“La semana pasada me hicieron un tratamiento de conducto (endodoncia) que costó unos $500”, dijo. “Antes me colocaron una corona que me costó varios cientos de dólares. Y ahora mismo tengo un diente roto, así que tengo que ir al dentista pronto”.

En total, Anthony calcula que pagará alrededor de $2.000 por esta atención este año, aunque tiene seguro dental.

“Tratar de evaluar el costo de cuándo ir a recibir atención dental y pagar por ello, frente a otras necesidades que tengo, es algo muy importante”, agregó Anthony.

La Asociación Dental Estadounidense (American Dental Association, ADA) informó que el tenía seguro dental en 2021. Pero esa cobertura no protege necesariamente contra facturas elevadas.

De hecho, 1 de cada 4 adultos con seguro dental reportó que el costo es una barrera para recibir atención, de KFF, una organización sin fines de lucro de información de salud que incluye ºÚÁϳԹÏÍø News.

Aquí hay tres cosas que debes saber para entender mejor tu plan dental y mantener los costos lo más bajos posible:

1. Incluso con seguro dental, tendrás que pagar por procedimientos

Los planes dentales suelen cubrir completamente la atención de rutina, pero solo pagan una parte del trabajo adicional. Los beneficios varían, pero muchos planes siguen la regla “100/80/50”: cubren el 100% de la atención preventiva, como limpiezas y exámenes, el 80% en el caso de procedimientos básicos, como empastes y endodoncias, y el 50% de otros procedimientos mayores.

Además, los planes dentales suelen tener un límite máximo anual de pago, por lo general, de entre $1.000 y $2.000. Los pacientes deben pagar cualquier costo que supere ese límite. Por ejemplo, si tu plan tiene un máximo de $1.500 y necesitas $4.000 en tratamientos dentales, tendrás que pagar la diferencia de $2.500.

1. ¿Enfrentas una factura dental alta? Tienes opciones

Puede resultar incómodo hablar de dinero directamente con un dentista, pero es útil ser claro sobre lo que puedes pagar.

Muchas clínicas odontológicas ofrecen opciones de financiamiento para ayudar a los pacientes a manejar el costo de la atención, incluyendo estimaciones previas al tratamiento y planes de pago. Si recibes un presupuesto que parece muy alto, revisa los detalles y considera buscar una segunda opinión. También puedes preguntar si ofrecen algún descuento.

Si necesitas una opción de menor costo, puedes considerar las escuelas de odontología, que a menudo ofrecen atención con descuento, o los , que ajustan los precios según los ingresos del paciente.

1. Visitar al dentista con regularidad puede ayudar a mantener bajos los costos

Sarah Olim, dentista generalista en Katy, Texas, recomienda a sus pacientes hacer cita cada seis meses.

“Lo mejor que puede hacer para reducir el costo de ir al dentista es asegurarse de ir con regularidad y tratar los problemas a tiempo”, dijo.

Olim atiende a pacientes sin importar cuánto tiempo haya pasado desde su última visita. Pero advirtió que quienes esperan varios años entre consultas pueden encontrar que sus citas son más costosas y más incómodas.

¿La razón? Los problemas dentales generalmente no se resuelven por sí solos. Por ejemplo, una caries pequeña que requiere un empaste rápido puede costar $200. Si no se trata, puede convertirse en un problema mayor que requiera un tratamiento de conducto o endodoncia y una corona, con un costo de miles de dólares.

Tu dentista también te recomendará seguir medidas preventivas básicas: cepillarte los dientes durante dos minutos, dos veces al día. Olim aconseja a sus pacientes tomarse el tiempo o escuchar una canción que les guste para asegurarse de cepillarse el tiempo suficiente.

Personas y políticas

Los legisladores federales han intentado aumentar el acceso de los niños al seguro dental. Bajo la Ley de Cuidado de Salud a Bajo Precio (ACA), la atención dental se considera un , por lo que los planes de salud en el mercado individual deben ofrecer cobertura dental para menores de 18 años.

Los programas estatales de Medicaid también .

Emily Siner, de Nashville Public Radio, contribuyó con este informe.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

Russell Anthony made eight trips to the dentist last year. The 65-year-old retiree in Nashville, Tennessee, hopes to go less often in 2026, but he’s already made a few visits.

“I had a root canal just last week that was like $500,” he said. “The week before that, I had a crown that cost me several hundred dollars. And as we speak, I have a broken tooth, and I have to go and see the dentist soon.”

In all, Anthony — uncle of HealthQ host Cara Anthony — expects to pay about $2,000 for dental care this year, even though he has dental insurance.

“Trying to weigh the cost of when to go to get dental care and paying for it, versus the other needs that I have, is something that’s very important,” Russell Anthony said.

The American Dental Association reported that had dental insurance in 2021. But that coverage does not necessarily protect against large bills. In fact, 1 in 4 adults with dental insurance reported costs as a barrier to care, according to a by KFF, a health information nonprofit that includes ºÚÁϳԹÏÍø News.

Here are three things to know to better understand your insurance plan and keep your dental costs as low as possible:

1. Even With Dental Insurance, You’ll Have To Pay for Procedures

Dental plans typically cover routine care in full but pay only a portion of additional work. Benefits vary, but many plans follow the “100/80/50” rule, covering 100% of preventive care like cleanings and exams, 80% of basic procedures like fillings and root canals, and 50% of other major procedures.

Plus, dental plans often have a maximum annual payout, usually between $1,000 and $2,000. Patients are responsible for any costs above that. For example, if your plan maxes out at $1,500 and you need $4,000 of dental treatments, you will be on the hook for the difference of $2,500.

2. Facing a Big Dental Bill? You Have Options

It might feel uncomfortable to talk about finances directly with a dentist, but it’s helpful to be up-front about what you can afford.

Many dentist offices offer financial options to help patients manage the cost of care, including pretreatment estimates and payment plans. If you get an estimate that seems especially high, talk through the items and consider getting a second opinion. It never hurts to ask the office for a discount.

If you need a lower-cost alternative, consider looking into dental schools, which often offer discounted care, or , which use sliding scales based on a patient’s income.

3. Seeing Your Dentist Regularly Can Help Keep Costs Low

Sarah Olim, a general dentist in Katy, Texas, encourages her patients to come in for visits every six months.

“The best thing that you can do to mitigate the cost of going to the dentist is make sure that you are going regularly and trying to take care of things early,” she said.

Olim welcomes patients no matter how long it’s been since their last visit. But she cautioned that patients who wait a few years between visits may find their appointments are more expensive and more uncomfortable.

The reason? Dental problems often don’t resolve on their own. For example, a small cavity that needs a quick filling might cost $200. If left untreated, it could turn into a larger issue requiring a root canal and crown — and cost thousands.

Your dentist will also encourage you to follow the best preventive maintenance: brushing your teeth for two minutes twice a day. Olim tells her patients to use a timer or listen to a favorite song to make sure they brush long enough.

People and Policy

Federal lawmakers have tried to increase children’s access to dental insurance. Under the Affordable Care Act, dental care is considered , so health insurance plans on the individual marketplace must offer dental coverage for those 18 or younger. State Medicaid programs are also for children.

Emily Siner at Nashville Public Radio contributed to this report.

HealthQ is a health series from reporters Cara Anthony and Blake Farmer, approachable guides to an unapproachable health care system. It’s a collaboration between Nashville Public Radio and ºÚÁϳԹÏÍø News.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

En pocos días, Reynolds estaba tan desesperada que ella y su esposo tuvieron que sujetar físicamente a Jonah para obligarlo a tomar el remedio, echándoselo en la garganta mientras él gritaba de dolor.

