Good Health Care Doesn't Have to Feel like Pulling Teeth
In early June, Illinois governor Pat Quinn signed a package of cuts to the Medicaid program that was designed to save the state money and “save” the Medicaid program.
Last week, we examined the three components of a good health care program:
- Providing great outcomes and
preventing bad ones. - Caring for the whole person.
- Fiscal sustainability.
This is the second in an ongoing blog series in which we examine the Medicaid cuts from the SMART Act, recently signed by Governor Quinn, and measure them against the standard we have set for good health care. Some of the changes measure up, while others fall short. One of the cuts we think falls woefully short is the near elimination of dental care for adults on Medicaid.
According to the federal Medicaid rule, adult dental services are in the “optional” service group; this means that states aren’t required to provide these services for their Medicaid-eligible populations. Under the SMART Act, Illinois’s Medicaid program will no longer pay for preventative services for adults on the program; emergency extractions will still be provided.
These cuts mean that preventive services, like cleanings and even fillings, are not covered by the Medicaid program; sadly, this change means the cut obviously fails our first component—providing great outcomes and avoiding bad ones. Ideally, we would like all Illinois residents to be in good oral health, which is impossible to maintain without a regimen of regular visits and cleanings. These preventive visits are when we catch the little problems, like cavities, before they become big problems, such as completely unsalvageable teeth that need to be pulled, or dangerous infections.
We also want to have a holistic approach to health care. It’s always been confusing to me why dental coverage is singled out as an optional piece. When any preschooler can tell you that your mouth is a part of your body, why can’t our Medicaid program accept this simple fact? Oral health is obviously a part of your overall physical health, and any distinctions we draw between the two are illusory. Poor oral health care is related to other adverse physical conditions, including low birthweights, coronary heart disease, strokes, and even cancer. That’s right—by refusing to cover one part of the body now, we could be setting up other parts of the body for (expensive) future problems. This is an obvious failure on our second component of providing holistic health care.
Our third component is fiscal sustainability. At first blush, it looks like eliminating adult dental will save the state around $35 million, but let’s think about that number for a second. People with severe dental issues that cause pain or infections won’t all give up on relief—they will look for it. Emergency room treatment is a mandatory Medicaid category for states, so if individuals seeks dental care there, they cannot be turned away. A new report entitled “A Costly Dental Destination” from the Pew Center on the States estimates that preventable dental conditions were the primary reason for 830,590 ER visits by Americans in 2009, which is a 16% increase from 2006. The same report noted that from 2008-11, hospitals in the Chicago area alone saw nearly 77,000 visits for dental-related issues.
According to the Pew report, the average cost of a Medicaid enrollee's hospital treatment for dental issues is approximately 10 times more than the cost of preventive care from a dentist. Dr. Frank Catalanotto, professor of dentistry, noted that “Preventive dental care such as routine teeth cleaning can cost $50 to $100, versus $1,000 for emergency room treatment that may include painkillers for aching cavities and antibiotics from resulting infections.” That’s simply not cost-effective. These visits cost the Medicaid program millions of dollars each year, but they result in very little actual improvement for the patients. That’s because emergency rooms generally don’t have dentists on staff—so doctors can’t get to the root of the problem to fix it, but usually can prescribe nothing more than antibiotics and painkillers. Since the underlying problem continues, patients must return to the emergency room when their symptoms return. So, sadly, this change fails our third component of fiscal responsibility by a wide margin.
However, dental organizations are already speaking out against the cuts. Dave Marsh of the Illinois State Dental Society noted that these cuts are really just shifting the cost of the problem elsewhere: “You're going to see a lot of people waiting when they have tooth decay, toothaches, waiting until it gets to a point where they're going to go to the emergency rooms. And the cost of emergency care, as you're well aware, skyrockets over the cost of dental care."
Sorry, Illinois. This change to “save” the Medicaid program simply doesn’t measure up to the standard of good healthcare. Be sure to check back in with us as we examine other cuts in S.B. 2840 and measure them against our three-part standard.
