FLORENCE, Ala. — Sometimes, in a quiet moment between appointments, Dr. Carson Cruise runs the financial numbers through his head. They make a cold but compelling case: If he dropped all of the Medicaid patients from his small-town pediatric dental practice, he could make the same money while working far fewer hours.
Cruise, 36, owns a dental clinic in the picturesque Alabama town of Florence, home to the University of North Alabama, tucked into the rural northwest corner of the state. He and his wife have two little boys, ages 3 and 5. They sold their small family farm recently because it became too difficult to keep up with it and his practice and still have time for their family.
All of his patients are children. About half of them have their dental care covered by Medicaid, the joint federal-state health insurance program for people with low incomes. They come to his clinic from across the region, he says, and some parents drive from rural communities an hour away. He’s got a waitlist four or five months long…