ADA urges DOJ to enforce health insurance antitrust reform

Association comments on competition in dental insurance market

The ADA is commenting on competition in the dental insurance market, applauding the Department of Justice’s renewed focus on competition in health care and offering its perspective on how historically limited competition in dental insurance harms patients and dental professionals.  

In a May 21 letter, the Association outlined the factors contributing to this issue and recommended actions to promote fair competition and protect consumers. Specifically, the letter highlights: 

• The role of the McCarran-Ferguson Act’s antitrust exemption in shaping the dental insurance landscape.  
• The Competitive Health Insurance Reform Act of 2020 and its implications for dental insurance.  
• State laws and regulatory structures that may reinforce anticompetitive practices.  
• The practical consequences for dental providers and patients of a market with few competitors.  

“We write in a policy-focused, technical spirit, urging [the anticompetitive regulations] task force to take steps that ensure dental insurance markets serve the public interest, not just entrenched incumbents,” ADA President Brett Kessler, D.D.S., and Interim Executive Director Elizabeth Shapiro, D.D.S., J.D., said in the letter.  

The Association urged enforcement of the Competitive Health Insurance Reform Act to remove a longstanding impediment to competition and to address collusion and exclusionary conduct.  

The law limits the antitrust exemption available to health and dental insurance companies under the McCarran-Ferguson Act, which exempted insurance companies from federal antitrust scrutiny for most insurance-related conduct. Signed into law in January 2021, the Competitive Health Insurance Reform Act makes federal antitrust laws fully applicable to the insurers’ business conduct.  

“In plain terms, as of 2021 dental insurers must ‘play by the same rules’ as companies in other industries. Price-fixing, bid-rigging, market allocation, and other collusive practices by dental insurers are no longer immune from federal scrutiny,” Drs. Kessler and Shapiro wrote.  

In the letter, the Association emphasized that although the Competitive Health Insurance Reform Act was enacted into law, it must also be followed by vigilant enforcement. The task force should treat its implementation as an opportunity to re-examine the dental insurance market and identify practices that now warrant intervention, according to the ADA.  

The letter also outlined patient harms resulting from market concentration, including suppressed reimbursement rates, narrow networks and reduced access to care. It warned that consumers face limited plan options, higher out-of-pocket costs and fewer in-network providers, especially in states where one or two insurers dominate the market. 

The ADA presented six detailed recommendations for Department of Justice action, including conducting a market study, issuing updated antitrust guidance, reviewing mergers and vertical integration, and supporting state reforms such as “any willing provider” protections and transparency requirements. 

“With the passage of [the Competitive Health Insurance Reform Act], Congress and the administration have signaled that this status quo must change. The letter of the law has changed, but realizing its promise requires diligent follow-through,” Drs. Kessler and Shapiro wrote. “We urge the [Department of Justice] to use all available tools from enforcement actions to advocacy for regulatory reform to promote competition in dental insurance.”