Thursday, March 26, 2015

Issues with Affordable Care Act, Part 2

In my opinion, as a medical care provider, the real issue with the Affordable Care Act is not the insurance aspect.  Single payer is single payer, it is obviously used widely in many developed countries throughout the world.  The real issue is the difficulty in getting quality medical care.  That has been a reported problem in many of these same countries.  So let’s get back to dentistry in California.  Before Covered California, Denti-Cal had the fourth lowest reimbursement rate for dental treatments of all the 50 states, despite our higher cost of living.  In fact, those rates for dental treatment have not seen any increases since the year 2000 and last year the legislature decreased funding for Denti-Cal additional 10%.  Obviously, as a dentist in California it is very difficult to see Denti-Cal  patients no matter how altruistic you are with such slow reimbursement rates and in fact fewer than 10% of us are currently seeing Denti-Cal patients.  I stopped seeing Denti-Cal in the late 90's as Sacramento and San Diego counties started an HMO style reimbursement program and in fact fewer than 40% of pediatric dental patients have access to their free dental care.  In California there are 5 counties that do not have a single dentist provider.   So how does the government plan to resolve this problem?  Well the Affordable Care Act raised the reimbursement rates for Pediatric Dentistry to the same level as Medi-Care rates for all Denti-Cal reimbursements.  Great, so now many more dentists can see these new Covered California pediatric patients.  Not so fast!  This supplemental reimbursement from the federal government is only until 2016 at which time it starts to phase out.  Well who is going to make up the difference?  Obviously the state of California will (i.e.we tax payers.)  Do we have the funds for that or do we have to cut back the program again?  Don’t hold your breath.  Because we could not afford the old, very low, reimbursement rates that served millions of fewer children.  So what will happen?  I don’t know.  But with past experience as a guide, it will not be pleasant.  And while I agree that many children will now have insurance, very few will be able to get adequate dental care, and isn’t that really what we are trying to accomplish?  Is this the right answer?  Once again we, the informed voting public, will make the final decision at the next election.  Thus the reason for the blog.  We need to make informed decisions and put children first and hopefully we can resolve some of the issues.    

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