“Nos rompió el corazón”, contó Reynolds, que en ese momento vivía en Georgetown, Kentucky. “Y recuerdo que pensé que no debería tener que llegar a eso”.

Reynolds no pudo encontrar un dentista con una cita disponible que pudiera atender a Jonah, que es autista y a menudo se resiste a los exámenes dentales por hipersensibilidad y ansiedad. Durante cinco días, Reynolds llevó a Jonah dos veces a una sala de emergencias cercana, mientras el niño lidiaba con un dolor persistente y fiebre por lo que probablemente fuera un diente infectado con un nervio expuesto.

En la sala de emergencias no había dentistas; las dos veces la familia regresó a casa solo con analgésicos y una bolsa de hielo.

En todo el país, cada vez más niños llegan a las salas de emergencias por problemas dentales prevenibles. Dentistas, higienistas e investigadores atribuyen esa tendencia a la falta de profesionales de odontología pediátrica en zonas rurales y a un deterioro de la higiene bucal desde la pandemia de covid-19.

Decenas de miles de niños terminan en el hospital por emergencias dentales cada año, según Melissa Burroughs, directora sénior de políticas y defensa del paciente de la organización nacional sin fines de lucro CareQuest Institute for Oral Health.

Las visitas a salas de emergencias por problemas dentales no relacionados con lesiones físicas aumentaron en niños menores de 15 años entre 2019 y 2022, según un informe publicado a finales del año pasado por CareQuest.

Los datos locales reflejan esa tendencia nacional.

En el Hospital de Niños de Colorado, en el área de Denver, los casos dentales no traumáticos —como caries o infecciones de encías— atendidos en la sala de emergencias aumentaron un 175% entre 2010 y 2025, según Sarah Bonar, vocera del hospital.

En Kentucky, donde vive Jonah, las visitas de niños a salas de emergencia por problemas dentales aumentaron un 72 % entre 2020 y 2024, según los registros del estado.

Los cambios de política ejecutados por el gobierno de Donald Trump podrían empeorar la tendencia.

La ley de reconciliación presupuestaria federal de 2025 impulsada por el presidente, conocida como One Big Beautiful Bill Act, pidió recortes de miles de millones de dólares a Medicaid, lo que podría obligar a los estados a limitar o eliminar la cobertura dental del programa de salud pública para personas con bajos ingresos o con discapacidades.

Nuevos requisitos de elegibilidad de Medicaid en algunos estados podrían afectar el acceso de los niños a la atención dental, aunque el programa les garantiza esa cobertura. Investigaciones muestran que cuando los padres pierden Medicaid, incluso los niños que mantienen su cobertura tienen más probabilidades de tener y de ir al dentista.

La administración Trump también ha promovido el escepticismo sobre el flúor. muestran que el flúor en el agua potable y los tratamientos tópicos con flúor previenen y reducen de forma importante la caries dental.

En meses recientes, la Administración de Alimentos y Medicamentos (FDA, por sus siglas en inglés) contra el uso de suplementos de flúor y la Agencia de Protección Ambiental (EPA, por sus siglas en inglés) sobre “posibles riesgos para la salud del flúor en el agua potable”.

El secretario de Salud y Servicios Humanos, Robert F. Kennedy Jr., ha llamado al flúor un “” y un “”. Un estudio de 2025 en JAMA Pediatrics vinculó niveles altos de flúor con un coeficiente intelectual más bajo en niños, pero solo con concentraciones del nivel recomendado en el agua potable pública.

, un dentista pediátrico en la University of Washington que estudia la reticencia al flúor, teme que las posturas anti flúor erosionen aún más la confianza en los tratamientos con flúor.

Desde el comienzo de 2026, legisladores en por lo menos 15 estados han presentado proyectos de ley para prohibir o limitar el flúor en el agua potable pública. Utah y Florida se convirtieron en 2025 en los primeros estados en aprobar esas prohibiciones.

“¿Eso va a tener un efecto en las tasas de caries? Absolutamente”, sostuvo Chi.

Aumentan los casos dentales graves

Las dentistas pediátricas Katherine Chin y Chaitanya Puranik dijeron que están atendiendo a más pacientes como Jonah en el hospital infantil de Colorado. Los casos graves también se han vuelto más frecuentes. Puranik agregó que antes, por lo general, veía pacientes con una sola caries, pero ahora a menudo llegan con caries en toda la boca.

Durante la pandemia, muchos consultorios dentales . Además, estudios muestran que los niños también , un factor de riesgo importante para los problemas dentales.

Las caries graves que llevan a la extracción de dientes pueden afectar el y, a veces, causar problemas a largo plazo para o .

Millones de personas viven en zonas de Estados Unidos donde , con pocos dentistas a una distancia razonable en auto. Además, según la American Dental Association, solo atiende a pacientes de Medicaid, debido a las bajas tasas de reembolso, que en promedio son de lo que cobran habitualmente.

Los niños con discapacidades intelectuales o del desarrollo pueden tener aun más dificultades para acceder a atención dental de calidad.

Pocos dentistas generales tienen suficiente formación pediátrica para atender a niños con discapacidades como Jonah, que se agobian con facilidad o necesitan sedación para un examen, una organización sin fines de lucro de información de salud que incluye a ºÚÁϳԹÏÍø News.

tienen necesidades especiales de atención médica, y esos niños tienen de no tener cubiertas sus necesidades dentales. Sus padres también de tener problemas para .

Cuando era más pequeño, Jonah no dejaba que sus papás le cepillaran los dientes. Esto le generó caries en sus dientes de leche, explicó su mamá.

Después de la primera visita de Jonah a la sala de emergencias, Reynolds encontró un dentista general que tenía una cita disponible. Pero, a diferencia de un dentista pediátrico capacitado, dijo, el dentista no supo cómo examinar a Jonah de una forma que él pudiera tolerar y no estaba preparado para sedarlo. Jonah se fue sin tratamiento y pronto, cuando volvió la fiebre, regresó a la sala de emergencias.

Las salas de emergencias rara vez ofrecen soluciones

, pediatra en el condado de Washington, en Maine, aseguró que está viendo “las caries más horribles” en Down East Community Hospital.

Las salas de emergencia a menudo no están preparadas para tratar problemas dentales, explicó Weitz. Como a la que fue Jonah en Kentucky, Down East no tiene dentistas entre su personal. Weitz a menudo termina recetando antibióticos como medida temporal. “Pero un mes después, los pacientes regresan porque la situación vuelve a agravarse”, dijo Weitz.

Como posible solución, estados como Maine y Alaska están proponiendo usar fondos del , dotado con $50.000 millones, para desarrollar la fuerza laboral de salud bucal o crear centros especializados de atención dental que puedan atender mejor y más rápido a niños con necesidades especiales de atención médica.

Pero esas iniciativas no resolverán la pérdida de cobertura que se anticipa por Ìýlos recortes a Medicaid.

El año pasado, California otorgó $47 millones en subvenciones estatales para desarrollar o ampliar más de 120 centros odontológicos destinados a atender a pacientes con necesidades especiales de atención médica.

La emergencia dental de Jonah le costó a Reynolds una semana sin trabajar en su empleo como peluquera de perros y a Jonah tres días de tercer grado, además de los cientos de dólares que tuvieron que pagar de su propio bolsillo.

Finalmente, Reynolds encontró a un especialista en cirugía oral que le extrajo el diente. Pero incluso eso salió mal. Cuando Jonah se alteró por el pinchazo de una aguja, el cirujano amenazó con sujetarlo por la fuerza, contó Reynolds. Agregó que el profesional se fue rápidamente después del procedimiento sin darle un diagnóstico claro de qué había causado el dolor de Jonah.

