State health officials are pushing this year to restore adult Medicaid coverage for basic dental care nearly eight years after it was cut amid the 2008 financial crisis.

The lack of coverage has left about 180,000 adults throughout the state without access to preventive care, and few options other than to have a tooth pulled that is badly decayed or infected.

Health officials overseeing community health centers that largely treat low-income populations say the effects of the cuts have harmed not only their patients’ overall health, but can keep people stuck in a cycle of poverty because of the social stigma of having decayed or missing teeth when they try to find work.

“It is amazing to me that we treat it as some sort of luxury thing,” said David Derauf, executive director of Kokua Kalihi Valley Comprehensive Family Services, of dental insurance. “Dental pain and dental suffering is relentless, it is highly distracting, it is consuming and it is fatiguing.”

As part of Gov. David Ige’s biennial budget that was submitted to the Legislature last month, the Department of Human Services is asking legislators for $4.7 million for six months of the 2018 fiscal year and $9.4 million for the 2019 fiscal year to cover the costs of restoring benefits.

The elimination of dental coverage “has continued to cause challenges for our members because oral health is an integrative part of people’s overall health,” Judy Peterson, DHS’ Med-QUEST division administrator, told members of the Senate Ways and Means Committee on Friday during a budget briefing.

Ige’s $28.5 billion proposed budget will be debated throughout the legislative session, which opened Wednesday and goes through early May. Lawmakers are free to amend the budget, but Ige can choose not to release funds for allocations he doesn’t approve of.

The Ige administration also sought to restore adult dental coverage last year, but the Legislature stripped it from its final budget.

Ways and Means Chairwoman Jill Tokuda told the Honolulu Star-Advertiser after Friday’s budget briefing that last year lawmakers chose not to add much to the Medicaid budget in order to get a better handle on the program’s costs. But she said she was hopeful that this year coverage would be restored.

“It was a hard decision,” she said of the recession-era cuts. “But when you had to stare down the barrel of a billion-dollar deficit, you had to make real tough decisions at the time.”

The cuts appear to be causing more visits to emergency rooms, which are costly and not very beneficial.

After the adult dental health benefits were cut, the number of visits to emergency departments doubled for people on Medicaid, according to a 2015 Health Department study that compared data from 2006 and 2012. The report notes that emergency departments generally don’t provide dental services, other than to prescribe pain medications.

The average cost for a preventable oral health visit to the emergency department is about $2,834, according to the Health Department.

Meanwhile, community health centers have been struggling to cover the costs of dental care for their low-income patients themselves, but say that the services that they are able to offer are limited.

“It’s just not a good way to cut costs,” said Vija Sehgal, chief quality officer for the Waianae Coast Comprehensive Health Center.

Physicians say there are links between poor oral health and increased risk of diabetes, heart disease and poor pregnancy outcomes, all of which add costs to the medical system.

There are also the social costs of having bad teeth, including a loss in self-confidence and difficulties in finding employment.

“Try going to an interview when you have a mouthful of rotten teeth,” said Sehgal. “Who is going to hire you? That just wraps them up in a cycle of poverty.”

Derauf said that it is a peculiarity of the American medical system that dental insurance is separated out from general health insurance.

“Someone can have a paper cut and go to the emergency room and get treated for that, but if that same person has some really serious dental issues that will mean that that person won’t find work or be in chronic pain and suffering or have the rest of the body affected over a long period of time, sorry, we can’t do anything about that,” he said. “Fundamentally, that is the part that bothers me the most. It makes no sense at all. The mouth truly is a vital organ, and it needs to be treated as such.”