When insuring more patients is not enough

Kaiser Health News reported on a shortage of dentists in Tennessee, especially in light of over 600,000 Medicaid patients who might soon receive dental benefits. Part of the shortage of dentists seems to stem from a belief in the 1980s that there would be too many dentists (and so fewer people applied to dental school), but part of the problem also seems to be that dentists might not be paid enough in rural areas, where Medicaid patients might constitute a larger percentage of the overall population. Medicaid often reimburses providers less than half of what commercial insurers are willing to pay. Consequently, many providers may be unwilling to accept Medicaid.

The article explained that the cost of dental school (probably similar to medical school) is so expensive that most enrollees need to take out large loans, which later require large monthly payments. As a result, recent graduates are more likely to work in urban or suburban areas where they can be paid significantly more. There might be ways to help mitigate this shortage (the article discussed bolstering the finances of two dental schools), but a core issue seems to be that Medicaid does not pay enough. So, even though a Medicaid patient might have insurance coverage, that coverage might not be that helpful if the patient cannot find a provider who accepts that insurance (similar complaints have arisen about Medicare). One way of addressing this would be to require that Medicare and Medicaid have to satisfy the same provider network requirements that are imposed on commercial insurers. Presumably, if insufficient numbers of providers accept those insurance plans, the insurers would need to raise their rates.