La extracción terminó con el dolor de muelas, pero Reynolds opinó que más profesionales deberían saber cómo manejar casos como el de Jonah, con más sensibilidad hacia las familias.

Cuatro años después, todavía sigue fresco en su memoria el momento en que tuvo que obligar a Jonah a tomar el medicamento para el dolor. “Eso nunca se me va a olvidar”, concluyó Reynolds.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

Within a few days, Reynolds became so desperate that she and her husband had to physically restrain Jonah, dumping pain medication down his throat as he screamed in pain.

“It broke our hearts,” said Reynolds, who lived in Georgetown, Kentucky, at the time. “And I remember just thinking that it shouldn’t have to come to that.”

Reynolds couldn’t find a dentist with an opening who could treat Jonah, who is autistic and often resists dental exams due to hypersensitivity and anxiety. Over the course of five days, Reynolds took Jonah twice to a nearby emergency room as he struggled with persistent pain and a fever due to a likely infected tooth with an exposed nerve. The ER had no dentists; both times, the family was sent home with only pain medication and an ice pack.

Across the nation, more children are entering ERs for preventable tooth problems. Dentists, hygienists, and researchers attributed that trend to a shortage of pediatric dental care professionals in rural areas and worsening oral hygiene since the covid-19 pandemic. Tens of thousands of kids end up in the hospital for dental emergencies each year, according to Melissa Burroughs, senior director of policy and advocacy at the national health nonprofit CareQuest Institute for Oral Health.

ER visits for tooth problems unrelated to physical injuries for children under 15 years old from 2019 to 2022, according to a report released late last year by CareQuest. And local data reflects that national trend: At Children’s Hospital Colorado in the Denver area, nontraumatic dental cases, such as cavities or gum infections, in its ER increased 175% from 2010 to 2025, according to hospital spokesperson Sarah Bonar. In Kentucky, where Jonah lives, children’s visits to the ER for dental problems rose 72% from 2020 to 2024, according to the state.

Policy changes under the Trump administration are poised to worsen the trend. President Donald Trump’s 2025 federal budget reconciliation law, known as the One Big Beautiful Bill Act, called for billions in cuts from Medicaid, which may force states to limit or drop dental coverage from the public insurance program for those with low incomes or disabilities. New eligibility requirements for Medicaid in some states could affect kids’ access to dental care, even though children are guaranteed dental coverage under the program. Research shows that when parents lose Medicaid, even kids with coverage are more likely to have and to go to a dentist.

The Trump administration has also promoted skepticism about fluoride. show that fluoride in drinking water and topical fluoride treatments dramatically reduce tooth decay and prevent cavities. In recent months, the Food and Drug Administration against the use of fluoride supplements and the Environmental Protection Agency of “potential health risks of fluoride in drinking water.” Health and Human Services Secretary Robert F. Kennedy Jr. has called fluoride a “” and “.” A 2025 study in JAMA Pediatrics linked high levels of fluoride with lower IQ in children — but only at concentrations the recommended level in public drinking water.

, a pediatric dentist at the University of Washington who studies fluoride hesitancy, worries that these anti-fluoride stances will further erode trust in fluoride treatment. Since the start of 2026, lawmakers in at least 15 states have introduced bills prohibiting or limiting fluoride in public drinking water. Utah and Florida in 2025 became the first states to enact fluoride bans.

“Will that have an effect on cavity rates?” Chi asked. “Absolutely.”

Severe Dental Cases Rise

Pediatric dentists Katherine Chin and Chaitanya Puranik said they are treating more patients like Jonah at Children’s Hospital Colorado. More severe cases have become more common, too. Puranik said he used to typically see patients with only one cavity, but now his patients are often coming in with tooth decay throughout their mouth.

During the pandemic, many dental offices , and studies show children also increased , a major risk factor for cavities. Severe cavities that lead to tooth extraction can affect , sometimes causing long-term problems with or .

Millions of people live in in the U.S., with scant dentists within driving distance. On top of that, only treat Medicaid patients, due to low reimbursement rates, which are on average of their typical dental charges, according to the American Dental Association.

Children with intellectual or developmental disabilities may especially struggle to access quality dental care. Few general dentists have sufficient pediatric training to care for kids with disabilities such as Jonah, who are easily overwhelmed or need to be sedated for an exam, , a health information nonprofit that includes ºÚÁϳԹÏÍø News. Over have special health care needs, and those children are to have unmet dental needs. Their parents are also to finding a dentist.

When he was younger, Jonah would not let his parents brush his teeth, which led to cavities in his baby teeth, his mother said. After Jonah’s first visit to the ER, Reynolds found a general dentist with an opening. But unlike a trained pediatric dentist, she said, the dentist did not know how to examine Jonah in a way he could tolerate and wasn’t prepared to provide sedation. Jonah left without treatment and was soon back in the ER when his fever returned.

ERs Rarely Provide Solutions

, a pediatrician in Washington County, Maine, said he is fielding “the most horrifying cavities” at Down East Community Hospital.

ERs are often ill-equipped to treat dental concerns, Weitz said. Similar to the ER Jonah went to in Kentucky, Down East has no dentists on staff. Weitz often finds himself prescribing antibiotics as a temporary measure.

“But a month later, they’re back again because it’s flaring up again,” Weitz said.

As a potential solution, states such as Maine and Alaska are proposing to use money from the $50 billion to develop the oral health workforce or to create specialized dental care centers, which can better serve children with special health care needs on short notice. But those initiatives won’t address the loss of coverage anticipated from Medicaid cuts. California last year in state grants to develop or expand over 120 dental facilities to serve patients with special health care needs.

Jonah’s dental emergency cost Reynolds a week of work from her job as a dog groomer and Jonah three days of third grade, plus hundreds of dollars in out-of-pocket costs.

Eventually, Reynolds found an oral surgeon who extracted the tooth. But even that went poorly, she said. When Jonah became upset over a needle stick, the surgeon threatened to hold him down, Reynolds said. She said the surgeon left quickly after the procedure and never gave her a clear diagnosis of what caused Jonah’s pain. The procedure did resolve his toothache, but Reynolds said more professionals should know how to handle cases like Jonah’s, with sensitivity to the families. Four years later, forcing Jonah to take his pain meds still lives fresh in her memory.

“That will never leave my mind,” Reynolds said.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

But when Quinn chipped a tooth and it became infected, she could not find a dentist near her home who would accept her government health coverage and was taking new patients.

She went to an emergency room, receiving painkillers and antibiotics, but she remained in agonizing pain weeks later and paid a dentist $200 to extract the tooth.

Years later, it still hurts to chew on that side, she said, but Quinn — a 34-year-old who has four children and, with her husband, earns about $30,000 a year — still can’t find a dentist nearby.

“You should be able to get dental care,” she said, “because at the end of the day dental care is health care.”

The federal government has long required states to offer dental coverage for children enrolled in Medicaid, the joint state-federal health program for people who are low-income or disabled. Paying for adults’ dental care, though, is optional for states.

In recent years, several states have opted to expand the coverage offered by their Medicaid programs, seeking to boost access in recognition of its importance to overall health. So far, increasing adult dental care is a work in progress: In a sampling of six of those states by ºÚÁϳԹÏÍø News, fewer than 1 in 4 adults on Medicaid see a dentist at least once a year.

But under congressional Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last year, the federal government is expected to reduce Medicaid spending by more than $900 billion over the next decade. The range from about $184 million for Wyoming to about $150 billion for California.

State Medicaid programs typically expand or reduce benefits depending on their finances, and such massive federal cuts could force some to shrink or eliminate what they offer, including dental benefits.

