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.    

             

Issues with Affordable Care Act, Part 1

I thought my next blog should be in 2 parts because of the complexity of the topic and my attempt to keep the blogs relatively short, so people will actually read them.  The topic we will be discussing today is the status of dentistry in California and how it is affected by the Affordable Care Act or Covered California.  Unlike Hilary Care in 1994 the ACA specifically left out dentistry to a large extent.  So why do I need to discuss it in a dental blog?  Well, while there is no federal dental funding mandate for the ACA, it does have a requirement for children’s dental healthcare coverage up to the age of 19 (no, not 18 or 26) for all insurance companies participating in the exchanges, including Covered California.  Obviously, from appearance that is certainly not a problem for California dentists and all Californians up to 19, who now will be covered by insurance.  After all that certainly boosts the demand for dental services and that is good for dentists and good for the patients that will benefit from our services with better oral health.  That certainly sounds like a win-win but unfortunately that is not the case.  The hidden problem is that Covered California in the ACA wants to increase patient care by subsidizing the cost of that increased patient access by putting millions of children into a single payer program paid for by the government.  In California, that huge figure translates to 5.1 million in 19 year olds and younger patients on Denti-Cal (the California version of dental Medicaid or Welfare).  Well what is the problem with that?  Let’s put it into perspective.  California is the 8^th largest economy in the world with a gross state production (GSP) of approximately 2.05 trillion dollars or 13.2% of the federal gross national product (GNP).  We currently have an unemployment rate of 7.4%, the fifth highest in the nation, which is certainly nothing to be proud of (but it is getting better).  The states demographics in the current census is 30.1% 19 year olds and younger of our total population of 37 million.  That means we have a total of 11,100,000 19 year olds and younger.  That translates to 46% of child population on welfare. Is that a problem?  Only you can decide, but it is certainly concerning to me that if we are such a great state, why almost half of our children on Welfare?