Inside Opinion

What's on the minds of Tacoma News Tribune editorial writers

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Tag: Medicaid


Fluoridation: Where the real tax savings are

I was in my middle twenties before I knew what a cavity was. My friends had them; I almost felt left out.

I happened to have spent my early years in Madison, Wis., one of the first cities to have its water supply fluoridated.

Our editorial today argues for restoring Medicaid dental coverage for poor adults. That would cost the state something on the order of $30 million and the federal government more, since it would be paying for a further expansion of Medicaid under the Affordable Care Act.

Total Medicaid dental in Washington could come in at something north of $90 million per biennium.

That cost might be pared in the future if all of Washington’s cities adopted fluoridation, which the U.S. Centers for Disease controls has called “one of the 10 great public health achievements of the 20th century.” One study cited by the American Dental Association estimates that every $1 invested in fluoridation saves $38 worth of dentistry later.

Close to two-thirds of Washingtonians benefit from fluoridated drinking water, but a few bastions of enlightenment – including Olympia, Spokane and Bellingham – remain holdouts.
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A chance to get poor adults back to the dentist

This editorial will appear in Monday’s print edition.

Since the Great Recession hit five years ago, the Legislature has had to do dumb things with money – short-term spending cuts that, long term, were bound to cost more money than they saved.

One of these forced errors was the elimination of Medicaid dental coverage for more than 400,000 poor adults in recent years. For every dollar saved, the state forfeited another dollar in federal matching funds – and set itself up for higher medical expenses down the road.

It’s now time to reverse that penny-wise decision. With the Affordable Care Act about to supplement state Medicaid spending with federal, the restoration of dental care would leverage far more federal dollars than it would cost.

Dental infections are like other infections: Let them fester, and the problems only get bigger and more expensive.

After the Medicaid cut in 2011, adults who’d lost their coverage either had to seek charity care or go to the emergency room when they got a toothache.

Pain in the jaws and the teeth can be symptoms of nasty conditions, including abscesses turning into massive bacterial infections. Emergency room staffs can provide painkillers and antibiotics, but they can’t treat the underlying dental diseases.

Diabetes is the best illustration of pay-now-or-pay-more-later.
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Washington can’t afford blank checks for ER visits

This editorial will appear in tomorrow’s print edition.

Welcome, Medicaid patients, to the new world of parsimonious medicine.

At the behest of the Legislature, the state Health Care Authority – in the face of protests from emergency room doctors – is rolling out new restrictions on Medicaid payments for ER use. The docs say the rules threaten patients with real medical emergencies; the state says the rules merely target excessive use of some of the most expensive care on Earth.

The state has the better part of this argument. It is moving in the right direction – aggressive cost control – so long as it remains willing to adjust the regulations as needed if problems arise.

The big picture here is the human impact of any kind of unnecessary medical care. If one Medicaid patient with a $100 medical problem winds up creating a $1,000 emergency room bill, that’s $900 that might have been spent on care for nine other patients.

The Health Care Authority estimates that more than $50 million could be saved by shifting routine ailments away from emergency rooms. That money could be spent instead on broader medical coverage, child protective services, mental health counseling, etc. Unnecessary state services – including excessive ER use – rob necessary services that protect the vulnerable.

Getting down to particulars, ER physicians are alarmed that the state is reclassifying some dire-sounding diagnoses – such as chest pain – from emergency to non-emergency conditions.

The concern is legitimate. Any Medicaid client who shows up at a hospital with a serious cardiac problem – or signs of another life-threatening illness – should certainly be treated as an emergency patient. The hospital and his or her doctors should be reimbursed accordingly.
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Birth control coverage will be a boon for millions

This editorial will appear in Friday’s print edition.

Contraceptive use in the United States is an issue fraught with irony.

The women who can least afford to get pregnant – including the young, the poor and the uneducated – often have the least access to effective birth control. They may not have health insurance, but even if they do, it might be subject to a deductible or co-pay. So they’re more likely to use cheaper, less effective methods like condoms – or nothing at all.

Little wonder the United States has the highest rate of unintended pregnancies in the industrialized world. Almost half of all U.S. pregnancies are unplanned, and about 40 percent of those end in abortion. Medicaid and the Children’s Health Insurance Program alone spend more than $12 billion a year providing maternity care for low-income women and care for infants in the first year of life. Read more »