“We will lose all the gains we have made,” said Shillpa Naavaal, a dental policy researcher at Virginia Commonwealth University in Richmond.

Tennessee’s Medicaid program, for instance, spent nearly $64 million on its dental coverage in 2024 and saw a 20% decrease in dental-related ER visits, said Amy Lawrence, the program’s spokesperson.

But under the new law, Tennessee is projected to lose about $7 billion in federal funding over the next decade.

As of last year, 38 states and the District of Columbia offered enhanced dental benefits for adult Medicaid beneficiaries, according to the American Dental Association. Most of the others offer limited or emergency-only care. Alabama is the only state that offers no dental coverage for adult beneficiaries.

Since 2021, 18 states have enhanced their coverage to include checkups, X-rays, fillings, crowns, and dentures, while loosening annual dollar caps for benefits.

Use of dental benefits in states with the enhanced benefits is greater than in states with only limited or emergency coverage, though still low overall, according to with the latest data as of December. No more than a third of adult Medicaid recipients saw a dentist in 2022 in any state.

To review more recent progress, ºÚÁϳԹÏÍø News asked one-third of the states that have expanded their benefits in the past five years for their most recent data on the percentage of adults on Medicaid who visit a dentist at least once a year:

• Maryland — 22% (in 2024)
• Oklahoma — 16% (in 2025)
• Maine — 13% (in 2025)
• New Hampshire — 19% (in 2025)
• Tennessee — 16% (in 2024)
• Virginia — 21% (in 2025)

In comparison, about 50% to 60% of adults with private dental coverage see a dentist at least once a year, according to the ADA.

Nationwide, 41% of dentists reported participating in Medicaid in 2024, a share that has remained stable over the past decade despite the dental benefit expansions in many states, the ADA says. Many participating dentists, though, limit the number of Medicaid enrollees they treat, and some will not accept new patients on Medicaid.

Reimbursement rates have not kept up with costs, deterring dentists from accepting Medicaid, said Marko Vujicic, chief economist and vice president at the ADA Health Policy Institute.

Because of a lack of dentists who take Medicaid in southwestern Virginia, the Appalachian Highlands Community Dental Center in Abingdon sees patients who travel more than two hours for care — and must turn many away, said Elaine Smith, its executive director.

The center’s seven residents treated about 5,000 patients last year, most of them on Medicaid. About 3,000 people are on its waitlist, waiting up to a year to be seen.

“It’s sad because they have the means now to see a dentist, but they still don’t have a dental home,” Smith said.

Low-income adults face other barriers to dental care, including a lack of transportation, child care, or time off work, she said.

The inability to see a dentist has consequences broader than tooth pain. Poor dental health can contribute to a host of other significant health problems, such as heart disease . It can also make it harder to do things like apply for jobs and generally lead a healthy life.

Robin Mullins, 49, who has been off and on Medicaid since 2013, said a lack of regular dental visits contributed to her losing her bottom teeth. Unable to find a dentist near her home in rural Clintwood, Virginia, she drives almost 90 minutes to Smith’s clinic — that is, when she can afford to get time away from driving for DoorDash or find help watching her daughter, who has special needs.

She gets by with partial dentures but misses her natural teeth, she said. “It’s absolutely horrible, as you can’t chew your food properly.”

In New Hampshire, though, the challenges have more to do with low demand than a low supply of dentists, said Tom Raffio, chief executive of Northeast Delta Dental, which manages the state’s Medicaid dental program. The company has added new dentists to its list of participating providers, along with two mobile dental units that traverse the state, he said.

Raffio said Northeast Delta Dental also has publicized the state benefits using radio advertising and social media, among other efforts.

Until 2023, New Hampshire Medicaid covered only dental emergencies.

“Culturally, it’s going to take a while,” he said, “as people just are used to not going to the dentist, or going to the ER when have dental pain.”

Brooks Woodward, dental director at Baltimore-based Chase Brexton Health Care, called Maryland’s rate of roughly 1 in 5 adults on Medicaid seeing a dentist in 2024 “pretty good” considering the benefits had been enhanced only since 2023.

Woodward said many adults on Medicaid believe that you go to a dentist only when you’re in pain. “They’ve always just not gone to the dentist, and that’s just the way they had it in their life,” he said.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

Le preocupa que si abre demasiado la boca, la gente vea sus dientes astillados y cubiertos de placa. Inmigrante sin papeles, María no tiene seguro médico ni dental. Cuando le empiezan a doler los dientes, toma analgésicos. El verano pasado, un dentista le dijo que arreglarle la dentadura le costaría $2.400. Es más de lo que puede permitirse.

“Es carísimo”, dijo María, quien generalmente trabaja 12 horas al día subiendo y bajando de la cama a clientes y ayudándolos con la higiene, a tomar los medicamentos y con las tareas del hogar. “Necesito dinero para mis hijos, para el alquiler, para el transporte, para la comida. A veces, no me queda nada para mí”.

Una organización de defensa de los trabajadores inmigrantes puso en contactó a ºÚÁϳԹÏÍø News con María. Por temor a la deportación, pidió que solo se usara su nombre de pila en este artículo.

María se encuentra entre los que viven en California sin estatus legal, según estimaciones del gobierno federal.

El estado había buscado gradualmente incorporar a estos inmigrantes a su programa de Medicaid, conocido como Medi-Cal.

Pero ahora, ante el congelamiento de las inscripciones estatales, los residentes californianos de bajos ingresos que se encuentran en el país sin papeles, junto con los proveedores y trabajadores comunitarios que los ayudan, evalúan con inquietud los beneficios de avanzar con las solicitudes de Medi-Cal frente a los riesgos de ser descubiertos y deportados por el gobierno federal.

La Legislatura de California, que busca cerrar un déficit presupuestario proyectado de $12 mil millones, aprobó una propuesta del gobernador demócrata Gavin Newsom para finalizar la inscripción en Medi-Cal en enero de 2026 para los mayores de 19 años sin estatus legal. Los legisladores están en proceso de definir los detalles finales del acuerdo presupuestario antes de que entre en marcha el nuevo año fiscal.

Mientras tanto, las redadas federales de inmigración, que parecen haber afectado en el estado, ya están provocando que algunas personas teman buscar atención médica, según defensores de los inmigrantes y proveedores de salud.

Y se espera que la reciente noticia de que funcionarios de la administración Trump están , incluyendo su estatus migratorio, con las autoridades de inmigración erosione aún más la confianza en el programa.

Andrew Nixon, vocero del Departamento de Salud y Servicios Humanos de Estados Unidos (HHS), afirmó que la agencia, que supervisa los Centros de Servicios de Medicare y Medicaid (CMS), tenía la autoridad legal para compartir los datos y abordar la “negligencia sistémica sin precedentes bajo la administración Biden-Harris, que permitió que inmigrantes indocumentados explotaran Medicaid mientras millones de estadounidenses luchaban por acceder a la atención médica, particularmente en estados como California”.

Para complicar aún más la situación, la administración Trump ha amenazado con retener los fondos de estados que ofrecen cobertura médica a personas sin estatus legal.

Actualmente, alrededor de 1.6 millones de personas que residen en el país sin documentos están inscritas en Medi-Cal.

En 2016, California comenzó a ampliar Medi-Cal a personas de bajos ingresos sin estatus legal, comenzando con los niños, y luego lo expandió gradualmente a jóvenes, adultos mayores y, en enero de este año, a personas de entre 26 y 49 años. El Departamento de Servicios de Atención Médica del estado, que supervisa Medi-Cal, para ayudar a inscribir a las personas elegibles.

