Cutting dental care for 510,000 Minnesotans is not a solution

The Minnesota Legislature's Republican Senate majority wants to take dental and vision care away from up to 510,000 Minnesotans, offering a grim glimpse of what lies ahead if the state's provider tax sunsets this year.

Benefit cuts so harmful and sweeping should have received a careful airing at the Capitol. But this proposal, which is aimed at adults relying on the state's medical assistance and MinnesotaCare programs, was added late in the process to the Senate's sprawling health budget bill. There was no separate legislation proposing these changes, short-circuiting the chance for those affected by the cuts to adequately weigh in.

The proposal, championed by state Sen. Michelle Benson, R-Ham Lake, was spotlighted at a Tuesday news conference. GOP lawmakers held it up as an example of fiscally prudent hard "choices." In 2020, the forecast cost of dental services for adult medical assistance enrollees is $62.4 million.

But additional context is important. The amount of savings is not as impressive as it may seem. The state will not save $62 million because federal dollars pay the bulk of the cost for this dental care. The state's share is actually $17.7 million a year.

Nor does the state have to make this cut. Minnesota has relied for nearly three decades on its medical provider tax to help pay for medical assistance. The tax could be extended, though Republicans are opposed to doing so. The dental/vision cuts are just one example of what's at risk without a revenue source that will generate $684 million this year.

A cryptic note in nonpartisan staff's spreadsheet analysis of the Republicans' health budget bill underscores concerns about savings and the cuts' impact. The projected savings don't take into account "the value of offsets for services received in other service categories," the note reads. What that means: People without dental coverage often require expensive emergency care or hospitalization, which state programs will continue to cover. That will eat into savings.

These costs can add up quickly. In 2016, the tab for 69 patients who were hospitalized at Hennepin County Medical Center for severe dental infections came to $1.2 million. In the past three years, the hospital has also treated three patients with necrotizing fasciitis, sometimes known as the "flesh-eating" bacterial infection, stemming from a tooth infection. Each case cost $550,000 to $1 million, and officials there say the incidence is on the rise. Other conditions linked to poor oral health, such as cardiovascular disease, may also increase hospitalization costs. Recognition of this is why other states are enhancing dental coverage for low-income people.

In an interview, Benson reiterated the need to "bend the cost curve" for health care and disputed increased ER costs. She also raised a fairness issue: Should those on medical assistance get dental and vision insurance when those with incomes just above the line for aid often don't have this coverage?

It's a legitimate question about where the state's safety net ends, but the solution is to help those who are struggling, not take away dental care for 510,000 Minnesotans — 25,000 of whom are in Benson's home county of Anoka and 6,700 of whom live in Crow Wing County, where Senate Majority Leader Paul Gazelka lives.

Benson is right that health care financing remains a challenge, even with the provider tax. But benefit cuts should be the last resort, not the first.