Jack Klure: Charity care no replacement for Medicaid

January 26, 2014 

As the debate on Medicaid redesign or expansion continues to develop, one argument promoted by opponents is the idea of charity care as an alternative to improving Idaho’s public safety-net program. Charity care is alive and well in Idaho and has been helping to fill the gap for those in need for years. But charity care alone cannot solve this problem.

We have many volunteer programs developed by dentists and oral health groups that address the oral health needs of Idahoans with limited financial means. Give Kids a Smile in the month of February is significant charity care provided for children. However, dentists in Idaho give away free care on any day because the need is great. Programs for care range from dentists simply working on patients within their regular work day to large, one-day events with lots of volunteers to maximize the number of patients treated. I recently participated in one of these events hosted by the Idaho State Dental Association, United Way of Treasure Valley, Carrington College and the Genesis World Mission. At the Dental Mash we provided restorative services to more than 70 patients. The event was a success and many patients received care who would otherwise be visiting expensive emergency rooms. The challenge is that private practice dentists with small businesses can’t always work for free.

If the volunteer safety net can’t bear the weight of needs that exist, what is a viable solution? When I first considered Medicaid expansion, I was concerned that expanding a sometimes problematic program might not be the right direction for our state. Since that initial reaction, I’ve set aside my opposition to the Affordable Care Act and delved into the facts. As a result, my opinion has changed. Uncompensated care in Idaho’s emergency rooms is a growing financial burden on our health care system. We taxpayers bear that cost today via programs like Idaho’s Catastrophic Fund and county indigence programs. Regardless of whether the solution comes as part of federal health reform, we should be looking to resolve this challenge in a more cost-effective way for taxpayers and with better care for patients.

Medicaid redesign in Idaho didn’t start with the Affordable Care Act. It began years ago when the Idaho Legislature passed a Medicaid reform bill designed to give the state better control over the cost of the program. Since then, the state has explored managed care, accountable care models, medical home models, and other concepts to increase personal responsibility for participants and create a more cost-effective delivery system for Medicaid. The timing of this effort worked to Idaho’s advantage as we now can blend Idaho reform efforts with changes in federal law, allowing Idaho to create a better public safety net, while saving taxpayer dollars. We are also more likely to address a patient’s oral health needs if they are in the health care system.

This redesign plan would save taxpayers $53.6 million by eliminating the CAT Fund and $38.6 million by eliminating county indigent funds. In other words, Idaho Medicaid Redesign efforts create an ideal opportunity to improve the lives of Idahoans and provide taxpayers significant savings. This is an important issue, braced by compelling facts. I would encourage everyone to take the time to review the facts and share your views with our leaders.

If you are interested in knowing more about this issue, please go to therightmedicineforidaho.org

Dr. Jack Klure is past president of the Idaho Dental Association.

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