Es demasiado pronto para determinar el impacto que las últimas acciones estatales y federales estén teniendo en las cifras de inscripción, ya que los datos solo están disponibles hasta marzo. Sin embargo, muchos proveedores y defensores afirmaron que prevén un efecto negativo en la inscripción de inmigrantes, por miedo.

Seciah Aquino es directora ejecutiva de la Latino Coalition for a Healthy California, que apoya a los promotores de salud comunitarios, quienes ayudan a difundir la expansión de Medi-Cal a los adultos sin papeles. del seguro médico público en California son latinos, en comparación con solo el 30% de los beneficiarios de Medicaid en todo el país.

Aquino afirmó que su coalición les pedirá a los promotores que informen sobre los riesgos de compartir datos para que los miembros de la comunidad puedan tomar decisiones informadas. “Se toman muy en serio que el consejo que le dieron a un miembro de la comunidad ahora pueda perjudicarlos”, expresó.

Newsom condenó el intercambio de datos, calificándolo de “legalmente dudoso”, mientras que los senadores nacionales Adam Schiff y Alex Padilla, ambos demócratas, que el Departamento de Seguridad Nacional (DHS) destruya cualquier dato compartido.

El Departamento de Servicios de Atención Médica de California anunció el 13 de junio que estaba solicitando más información al gobierno federal. La que enviaba informes mensuales a los CMS con información demográfica y de elegibilidad, incluyendo nombre y dirección, según lo exige la ley.

De acuerdo a lo informado, también se compartieron con el DHS datos de los afiliados a Medicaid de Illinois, el estado de Washington y Washington, D.C.

Jamie Munks, vocera del Departamento de Atención Médica y Servicios de Familia de Illinois, la agencia estatal de Medicaid, afirmó que el departamento estaba “profundamente preocupado” por la noticia, y que los datos se transmitían regularmente a los CMS con el entendimiento de que estaban protegidos.

En Sacramento, los legisladores demócratas se encontraron en la incómoda situación de tener que reducir los beneficios de salud para residentes de bajos ingresos con un estatus migratorio insatisfactorio, incluyendo personas sin estatus legal, personas con residencia permanente (green card o tarjeta verde) por menos de cinco años, y algunas otras que están en proceso de solicitar un estatus legal o tienen estatus que los protege de la deportación.

Además de apoyar el congelamiento de la inscripción a Medi-Cal para inmigrantes mayores de 19 años que residen en el país sin documentos, los legisladores acordaron cobrar primas mensuales a todos los residentes con un estatus migratorio insatisfactorio de entre 19 y 59 años. Newsom propuso una prima mensual de $100 a partir de enero de 2027; los una de $30 a partir de julio de 2027.

“Lo que escucho en los sitios es que la gente me dice que les va a resultar muy difícil realizar estos pagos de primas, ya sean de $100 o $30”, dijo Carlos Alarcón, analista de políticas de salud y beneficios públicos del California Immigrant Policy Center, un grupo de defensa. “La realidad es que la mayoría de la gente ya tiene presupuestos limitados”.

La Legislatura rechazó una propuesta del gobernador para prohibir que los inmigrantes con un estatus migratorio insatisfactorio reciban atención de largo plazo en residencias de adultos mayores y atención domiciliaria a través de Medi-Cal, pero aceptó la eliminación de los beneficios dentales a partir de julio de 2026.

Los proveedores de atención médica afirmaron que, sin cobertura de Medi-Cal, muchos inmigrantes se verán obligados a buscar atención de emergencia, que es más costosa para los contribuyentes que la atención preventiva y de nivel primario.

Sepideh Taghvaei, directora dental de Dientes Community Dental Care del condado de Santa Cruz, presenció este fenómeno en 2009, cuando el estado para adultos. Los pacientes llegaban con la cara hinchada y un dolor insoportable, con afecciones tan avanzadas que requerían tratamiento hospitalario. “No es rentable”, afirmó.

El senador estatal Roger Niello, republicano y vicepresidente del comité de presupuesto del Senado, afirmó que cree que California no debería financiar Medi-Cal para personas sin estatus legal, especialmente considerando los desafíos fiscales del estado. También expresó su preocupación por la posibilidad de que la cobertura para quienes residen en el país sin papeles anime a otros a mudarse a California.

“Si mantenemos ese gasto para los no ciudadanos, tendremos que recortar en otras áreas, y eso sin duda afectará a los ciudadanos”, aseguró.

Los californianos también están cambiando de opinión. En una encuesta realizada en mayo por el Public Policy Institute of California, el 58% de los adultos se opuso al beneficio.

Para María, los cambios en las políticas de salud la han dejado paralizada. Desde que llegó aquí hace cinco años, su prioridad ha sido ganar dinero para mantener a sus tres hijos, a quienes dejó con sus padres en su país de origen, contó.

La mujer no se enteró de que podría ser elegible para Medi-Cal hasta principios de este año y no había tenido tiempo de completar el papeleo. Después que una amiga le dijera que el estado podría congelar la inscripción en enero, comenzó a apresurarse para completar el proceso de inscripción.

Pero entonces se enteró de que los datos de Medi-Cal se habían compartido con las autoridades de inmigración. “Decepcionada y asustada”, así describió su reacción.

De repente, inscribirse en Medi-Cal ya no le parece buena idea, dijo.

Phil Galewitz y Bram Sable-Smith contribuyeron con este artículo.

Esta historia fue producida porÌý, que publicaÌý, un servicio editorialmente independiente de laÌý.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

If she opens her mouth too wide, she worries, people will see her chipped, plaque-covered front teeth. An immigrant without legal status, Maria doesn’t have health or dental insurance. When her teeth start to throb, she swallows pain pills. Last summer, a dentist said it would cost $2,400 to fix her teeth. That’s more than she can afford.

“It’s so expensive,” said Maria, who often works 12-hour days lifting clients in and out of bed and helping them with hygiene, medication management, and housework. “I need money for my kids, for my rent, for transport, for food. Sometimes, there’s nothing left for me.”

ºÚÁϳԹÏÍø News connected with Maria through an advocacy organization for immigrant workers. Fearing deportation, she asked that only her first name be used.

Maria is among what the federal government estimates are living in California without legal status. The state had gradually sought to bring these immigrants into its Medicaid program, known as Medi-Cal. But now, facing a state enrollment freeze, low-income California residents in the U.S. without legal permission — along with the providers and community workers that help them — are anxiously weighing the benefits of pushing forward with Medi-Cal applications against the risks of discovery and deportation by the federal government.

Seeking to close a projected $12 billion budget deficit, California Gov. Gavin Newsom, a Democrat, signed a balanced state budget on June 27 that will end new Medi-Cal enrollment in January 2026 for those over 19 without legal status.

Meanwhile, federal immigration raids — which appear to have targeted in the state — are already making some people afraid to seek medical care, say immigrant advocates and health providers. And the recent news that Trump administration officials are , including immigration status, with deportation authorities is expected to further erode trust in the program.

U.S. Department of Health and Human Services spokesperson Andrew Nixon said the agency, which oversees the Centers for Medicare & Medicaid Services, had the legal authority to share the data to address “unprecedented systemic neglect under the Biden-Harris administration that allowed illegal immigrants to exploit Medicaid while millions of Americans struggle to access care, particularly in states like California.”

Further complicating matters, the Trump administration has threatened to withhold funds from states that provide health coverage to people without legal status. Currently, about 1.6 million people in the country without authorization are enrolled in Medi-Cal.

In 2016, California began opening Medi-Cal to low-income people lacking legal status, starting with children, then gradually expanded it to young people, older adults, and — in January 2024 — those ages 26 to 49. The state Department of Health Care Services, which oversees Medi-Cal, to help get eligible people enrolled.

