This week state leaders announced they had found enough donations to restore emergency dental care for tens of thousands of Medicaid recipients. The arrangement forestalled a political impasse over the issue—but is raising important questions—should private money be used to fund public programs—and what does the story reveal about government's obligation to those in need?
[Doug Fabrizio, Host]:
This week- with a deadline fast approaching – Utah governor Jon Huntsman was able to pull together a partnership to restore emergency dental care for tens of thousands of Medicaid beneficiaries. The arrangement forestalled a political impasse, but everyone understands it's only a temporary solution to a lasting problem. Today on Utah NOW- what's the government's obligation to those in need and can it – should it- rely on private money to fund public matters …
Hello, and welcome to Utah NOW. I'm Doug Fabrizio. On Wednesday – Utah governor Jon Huntsman unmasked the anonymous donor who had stepped forward to provide half of the money that would keep emergency dental care for Medicaid beneficiaries from expiring. The name of billionaire James Sorenson was only a mystery for a few days. Intermountain Healthcare agreed to kick in the other million dollars. But in some ways – this partnership was no triumph. Some say it represented a failing of both the state and federal government. It certainly raises important questions…
Are private donations a proper way to fund government programs – could they be an option when times are lean – and what does it mean for the state's obligation to care for those in need?
In Focus: Pay as You Go
[Governor Jon Huntsman, Utah]:
For us it was important that we got to the endpoint…that it was a solution…to carry 40,000 people in need for the upcoming year.
State leaders were clearly relieved this week - that they had soothed a squabble between the governor and the legislature – that they had beaten a deadline and found a way to fill a gap in the Medicaid program - but this is just one shortfall of one program – others loom - and most everyone at the announcement understood this fix was temporary…
[Senator John Valentine, President, Utah Senate]:
It's not a full restoration of dental for Medicaid recipients, but it does do something for that particular group. It gives us a chance to then work through some of the complexities of this particular area .
Medicaid funding equations are difficult to explain – much like the relationship between federal money and state money – but at the end a rather byzantine trail – are people in need – some 40-thousand of them..
I have probably went through three, four pair of dentures in the roof of my mouth because I have no bone in the front part of my gum. And I'll never be able to wear a pair and eat properly unless I have a bone transplant in the front.
I had to join Medicaid approximately four years ago. I had problems concerning my teeth, I was getting sick over and over again because of bad teeth.
Joy Malan and Dolly Chidister are just two of the thousands of Utahns who were going to lose their Medicaid dental benefits at the end of this month. They understand the money provided by James Sorensen and IHC won't solve the problem in the long term – but for now – a year-long grace period will do – and they're grateful...
It's amazing to me, and I really want to thank them. It's just amazing to me to know that someone out there that cares about us and that wants to help us. My concern is what happens after this. If after the first of July if I need further work, whether it's a root canal or whatever the case may be, it's not going to be there for me.
Joy and Dolly aren't entirely sure where to focus their frustration – they know it's complicated - they understand the issues of health-care are national in scope – but they're also disappointed it took private donors to restore their dental care - in this sense – the issue is mostly personal...
I would challenge them to try and go and try to eat without any teeth in your mouth. I would challenge them to live in illness after illness after illness…caused by infections in your teeth.
Let them go out and maybe have a nice dinner, and go through the total embarrassment of not even being able to chew a piece of meat.
You know, if they just took care of the problem, there wouldn't be thousands of dollars spent going to emergency rooms, going to the doctor because you have a sinus infection or an ear infection or your jaw is infected or your throat's infected from dental problems.
This story has highlighted a political dispute between Governor Huntsman and state lawmakers. The governor had tried to get legislative leaders to fund the Medicaid dental services during the recent special session - but legislators are resistant to fund optional services when Medicaid costs are growing out of hand.
Joining us for some perspective is…From senate leadership , Majority Leader Senator Peter Knudson (R), and Minority Whip, Senator Gene Davis (D), from the house we're joined by Representative Greg Hughes (R) and from the Legislative Medicaid Interim Committee, representative David Litvack (D).
Welcome to you all, thank you for being here …
Senator Knudson I'd like you to respond to this impression that seems to have been left with a number of Utahns that lawmakers went ahead and found $15 million for a parking garage but wouldn't fund $2 million for services for the needy. It's the impression that's left. How are you reacting to that?
[Sen. Pete Knudson (R), Majority Leader]:
Well, I can understand the public's reaction. Mainly because our budgeting process is not an easy thing to understand. But the issues are really separate from each other. Funding for the parking garage is totally an issue that's being funded through a bonding program for the renovation of the state capitol. It's unfortunate that the two issues happened to appear simultaneously, because it does give the impression that we would rather have a place to park cars than to take care of public needs. But if I might go a little bit further.
