The Doctor Will See You Now — Tobacco Taxes Must Increase Patient Access to Health Care

April 05, 2017
Area(s) of Interest: Access to Care 

By Ruth Haskins, M.D., President of the California Medical Association (CMA) and Clelan Ehrler, DDS, MS, President of the California Dental Association (CDA).

CDA represents more than 27,000 dentists, and CMA represents over 43,000 physicians in all modes of practice and specialties.

Last November, over 64 percent of Californians voted in favor of a $2 per pack tobacco tax hike in the form of Proposition 56, the California Healthcare, Research and Prevention Tobacco Tax Act of 2016.

Voters overwhelmingly sent a message to Big Tobacco — products that cause cancer and kill people must also pay for part of the billions California spends to treat people with tobacco-related diseases. To that end, voters also intended for the tax revenues to help low-income Californians access health and dental care.

Increasing access to care is especially critical now that enrollment in our state’s Medicaid program, Medi-Cal, has surged to 14.3 million patients, which includes over 50 percent of all California children. One in three Californians’ health now depends on their ability to see doctors and dentists who accept Medi-Cal and its dental program, Denti-Cal.
Unfortunately, Medi-Cal suffers from chronic underfunding, which is causing serious consequences for patients. Only 20 percent of California dentists are able to accept Denti-Cal patients, and 40 percent of California doctors provide 80 percent of Medi-Cal visits.

These statistics have real-world repercussions — patients commonly encounter long delays for appointments, report trouble finding a specialist and have to travel long distances to receive care.

While Prop 56 supporters voted to help alleviate this unsustainable situation, Governor Jerry Brown’s proposed 2017–18 budget takes $1.2 billion of tobacco tax revenues that were required to improve access and instead, applies it toward existing state budget obligations in Medi-Cal.

In essence, the Governor’s proposed budget simply adds more patients to the back of the line and maintains the status quo, which does nothing to help patients gain needed access to doctors and dentists. Even the Legislative Analyst’s Office reported this use of funds goes against the “common sense view” of the tobacco tax.

Perhaps Governor Brown hasn’t heard the stories of patients who are suffering because they can’t see a doctor or dentist.

One such case involves a Redding cancer patient who waited six months for a biopsy because she had difficulty finding a doctor who accepts Medi-Cal. Or the health center in San Diego that provides care to 65,000 Medi-Cal patients annually and makes at least 2,500 referrals to specialists, but due to affordability, wait times and constrained access, less than half of these patients are able to receive needed care.

In another instance, a 4-year-old boy was medically compromised and died due to a delayed dental treatment. The child had serious medical complications and abscesses, which required treatment in the hospital setting. Due to the lack of access to a Denti-Cal provider, this child had to wait over a year for treatment. As a result of the delays, he survived dental surgery, but died in recovery due to an infection throughout his body from the abscesses.

This is why the California Medical Association and the California Dental Association are calling on the legislature to uphold the will of Prop 56 voters and use the tobacco tax revenues to increase Medi-Cal patient access to doctors and dentists.

And we urge Governor Brown to continue to work with us — our plan strengthens Medi-Cal and Denti-Cal, which will lead to healthier patients and long-term financial savings to the state.

NOTE: CMA/CDA press release.


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