It’s too early to tell what impact the latest state and federal developments are having on enrollment numbers, since data is available only through March. But many health care providers and advocates said they expect a chilling effect on immigrant enrollment.

Seciah Aquino is executive director of the Latino Coalition for a Healthy California, which supports community health workers — also called promotores — who help spread awareness about Medi-Cal’s expansion to adults lacking legal status. Just over half of are Latino, compared with just 30% of Medicaid enrollees nationwide.

Aquino said her coalition will tell promotores to disclose data-sharing risks so community members can make informed decisions.Ìý

“They take it very personally that advice that they provided to a fellow community member could now hurt them,” Aquino said.

Newsom condemned the data sharing, calling the move “legally dubious,” while U.S. Sens. Adam Schiff and Alex Padilla, both Democrats, that the Department of Homeland Security destroy any data shared. Ìý

California’s Department of Health Care Services announced June 13 that it is seeking more information from the federal government. The it submitted monthly reports to CMS with demographic and eligibility information, including name and address, as required by law.

Medicaid enrollee data from Illinois, Washington state, and Washington, D.C., was also reportedly shared with DHS. Jamie Munks, a spokesperson for the Illinois Department of Healthcare and Family Services, the state’s Medicaid agency, said the department was “deeply concerned” by the news and that the data was regularly passed along to CMS with the understanding that it was protected.

In Sacramento, Democratic lawmakers found themselves in the uncomfortable position of rolling back health benefits for low-income residents with unsatisfactory immigration status, including people without legal status, people who’ve held green cards for under five years, and some others who are in the process of applying for legal status or have statuses meant to protect them from deportation. In addition to the Medi-Cal enrollment freeze for immigrants 19 and older in the country without authorization, all enrolled residents with unsatisfactory immigration status from 19 to 59 years old will be charged $30 monthly premiums starting in July 2027.

“What I’m hearing on the ground is folks are telling me they’re going to have a really hard time making these premium payments,” said Carlos Alarcon, health and public benefits policy analyst with the California Immigrant Policy Center, an advocacy group. “The reality is most people already have limited budgets.”

The legislature rejected a proposal from the governor to bar immigrants with unsatisfactory immigration status from receiving long-term nursing home and in-home care through Medi-Cal but went along with eliminating dental benefits starting in July 2026.

Health care providers said that without Medi-Cal coverage, many immigrants will be forced to seek emergency care, which is more expensive for taxpayers than preventive and primary-level care. Sepideh Taghvaei, chief dental officer at Santa Cruz County’s Dientes Community Dental Care, saw this play out in 2009 when the benefits. Patients came in with swollen faces and excruciating pain, with conditions so advanced that they required hospital treatment. “It’s not cost-effective,” she said.

State Sen. Roger Niello, a Republican who serves as vice chair of the Senate budget committee, said he believes California shouldn’t be funding Medi-Cal for people who lack legal status, particularly given the state’s fiscal challenges. He also said he worries that coverage of people in the country without authorization could encourage others to move to California.

“If we maintain that expense to the noncitizen,” he said, “we’re going to have to cut someplace else, and that’s undoubtedly going to affect citizens.”

Californians, too, are going through a change of heart. In a May poll conducted by the Public Policy Institute of California, opposed the benefit.

For Maria, shifting health care policies have left her feeling paralyzed. Since she arrived here five years ago, the caregiver’s focus has been on earning money to support her three children, whom she left with her parents in her home country, she said.

Maria didn’t learn she might be eligible for Medi-Cal until earlier this year and hadn’t yet found time to complete the paperwork. After a friend told her that the state could freeze enrollment in January, she began rushing to finish the sign-up process. But then she learned that Medi-Cal data had been shared with immigration authorities.

“Disappointed and scared” was how she described her reaction.

Suddenly, she said, enrolling in Medi-Cal doesn’t seem like a good idea.

Phil Galewitz and Bram Sable-Smith contributed to this report.

This article was produced by ºÚÁϳԹÏÍø News, which publishes , an editorially independent service of the .Ìý

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

A podcast producer and director emeritus of WOUB Public Media zeroed in on our article about restless doctors, sharing his thoughts on X:

This must be Trump and Kennedy's idiotic plan to make American Healthy Again…

— Tom Hodson (@thodson)

— Tom Hodson, Athens, Ohio

Oh, Canada Welcomes American Doctors!

The article “American Doctors Are Moving to Canada To Escape the Trump Administration” (May 30) presents us Canadians with welcome news. In every part of Canada, in every province, there are not enough doctors. In our city of Victoria, for instance, many people do not have a family doctor because so many doctors have retired; those who are left are unable to take new patients because their lists are full. Walk-in clinics are overbooked, the emergency rooms at the hospitals all have overfull waiting rooms and doctors and nurses are doing 12-hour or longer shifts. We need doctors and will welcome American doctors here with wide-open arms.

There are many aspects of Canada’s health system that could help lure American doctors to join us. The mortality rate for infants and mothers in the USA is worse than in Cuba. Ours is much better. We do not have a director of national health preaching against the use of vaccination. Our national record for health care during the covid pandemic emergency was second to none. Our women’s clinics are not plagued by political ideology. Our society has always been more open than that of the USA to immigrants and others of all races.

Doctors who agree to work for the armed forces receive special benefits. The experience is known to be valuable and rewarding.

I would also recommend Quebec as a great place to live and work. This would present a valuable opportunity for doctors and their families to learn French. France has a wonderful health service and would be a great place for family members to study and work. Germany is also a great place for medicine and health care. An added plus, besides learning the German language, is that the medical schools and universities, once they accept students, including foreigners, do not charge tuition. No post-graduation debt in Germany. That has proved to be a great policy for Germany. It attracts brainy students from all over the world and ensures the continuing high level of the German health system.

American doctors, Canada is an excellent option for escaping from the threat of autocracy. It can be a very positive step to leave the USA after realizing that the world is open to you and your family. Canada fits Americans comfortably. As our Prime Minister Mark Carney told President Donald Trump in his Oval Office, “Canada will never, never, never be your 51st state.” So, American doctors, pack your luggage, come on over and join us. We will welcome you very warmly and help you in every way we can!

— Philip Maxwell, Victoria, British Columbia

A Seattle reader delivered a diagnosis on X:

So I guess this article and the Dr. Interviewed are far left progressive. The US is better off without them.

— Daniel Arroyo (@danielarrmaga)

— Daniel Arroyo, Seattle

Tellin’ It Like It Is, Baby

The article “The New Old Age: Honey, Sweetie, Dearie: The Perils of Elderspeak” (May 9), hit home for me.

Several years ago, my health plan referred me to an ophthalmologist’s practice. After one appointment, the woman who was supposed to schedule me for my next one called me “Sweetie.” I don’t remember what I said, but I took umbrage and walked out.

There were other problems (the doctor who examined me didn’t introduce himself, for one thing). I went home and wrote a complaint letter to my health plan. They gave me another referral and reported the practice to Medicare.

I only wish I had read this article a month ago. I had a biopsy in a hospital last month, and one of the nurses spoke to me as if I were a 2-year-old. I would have been prepared to deal with this then.

— Sue Kamm, Los Angeles

The director of the Pitt Band at the University of Pittsburgh threw down the gauntlet on X:

Any who addresses me with "Elderspeak" will be dealt with harshly. You've been warned.

