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Editorial: Idaho needlessly brings fiscal pain on itself

Idaho lawmakers are finding that cuts in adult dental care bite back.

They recently learned the 2011 reduction merely shifted costs to emergency rooms. The hospital costs of dental-related visits went from $30,000 a month in 2011 to $65,000 a month today.

Legislators can’t say they weren’t warned. Two years ago, physician and Sen. Dan Schmidt, D-Moscow, said, “You can save money in your car by not changing the oil, but that’s not the right way to save money.”

For lawmakers, it’s a painful lesson in budget management. For emergency room patients, it’s been pure pain. In just one case, sepsis caused by an abscessed tooth cost the Medicaid program $300,000, according to Idaho Health and Welfare Director Dick Armstrong.

Now, lawmakers are considering restoring nonemergency dental coverage under Medicaid to 27,000 Idahoans.

The Legislature could’ve skipped this ordeal by researching what occurred in Spokane County when the state cut adult dental care. Emergency room visits jumped 18 percent between 2005 and 2009, according to a 2010 Spokane Regional Health District report, while costs increased from $1.6 million to $4.1 million.

Those numbers should drop because the state accepted the expansion of Medicaid under the Affordable Care Act. Last year, the Washington Legislature budgeted $23.3 million for the 2011-13 biennium to restore adult nonemergency dental care to some of the 100,000 people who lost it due to budget cuts. The feds are sending the state $49.2 million to sign up newly eligible people.

That should put tens of thousands of people in dental chairs instead of emergency rooms, where advanced infections can lead to serious health consequences.

Idaho, on the other hand, turned down the Medicaid expansion under Obamacare, so lawmakers are groping for a solution after rejecting the obvious one.

The state’s unique arrangement for covering catastrophic care for the poor is also causing budgetary nightmares. Under this plan, the state taps general fund revenue and local property taxes to cover unpaid bills. There is no federal match. Unsurprisingly, the costs are rising, because prevention isn’t part of the plan.

On Thursday, legislative budget writers learned the costs of catastrophic care doubled from 2002 to 2013, and the increase is expected to continue as long as preventive care is left out, according to a Spokesman-Review article.

The Legislature could repeal its catastrophic care plan and expand Medicaid, as state-commissioned consultants have advised, and the feds would pick up most of the costs. Milliman Consulting estimated that Idaho could save about $290 million over 10 years. The Idaho Hospital Association estimated it would avoid $407.4 million in added costs.

Philosophically, conservative lawmakers loathe the expansion of government care, whether it’s Medicaid or the Affordable Care Act. But their obstinacy is inflicting unnecessary physical and fiscal pain.

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