Massachusetts Ballot Question 2: What you need to know about proposed changes for dental insurance

Updated at 8:30 p.m. Oct. 5

When Massachusetts voters head to the polls next month, they will weigh in on a ballot question that could significantly change the dental insurance industry in the state. Orthodontist Mouhab Rizkallah, with the Committee on Dental Insurance Quality, and state Sen. James Welch, with the Committee to Protect Public Access to Quality Dental Care, joined Jim Braude on Greater Boston for a contentious debate about the ballot measure. Here’s what you need to know.

What would Question 2 do?

Massachusetts' Question 2 would introduce new regulations on dental insurance companies, including a legal requirement that companies spend a minimum of 83% of premiums on patient care rather than on administrative expenses — a figure known as the medical loss ratio. There is not currently a minimum.

A “yes” vote would approve the new regulations, while a “no” vote would make no changes to the current rules for dental insurance companies. It would be the first law of its kind in the country.

What are the arguments in support of Question 2?

Rizkallah, an orthodontist who has fought against dental insurers for a number of years, said that the measure would prevent insurance companies from taking advantage of patients.

“Ultimately what this comes down to is: Why is medical insurance regulated and dental insurance is not?” he said.

The measure has been endorsed by national dentist groups as well as local groups, including the Massachusetts Dental Society and the American Dental Association.

Rizkallah pointed to the example of Delta Dental. He said in 2019, the insurer "gave away" $291 million of surplus premium revenue to its parent company — which, he argues, should have gone to patients. Comparatively, Delta Dental that year spent $177 million on patient care.

With the new regulation, insurance companies would give money back to patients in the form of premium reductions, premium rebates and co-pay reductions, according to Rizkallah. He noted that the Massachusetts Dental Society in 2015 and 2019 had tried to pass a law that would cap administrative costs, but weren’t successful because of “the power of the dental insurance lobby.”

Rizkallah accused the “no” side of confusing voters and spreading disinformation.

What are the arguments against Question 2?

Welch defended his opposition to the ballot measure, and said it comes down to consumer cost and quality of care.

“When evaluating any healthcare policy or recommendation, you always want to think of three things, three main pillars: What’s the effect it’s going to have on costs to consumers? What’s the effect it’s going to have on access for consumers? And … the effect it’s going to have on the actual quality of care for consumers? And all three of those questions, this ballot question fails,” he said.

Dental insurance differs from medical insurance, and shouldn’t be regulated in the same way, Welch said. For example, dental insurance is not mandated in the state and has much smaller premiums.

Braude noted that outside of publicly reported data about Delta Dental, there is a lack of information about the true medical loss ratio for dental insurers. Welch cited a Tufts study that says the measure is “built on very thin information.”

He called the ballot question “flawed.”

“This question has not been vetted … there’s no way to know the numbers that the doctor is talking about,” Welch said.

The Massachusetts general election is on Tuesday, Nov. 8.

WATCH the debate: Question 2 would limit dental patient insurance money used on admin. costs in Mass.

Correction: This story was updated to correct the Delta Dental figures Rizkallah provided. We regret the error.