— Harry Bloomberg (@pittbandphoto)

— Harry Bloomberg, Pittsburgh

Don’t Gamble With Children’s Lives

Concerning Health and Human Services Secretary Robert F. Kennedy Jr.’s recommendation that healthy children needn’t receive the covid vaccine (“Trump’s Team Cited Safety in Limiting Covid Shots. Patients, Health Advocates See More Risk,” May 23), have pre-vaccine complications such as multisystem inflammatory syndrome in children been forgotten? A western lost both hands and both feet to MIS-C and will go through life with prostheses. Please remind people of these serious complications which, though infrequent, cannot be reversed. Not vaccinating is playing Russian roulette with your child!

— Gloria Kohut, Grand Rapids, Michigan

An upbraiding on X came from a reader Down Under:

This decision – apparently made without any expert consultation – will have international ramifications, especially among the vaccine sceptical.

— Lesley Russell Wolpe (@LRussellWolpe)

— Lesley Russell Wolpe, Sydney, Australia

Core to California’s Prosperity: The Fruits of Immigrant Labor

I found your article to be incomplete when it comes to offering the perspective of undocumented immigrants (“After Promising Universal Health Care, California Governor Must Reconsider Immigrant Coverage,” May 13). According to the Institute on Taxation and Economic Policy, undocumented immigrants to the California economy. It is disingenuous to present the cost of medical expansion to undocumented immigrants as a type of handout, when it is widely known that undocumented immigrants work without any prospect of receiving the benefits of their work in social programs. The fact that Gov. Gavin Newsom made the effort to expand benefits to undocumented workers was the right thing to do, and we should work toward rearranging funding to continue the expansion and not retrench during a time when unidentified people are apprehending undocumented workers on their way to work and more than ever face the possibility of suffering human rights abuses. If you, as a news organization, don’t do them justice by inserting their contributions into the discussion, then you are being complacent to their dehumanization.

I grew up in Oxnard, California, and my entire life was surrounded by the fruits of farmworkers’ labor, many of whom were undocumented. If you drive up and down Rice Road at 5 a.m. every day, you will see hard-working people who, during the wintertime, have to stay during the night to warm up the crops. That type of love and dedication to their work — not for their benefit, but for their families and the state of California — should be recognized. I invite your readers to look for “” by Seth Holmes to start understanding the physical toll that working in the fields takes on young immigrants, even when they arrive as healthy bodies. Still, after years of working in the fields, they face a multitude of health problems and overall physical deterioration. They give their bodies in exchange for an American dream that may or may not materialize.

Undocumented farmworkers fill just one essential sector of the American labor economy that does not stop even during fires or pandemics, so please do better in highlighting the humanity of folks who are more than just the work they produce. It is essential to state that if it weren’t for their cheap labor, the Golden State would not be so golden. Look at Florida, where the criminalization of undocumented workers is leading to labor shortages now intended to be filled by children.

Health care is a minimum that can be provided for undocumented workers, not because of any other reason than health care is a human right, and undocumented workers pay their fair share in unclaimed social benefits. Health care for all!

— Jennifer Diana Figueroa, Oxnard, California

A sociologist who directs social policy at the Niskanen Center, a nonpartisan think tank, weighed in on X:

No matter what advocates told themselves and policymakers, it was never politically sustainable:“It’s making people look at the health care that they can’t afford and ask, ‘Why the hell are we giving it for free to people who are here illegally?’”

— Josh McCabe (@JoshuaTMcCabe)

— Josh McCabe, Lowell, Massachusetts

Improving a Prisoner’s Life Sentence

I was very impressed with “Prisons Routinely Ignore Guidelines on Dying Inmates’ End-of-Life Choices” (May 15), authored by Renuka Rayasam. I have visited prison twice: once to San Quentin as a member of the Berkeley YMCA wrestling team in 1963.

Then, in 1999, I was privileged to be appointed to a new American Hospital Association committee, the Circle of Life Awards Committee, which was created to recognize the most outstanding and innovative hospice and palliative care programs in the country. Among the many applicants in the first year was the Louisiana State Penitentiary Hospice, and it was selected as one of five finalists for a site visit in 2000. I indicated my interest in being a member of the site visit team. This prison, commonly known as Angola, is the nation’s largest maximum-security facility, and we were told prisoners sentenced to life will die there because there was no parole in Louisiana for such a sentence. We were also informed that there was a long waiting list of inmates wanting to be hospice volunteers because the program was so highly valued.

My most distinct memory of our visit was a conversation with a volunteer who said he had just come from bathing and feeding a terminally ill inmate who said, “I love you.” The volunteer was visibly emotional when noting he had never heard these words before, not from his father whom he never met nor even his mother. These comments clearly demonstrated the beneficiaries of the program were not just the patients; they were also the volunteers.

— Paul B. Hofmann, Moraga, California

On X, another reader from Australia dove into a discussion about fluoridation of drinking water in response to our coverage:

RFK making tooth decay great again

— Dan Jago (@dj1au)

— Dan Jago, Melbourne, Australia

How Fluoride May Hijack Thyroid Health

Stories about fluoride seem not to mention the chemical’s impact on thyroid health (“With Few Dentists and Fluoride Under Siege, Rural America Risks New Surge of Tooth Decay,” March 27). This seems an oversight because it’s estimated that 10%-20% of the population will have thyroid issues in their lifetimes.

When I was an unmedicated hypothyroid person — not taking any supplemental thyroid hormone — I frequently had cavities. After filling the cavity, my dentist would do me the favor of treating my teeth with fluoride. And then followed a period of lassitude so severe I felt my job was at stake, definitely placing me in the “fat and lazy” category, as described by Ozark Mountain Regional Public Water Authority Chairman Andy Anderson in your article. It took me several treatments to make the connection.

I don’t get cavities now and haven’t for about 20 years. I think my now-appropriate dosage of supplemental thyroid plays a role in that.

Studies about thyroid and fluoride vary in their conclusions. Thyroid deficiencies can have widely varied effects on our widely varied population. There may never be widely accepted guidelines. But people should be careful about what they put in their bodies.

— Joy Mullett, Houston

A self-described information technology health care entrepreneur stated his opinion simply while sharing the article on X:

FLOURIDE is poison! Daily Health Policy Report&utm_medium=email&_hsenc=p2ANqtz–TOtkdDDnhvAyd8nDZIAFejJobpsKBnLP5smKnlslyZjSC6tT9BHFfvtjE8tnngMhNn7huZCl4MKi1CdAi0QtZkvWmew&_hsmi=353879828&utm_content=353879828&utm_source=hs_email

— Earl Winter (@EarlWinter8)

— Earl Winter, Nashville, Tennessee

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

ºÚÁϳԹÏÍø News Southern correspondent Sam Whitehead discussedÌýwhat Medicaid cuts could mean for Georgia on The Atlanta Journal-Constitution’s “Politically Georgia” on May 14. Whitehead then discussed Georgia health bills on WUGA’s “The Georgia Health Report” on May 9. He also joined WNHN FM 94.7’s “The Attitude With Arnie Arnesen” to discuss Medicaid and work requirements on May 8.

• Read Whitehead and Renuka Rayasam’s “Government Watchdog Expects Medicaid Work Requirement Analysis by Fall.”
• Read Rayasam and Whitehead’s “Work Requirements Might Cut Medicaid Spending. But at What Cost?”

ºÚÁϳԹÏÍø News chief Washington correspondent Julie Rovner discussed drug prices on CBS News 24/7 on May 12.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

Now the grumbling has begun. Some of Kennedy’s allies say he’s become almost inaccessible since his confirmation and complain that he’s made glacial progress advancing MAHA goals, such as halting mRNA-based covid shots and removing fluoride from drinking water.

