We know that we're all going to be sharing Hawai'i's economic pain for at least the next several years, but cuts to the state Medicaid program would be not only highly counter-productive but downright foolish on several levels. Our healthcare industry is a big part of the local economy; taking another $100 million or so in revenues out of that sector is bound to cause further harm.

This dismal situation will be magnified when the loss of $100 million in revenues is coupled with a spike in uncompensated care. People's healthcare needs don't end just because their benefits do. And when they need care, they may be forced to get it at an emergency room, which is paid for, ultimately, by higher healthcare costs for everyone.

It is especially shortsighted to cut this particular budget item because more than half of this $100 million comes from the federal government. Can we afford to not take that money when it is desperately needed to provide care as well as support a lot of jobs and businesses in Hawai'i? Hawai'i has additional stimulus funds available to save us from making Medicaid cuts.

Cuts to Medicaid also threaten the capacity of the community health center safety net, just when it is seeing a tremendous uptick in demand. Our network of 14 nonprofit community health centers takes care of more than 120,000 people in Hawai'i. This cost-effective, essential safety net is sustained not solely by federal or state grants (although those, too, are vital) but also by Medicaid revenues. If that rug is yanked out from under them, health center funding will be stretched too thin to meet the needs of the growing numbers of people losing both their jobs and their employer-sponsored health insurance.

One program likely targeted for a particularly disastrous cut is "optional" Medicaid coverage for adult dental care. There is overwhelming evidence of the grim oral health of our kids — rates well over the national average for dental caries, baby bottle tooth decay, and unmet treatment needs. While dental statistics for adults are less well-documented, there's every reason to believe that children with poor oral health grow up to be adults with poor oral health. It should also be noted that access to affordable dental care is consistently ranked among the most worrisome gaps in communities across the state, especially for people who are impoverished or homeless.

Does access to dental care matter or is oral health just a luxury, part of a "Cadillac" Medicaid program? You bet your life it matters! Poor oral health may be an indicator of, or even lead to, life-threatening conditions such as heart disease, diabetes, premature birth, cancer, and deadly infections, not to mention disabling pain and disfigurement that can prevent an individual from getting a job.

The most important issue here, though, is the responsibility to cover healthcare for people who can't pay for it themselves. Taxes may need to be raised and cuts may need to be made but prudent leaders will prioritize life's essentials during this economic crisis. We're looking forward to working with our leaders in both the administration and the Legislature to rise to the challenge.

Beth Giesting is chief executive officer for the Hawai'i Primary Care Association. She wrote this commentary for The Advertiser.