This whole issue, in my judgment, is based on a lack of understanding throughout our society about the value of dental care. Legislators don't understand that, and so when it comes time for prioritization, they're moved by very emotional issues on these health care programs. But it's tradition that
We should point out this is a dentist speaking.
I'm a dentist, but I can tell you that every year we have to fight for a small place at the table for dental care issues, but society is recognizing how important dental care is, not only in the physical health, but the mental health of all of us. I think this debate we're having is going to be the greatest blessing for dental care that we've had for years, because we're bringing out what needs to be debated. Another part of this program is that dental reimbursement rates are so bad for dentists that many of them can't afford to participate in this program. We've got to change that.
Let me get some more voices involved in the conversation from this side of the table, I guess the aisle. How are you reacting to I guess the general impression and what you're hearing from Senator Knudson?
[Sen. Gene Davis (D), Minority Whip]:
As far as the health issue, the dental issue is exactly as Senator Knudson has painted it. We're learning more and more about general health and oral health at the same time. It is too bad that a couple of years ago we decided to make that option of dental and vision and take it off the table, not fund it at all, to come back, make that really an issue of how do we fund it? And we funded that with one‑time moneys, which of course went away, and with the prioritization of the health and human service appropriations committee, it didn't get up as high as it should have for the amount of money that was given to the committee. And as we tried hard to try to raise that issue a little bit harder, and raise that up so that we got the list down far enough to cover dental, in the final analysis it did not happen.
Let me see if I can get to the bigger issues as we're running out of time. The question, representative Litvack, let me ask you this. Do you see the fact that the governor had to go and get private funds to take care of this, do you see that as a failing of the system?
[Rep. David Litvak (D)]:
Absolutely. First of all I think it's bad public policy. It's a bad precedent to set. It's not what we want to have to do as we move forward. Now let me caution that with, if I'm someone, as we just saw, who needs that, it's a blessing. And you know we have to be grateful for those individuals, as Jim Sorenson stepping up and actually stepping up from that perspective. But it's bad public policy. And I agree completely with what the Senator Knudson said about the importance of dental, we're beginning to understand that. But I think where the biggest failing is, Doug, we fail to take responsibility; we made up a lot of excuses during the special session, to provide a critical need in our community. And that, to me, is the biggest failing. And we were out of touch with the will of the people. We didn't, whether we did not understand what was happening. And I think the two issues, the parking and the dental, are actually related. Because they're both about access. They were both about access and in one area we succeeded, because through the parking we're going to create greater access for our community to come up to the capitol during the session. But for those who need dental care, who connected to their physical health, we failed. And if I can just say real quickly, I'd love Representative Hughes to respond because we've had this debate. The biggest failure also is that that money was there. That money is there and was there for Medicaid, and all we had to do was give the department of health permission to use it. We weren't asking to appropriate new money, it was there, it would have been used for its purposes, and that we should all be embarrassed for.
Is it that simple Representative Hughes?
[Rep. Greg Hughes (R)]:
It's not, and Representative Litvack and I have had the opportunity to debate it. What we see is a $10 billion budget. What we see in health and human services is a $1.8 billion budget. What isn't talked about is the $31 million in federal funds that we were expecting in matching funds that didn't arrive that we were fortunate enough that when the taxpayers overpaid and we had surplus that we were able to plug those dollars in for essential care. Now, the problem with the special session is we become very myopic. We see dental care, not the budget in the larger sense. The issue that many have about Medicaid, and not just, it's not about dental it's about Medicaid, is that we have what we feel is the rearranging of chairs on the deck of the titanic. We have a much bigger problem. We have a task force or interim committee that's meeting this summer to deal with the shortfalls in Medicaid funding, where we are and what priorities we need to place. Now we have optional programs in Medicaid. We have more than all the surrounding states, whether that's Wyoming, Nevada, Colorado, even the social consciousness of the United States Massachusetts offers less optional programs than we do here in Utah. What we're saying is, let's prioritize. Of the $1.8 billion that we're going to spend, let's make sure dental's part of that. Let's make sure that we're serving the public the way we need to. Coming into a special session, looking at one, straining at one net is not, in my opinion is not good policy.
We're essentially out of time but I want to get your sense, just quickly, if you would, around the table quickly, what you think needs to happen in the next couple of months as a body, as lawmakers anyway, you're starting to think about this.
We need to continue this debate but more than just talk about it we need to take action and make sure that we don't have this problem again.
