The Medicaid Dilemma


Angel K.A. Ogbeide, DDS

Publish date

The Medicaid Dilemma
Topic(s): Health Policy & Insurance Policy

The ongoing struggle on how to best serve patient populations who utilize coverage offered through the Centers for Medicaid and Medicare Services (CMMS) is never-ending. The continuous reimbursement cuts that discourage providers from accepting this type of coverage only continue to grow.  Most recently, in the wake of news of the looming possibility of additional cuts, concerns in the healthcare community have grown louder. As the already gaping margin of access to care continues to widen for disenfranchised patient populations, budget cuts only exacerbate the problem. The part that can often frustrate providers and health systems is the perceived confusion on why the arsenal of providers available to treat these patients continues to dwindle. Though, it’s not a secret. 

The average debt of a doctoral-level health provider is $135,000 – $440,000, plus interest. Healthcare systems at-large and providers working in a private practice setting lose money if they predominately serve Medicaid and Medicare patients. To those who work in the clinical side of healthcare, this is not a surprise. In having to consider overhead, which includes paying staff members, rent or mortgage, utility bills, and provider salaries; the notion that it can somehow “even out in time” is unrealistic. Not with looming student loan payments ever-present. When a provider is faced with a job offer in the private sector with better pay or a job in the public health setting with lower pay and more non-clinical responsibilities in managing patients with adverse circumstances in every social determinant of health adding to pajama time, the private sector job will likely be more appealing. As is often said in healthcare, “the bottom line always wins.” Always. The burden of responsibility for solving this problem shouldn’t fall onto providers. There are so many additional responsibilities outside of clinical care that plague providers already. Why add another block to the burnout tower? After all, we have heard the stories of when it collapses. The solution remains the same-more– emphasis on improving funding to this branch of our federal and local infrastructures. Otherwise, we will be left in this cyclical pattern of frustration. 

As simple as it may seem, the need for policymakers and individuals in positions of power at various branches of government to prioritize this problem is rooted in a need for empathy. The one social class any individual can enter at any point is “disabled.” Whether from an acute, chronic, or terminal illness, any one of us could find ourselves in a position where we could lose our attractive “private” insurance benefits. I often wonder if the individuals deciding on budget cuts would be so quick to advocate for depleting already dwindling funds to CMMS if they were diagnosed with a terminal illness and forced to leave their careers for full-time treatment and care? It sounds like an overdramatization until your routine check-up at your primary care provider’s office turns into an oncology referral. When you become “those people.” When “those people” become your family and friends. It shouldn’t take that though. How the right thing to do continues to be the hardest thing to do is often discouraging. Regardless, we will continue to advocate for our patients. After all, “The one thing that doesn’t abide by majority rule is a person’s conscience.”

Angel K.A. Ogbeide, DDS is an Assistant Professor in the Department of Oral and Maxillofacial Surgery at Creighton University, School of Dentistry.

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