The fractures underscore the clash between Kennedy’s movement and President Donald Trump’s “Make America Great Again” agenda. Kennedy is pulled between his supporters who want swift action to disrupt traditional health care and Trump, who is focused more on tariffs and increasing deportations than on disease, according to four people close to Kennedy who asked not to be identified because they weren’t authorized to speak to the press. Many of the priorities driving Kennedy’s MAHA program are not top priorities of his boss.

Kennedy’s capacity to navigate those tensions has been further strained by a measles outbreak and the threat of a bird flu pandemic, the people said.

Some of his deputies are still being vetted and other key positions remain unfilled. That, along with resignations of top HHS leaders and sweeping staffing reductions, has created a gap in expertise. Kennedy sometimes calls close informal advisers on the run before meetings, and the crises have put him in a reactionary stance, working on weekends and marshaling staff for Sunday meetings, according to the people.

More churn is coming because of an set to eliminate about 20,000 jobs, including a 19% cut to the workforce at the FDA, which oversees food, nutrition, and vaccines.

HHS spokespeople didn’t respond to emails seeking comment.

To be sure, Kennedy’s ascendance represents a breakthrough for the MAHA movement, a broad collection of gadflies, groups, and wellness influencers who extol raw milk, metabolic health, and sustainable farming while lambasting Big Pharma, vaccines, and processed foods.

The coming months will test Kennedy’s ability to juggle the challenges and achieve Trump’s goals without losing the support of MAHA adherents, especially special interest and advocacy groups that helped him reach his influential perch overseeing one of the nation’s largest federal agencies. HHS, with a budget of almost $2 trillion, includes the Centers for Disease Control and Prevention, the National Institutes of Health, and the Centers for Medicare & Medicaid Services.

But the MAHA goals aren’t top agenda items for GOP voters, who tend to be focused more on the price of eggs than whether they’re organic.

The MAHA faithful “expect action” but their to-do list is not necessarily a high priority for voters or lawmakers, said Robert Blendon, a professor emeritus of health policy and political analysis at Harvard. “And should there be a big measles outbreak or avian flu, it would hurt the White House if there was a big conflict over vaccines going on,” he said.

An additional challenge for Kennedy is that not all MAHA and MAGA goals overlap. Trump wants to slash the workforce, which Kennedy has embraced. But fulfilling MAHA wishes will require more regulation, which runs counter to MAGA dogma favoring a smaller federal government.

MAHA wants fluoride out of water because followers say it leads to lower IQ levels in children, as well as arthritis and bone cancer. Kennedy that fluoride is dangerous and that the Trump administration would recommend it be removed from America’s drinking water. Fluoridated water is credited for vastly reducing rates of tooth decay in the U.S. In 2015, the CDC called water fluoridation one of the 10 greatest public health achievements of the 20th century, and only 15% of Americans think fluoride is harmful or detrimental to the public, based on a by market research company Ipsos.

MAHA adherents believe in the debunked claim that vaccines cause autism, and Kennedy just to work on a study on possible connections. In fact, HHS has launched an effort that Kennedy said will Ìýwhat has caused the “autism epidemic.” Many autism researchers say this timeline about the study’s seriousness. MostÌývoters support vaccines and believe in their benefits. Eight in 10 parents with children under age 18 say they normally keep them up to date with recommended childhood vaccines, according to a .

And MAHA wants to replace seed oils, which the movement’s followers claim without evidence are unhealthy, with animal fats such as beef tallow, which is , which can contribute to high cholesterol and heart disease. Only 13% of Americans believe seed oils are unhealthy to consume, based on a poll by the industry-backed .

Perhaps no goal is more important to many MAHA followers, however, than banning the mRNA technology behind covid vaccines by Moderna and Pfizer.

“The big threat is that we still have covid-19 vaccines on the market,” said Peter McCullough, who has been criticized for spreading covid misinformation and has informally advised Kennedy. “It’s horrendous. I would not hesitate; I would just pull it. What’s he waiting for?”

The FDA says covid shots . They are credited for saving millions of lives worldwide during the pandemic, and two NIH-funded scientists who advanced mRNA technology were in physiology or medicine in 2023.

Yanking authority for mRNA-based covid vaccines could backfire because Trump sees “Operation Warp Speed,” the federal effort to develop the shots, as one of his signature achievements, according to one of the people close to Kennedy. And it would have been impolitic to take action before the confirmation of an FDA commissioner, the person said. Marty Makary, a Johns Hopkins University researcher, was confirmed on March 25 to the post.

Kennedy also isn’t calling all the shots. He was initially unaware of the , a veterinarian who recently chaired an NIH advisory board, to head the White House’s pandemic office, according to one of the people.

Kennedy did choose Susan Monarez, a former deputy director of the Advanced Research Projects Agency for Health, as acting CDC director. Trump nominated her for Senate confirmation to lead the agency on March 24. Kennedy felt she had worked well with Trump’s job-cutting Department of Government Efficiency and did a great job in her acting director position, one of the people close to him said.

Kennedy is also in a difficult position regarding Trump’s , which Kennedy chairs. The panel’s charge to investigate and deliver an action plan on the nation’s decades-long increase in chronic illness, with a special emphasis on children, is a clear pitch to the MAHA movement. But Trump has told Kennedy, according to one of the people, that he wants to see measurable progress in a year to 18 months — which is hard both to define and to achieve.

While Kennedy is a scion of the country’s most famous Democratic family, he is widely distrusted in the medical community because of his fringe views on vaccines and his rejection of established science. Since taking office, he has tried to cultivate relationships with MAGA-leaning state officials, including West Virginia’s governor, Republican Patrick Morrisey. And his alliance with Trump is new. When Kennedy was running for president in 2024, Trump took to his to say, “Kennedy is a Radical Left Democrat, and always will be!!!” — though Trump’s administration includes other onetime adversaries such as Secretary of State Marco Rubio.

Many of Kennedy’s nutrition and health goals would require regulation, which clash with Trump’s anti-regulatory agenda and his focus on a lean federal government.

Meanwhile, he’s relied on his principal deputy chief of staff, Stefanie Spear, a longtime Kennedy aide who has taken on the role of traffic cop in the department. He’s also leaned on HHS chief of staff Heather Flick Melanson for expertise. She was a senior adviser to former HHS Secretary Alex Azar in Trump’s first term.

Kennedy’s close circle of informal advisers includes nontraditional doctors, fellow vaccine opponents, media personalities, and self-appointed health gurus. Some have gained unprecedented influence and access to the innermost workings of federal health agencies.

, for example, is a Kennedy ally whose such as saunas and supplements. His statements have dismayed some scientists, such as when he called covid vaccine mandates for children a “war crime” and said without evidence that “” people don’t die from covid. In March, Means joined the White House as a special government employee and MAHA adviser.

Others in Kennedy’s orbit include Del Bigtree, a television producer who founded the anti-vaccination group Informed Consent Action Network, and some officials from the previous Trump administration. Aaron Siri, a lawyer for Kennedy, is no longer involved in vetting candidates for HHS positions, one of the people said.

“‘Nontraditional’ as a description for these people is not enough. We’re talking about beyond the outer fringes of medicine,” said Irwin Redlener, senior adviser for the National Center for Disaster Preparedness at Columbia University, of Kennedy’s inner circle. “This faux expertise is really dangerous.”

Even as some MAHA adherents press for swifter action, Kennedy’s recent comments and actions suggest public health ideas once dismissed as fringe or unscientific now have an advocate at HHS.

Kennedy claimed without evidence that is an effective treatment for measles. He’s suggested letting the bird flu virus through infected chicken flocks even though scientists say that could unleash dangerous mutations.

And he’s backed cellphone bans in schools, saying in kids. Most studies have found no such link.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).