I'd say more than rearranging the seats on the titanic. Washington we really need to be looking at is how many icebergs are out there that we need to make sure that we avoid, and health care is one of those issues that we have to be very, very careful about. And we have to be very straight forward, because we don't want to go out tomorrow morning with the headlines saying people are dying because the state's not willing to put the dollar up to take care of the needs of poor and disadvantaged individuals.
Let's just remember that the taxpayers are paying these dollars and we absolutely, I concur, need to prioritize and make sure that we're taking care of those in need. But think the taxpayers are paying and it's up to us to do the heavy lifting and make sure we're putting those dollars as we have them that we can sustain and put them in the right place.
It's not a wallet issue, it's a human being issue. It's not just a Medicaid issue it's a health care issue. Health care rates are growing in the private market, two times if not more than Medicaid so we have to as we have this dialogue about Medicaid include all the health care and take care of all the people in our community
Gentlemen, thanks very much for being with us.
In this week's Vox Populi people were responding to the political questions that play in this story and the social ones. For many this is a question of priorities.
I believe that they are more self involved, more focused on their power, and what's going to gain them in the long run rather than what the people are trying to tell them.
Government here has always seemed to be self‑centered and short sighted. It doesn't seem like they can look beyond, you know, two or three years down the road and see what's going to happen. So parking structures of course are more important than the health of people.
I really thought they should have taken care of the poor. I think we always got to take care of the needy in our community first. I like the idea of the parking structure but they should have got, you know, at least put that bill in so that it would help the needy in our community.
I'm not into doing all this stuff for the poor and the needy. I think we need to help them but I think there's a dividing line. I think sometimes we cross that line, we're like let's do everything for them and I think it causes more harm than good. So I actually don't have a problem and I do want a nice capitol. I want a nice parking structure, I think that's necessary.
It seems to me like a $15 million parking structure versus $2 million for dental benefits to make people healthy should be on their top priority.
They need to get their priorities straight. That's the people's money, and we need to take a look at the big picture and see what's most important to be spending taxpayer money on.
Like other states around the country Utah 's seen substantial cuts in Medicaid for the last two years. In lean times it's often the optional services like vision or dental care that are the first to go, but just how optional are these things for the people who really need them? And where do these kinds of things fit among roads or education when government leaders are making priorities? Judi Hillman is director of Utah Health Policy Project and Pamela Atkinson, Special Advisor to Governor Huntsman she was instrumental in finding a solution to this Medicaid funding crisis. Welcome to you both, thanks for being with us.
Pamela Atkinson, to you first. I asked the question of lawmakers whether or not this $2 million you were able to put together represented in some ways, could be seen as a failure of the way the system is supposed to work.
[Pamela Atkinson, Community Advocate]:
I think it could be seen by some, Doug. But I also think it was an opportunity for Utahns to once again show their compassion, and their generosity. And besides the $2 millions from Jim Sorenson and also Intermountain Healthcare, we had dozens and dozens of people send in checks ranging from $5 up to $5,000. So I'm not so sure it was a failure of the system, because I think with this Medicaid committee in the legislature they're trying to be proactive in light of all the federal cuts that are coming for Medicaid.
Judi Hilman, why isn't it good precedent to rely on charity to fund some of these government programs?
[Judi Hilman, Director, Utah Health Policy Project]:
Well, because it's not going to be reliable. Okay, you know I think that I would love to have a conversation with James Sorenson, first of all I'm very grateful for what he has done. But I think it's really important for him and Intermountain Healthcare to say, make a point of saying, this is just for this year, and now please, Medicaid Interim Committee, let's get to the bottom of our difficulties with Medicaid. You know, this is, you were talking about how optional services are often cut during lean years. This is not a lean year. We had a billion dollar surplus. There is no reason why, even in the face of the federal pull back on Medicaid, there's no reason why we could not have, we didn't take care of the dental and the vision problem. You know, I
There has to be some reason. What's the reason I mean why didn't they, for example? How are you responding to that?
The pull back from the federal government I think is in a lot of ways that is being used, I think, as a strategy, as a ruse to sort of cut Medicaid down to size. You know I think this is the same legislature that has rejected cost saving measures like the preferred drug list, or bulk purchasing of pharmaceuticals. In those two approaches alone, or in disease management approaches that we could be doing, or in a restructuring of our longterm care, we can save more than enough to cover the federal pull back, all the optional services, and we could put the parents' benefits back but they've rejected that. So I think we've got to start looking at and start making more responsible choices.
Pamela Atkinson how are you seeing it?
I think when we're looking at 42 and a half billion dollars being cut in deficit reduction bill across all of the states, I think each state is going to have to say woah back there, wait a moment.
In Utah there are 300 programs that are funded by Medicaid in the Department of Health, Department of Human Services, and Department of Workforce Services. And so I think what we're trying to do, the legislature and those of us who are advocates, looking at every single program in this Medicaid committee, and saying, how much money does it get from the state?
