations — can allow them to operate.
But a federal measure says states must approve dental therapists for tribes to pay for their services through Medicaid, a government health care program for low-income people.
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That approval has run into a roadblock over the years. The concept of dental therapists is opposed by the powerful dentist lobby, the Washington State Dental Association.
But the organization didn’t oppose this bill, in part to make peace with tribes who have been fighting for the legislation.
With fewer critics, the bill sailed through the Democrat-majority House on an 80-18 vote Thursday after getting unanimous approval in the GOP-led Senate. Gov. Jay Inslee is expected to sign it.
“I’m very happy that it’s being done finally,” said state Sen. John McCoy, a Democrat from Tulalip, who is the bill’s primary sponsor. McCoy said he has been exploring how to help get dental therapists on tribal land since 2006.
McCoy — a member of the Tulalip tribe — said Native Americans often struggle to get basic dental procedures that can prevent long-term oral health issues because of barriers like cost and a scarcity of dentists to serve reservations.
A study published in 2016 by Indian Health Services, a federal agency, shows American Indian and Alaska Native adults suffer tooth decay disproportionately, compared with other racial and ethnic groups, and are more likely to have missing teeth and other dental diseases.
Dental therapists are licensed with a two-year degree, increasing the likelihood that tribal members will become therapists and serve their own communities, proponents say. By comparison, becoming a dentist can take eight years of school.
And with the help of federal dollars, dental therapists can provide low-cost preventative dental care for patients.
The bill “is an expansion of care” for tribes, said state Sen. Ann Rivers, a Republican from La Center, who is chairwoman of the Senate’s Health Care Committee and was a co-sponsor of the measure.
Rivers said having Native American dental therapists on tribal lands has an added bonus: They can better understand “the cultural aspect of the clientele that they’re serving.”
“The end result is that our tribal populations will have ready access to excellent dental care,” she said.
Some state lawmakers, such as Port Orchard Republican Rep. Michelle Caldier, still have doubts that dental therapists will improve access to care.
Caldier, who is a dentist, voted against the bill in the House and said she had concerns therapists don’t have enough training to perform some procedures, like pulling teeth.
“Basically you’re having somebody with 1-2 years of training doing something that someone with 8 years of training would not do,” Caldier said of some procedures that dental therapists can perform. Dentists “would refer to a specialist with 11-12 years of training because of the complication” of some procedures.
The dental association opposed a similar bill last year despite its narrow focus on tribes. Bracken Killpack, the dental association’s executive director, said the association was trying to “turn a leaf and engage with tribal communities” better.
The association still opposes other bills in the Legislature that would authorize dental therapists around the state.
State Sen. Randi Becker, R-Eatonville and vice chairwoman of the Senate’s Health Care Committee, said she was reassured that dental therapists won’t provide substandard care after visiting the Swinomish tribe, which employs a dental therapist with help from grant money. She said dentists still have to supervise dental therapists, which helps avoid problems.
Mel Tonasket, the vice chairman of the Colville Tribal Council, told a Senate panel in January that it’s difficult for the Confederated Tribes of the Colville Reservation to hire dentists, in part because of their remote location. At one point in recent years, they had one dentist trying to see about 6,000 patients, he said.
Tonasket said doctors outside the tribe won’t always take Medicaid insurance either.
“When we got word on the dental therapist program and started looking into it, we said ‘that would fit us,’ so we can get into some preventative care,” he said.