The federal government? What is it they're doing? What difference did it make? So I think it's a very responsible, proactive stance being taken by our legislature.
What do you make of the word "optional"? I wonder if you would be troubled by that term?
If you see there's something philosophical going on in terms of the difference that lawmakers may see between making choices about infrastructure like education and transportation, and maybe human infrastructure like health care?
Right. When the federal government, when congress established Medicaid in 1965, they realized that it was going to be this huge commitment and undertaking for states to be able to pay for full benefits for health care. So they made this whole long list of services that are medically necessary, including prescription drugs, okay? Are optional, they made them optional because that was the only way they could get this program going, okay? But a lot of states, most states cover most optional services, because when you really do your home work and you really get into the science of, how much do you save by paying for these things up front? What kind of economic impact do you get from spending, taking care of these services using Medicaid with a generous 3 to 1 federal match that we have from the feds, it ends up being most cost effective for a state to cover all of these so called optional services. Okay, and then if you look at the populations and you ask yourself, what do you want for these low‑income parents getting off of welfare? What sort of quality of life do we think a person with a disability or a senior citizen should have? Someone who's paid their dues, maybe, raised families, and now they're looking at their later years when, you know, do we want a quality of life for folks? You heard from Joy earlier. A quality of life says that health care does not stop at the neck, okay? You get your dental work done because then you'll have the rest of your physical health, and so it's not optional.
How do you take that? I mean the idea of whether or not these kinds of human needs are being plugged in appropriately in the equations of funding in government?
Well, I look at the fact that 58 percent of Medicaid services are optional. But then as I start to break them down, I'm thinking, how could they possibly be optional? If you look at dental care, we already know that certain gum diseases now affect the heart. So you have cardiac problems.
We also know that if people aren't eating properly because of an abscessed tooth, they get other infections; they cannot remain as productive members of our society. And we know that people have had to stop work because of that. So I think each of these services has to be looked at in terms of, as Judi says, the quality of life. But when 58 percent of services are named by the federal government as optional, places an increasing burden on the state.
About 30 seconds left. As states are considering how to best provide health care for their people, what should Utah lawmakers be thinking about? Just briefly?
Well you know I think we have to stop targeting Medicaid. Health care costs are the problem. In fact they are twice as much the problem as Medicaid. We should stop targeting Medicaid and recognize for the population that is rely on it there is no other way to deliver cost effective care.
I think we just have to look at all of the services being funded by Medicaid, I think the Medicaid committee is on the right track, we have to see how does it affect the individuals, and the state as a whole?
Ladies, thanks very much.
Now an update on our program last week where we spoke with Philosophy professor Jeffrey Nielsen. You'll recall Nielsen himself an active member of the church of Jesus Christ of Latter‑day Saints wrote an OP‑Ed piece in the tribune which criticized the church's stance on gay marriage. He is still working out the implications of speaking out but as he explained to us last week for him this is a crucial matter of conscience.
[Jeffery Nielsen , Philosopher and Author]:
Is a world that fails to be open and transparent and makes us fearful of expressing opinions, is that a world or a church that's worthy of my children? And that's what motivated me to write, to sort of find out whether this is a world and a church that's worthy of my children.
So, in essence, this is a moral question.
It is. It is not a religious or theological question, for me it is a moral issue. What is our obligation when it comes to treating one another as human beings?
Needless to say Jeffery Nielsen's stand has prompted a number of responses among them Laia Solen from Provo .
“I have a deep respect for those who are committed to what they believe is morally right but I would remind us all we're only morally great when our morals align with the greatest moral law of all, to love our neighbor as ourselves.”
Viewers have a lot to say about the part of the show that dealt with the proposed constitutional amendment defining marriage as between a man and a woman. Laurel Maurer from Riverton said she was sickened by the fact it didn't take on the well being of children. She said,
“I believe God gave men and women different attributes which compliment each other creating a perfect balance in which to raise children, eliminating one of them two damage this balance.”
Douglas Bundy from Layton says gay marriage is about gay sex. He writes,
“Homosexuality was once considered a perversion but it's now widely accepted as a natural sexual variation. This kind of view of mankind's most sacred gift is a grave error.”
Ron Patterson of Ogden , says,
“Committed relationships between two persons are more than just the physical act of sex. If two people have made a lifetime commitment then it doesn't matter if they are of the same gender or not.”
Well that's Utah now for this evening. Thanks for joining us. Remember you can join the conversation with an email, send us your comments to UtahNOW@kued.org . In the meantime we'll be back next Friday with another edition of Utah now. Until then, I'm Doug Fabrizio.
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