LISTEN: Your dental insurance might not cover what you expect.

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.

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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 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.

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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.

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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. 

“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.  

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

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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

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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  what has caused the “autism epidemic.” Many autism researchers say this timeline about the study’s seriousness. Most voters 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.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

For its refusal, the Ozark Mountain Regional Public Water Authority has received hundreds of state fines amounting to about $130,000, which are stuffed in a cardboard box and left unpaid, said Andy Anderson, who is opposed to fluoridation and has led the water system for nearly two decades.

This Ozark region is among hundreds of rural American communities that face a one-two punch to oral health: a dire shortage of dentists and a lack of fluoridated drinking water, which is widely viewed among dentists as one of the most effective tools to prevent tooth decay. But as the anti-fluoride movement builds unprecedented momentum, it may turn out that the Ozarks were not behind the times after all.

“We will eventually win,” Anderson said. “We will be vindicated.”

Fluoride, a naturally occurring mineral, when added to drinking water, according to the Centers for Disease Control and Prevention and the American Dental Association. But the anti-fluoride movement has been energized since a government report last summer found a possible link between lower IQ in children and consuming amounts of fluoride that are higher than what is recommended in American drinking water. Dozens of communities have decided to stop fluoridating in recent months, and state officials in Florida and Texas have urged their water systems to do the same. to become the first state to ban it in tap water.

Health and Human Services Secretary Robert F. Kennedy Jr., who has long espoused fringe health theories, has called fluoride an “” and “dangerous neurotoxin” and said the Trump administration will recommend it be removed from all public drinking water.

Separately, Republican efforts to extend tax cuts and shrink federal spending may squeeze Medicaid, which could deepen existing shortages of dentists in rural areas where many residents depend on the federal insurance program for whatever dental care they can find.

Dental experts warn that the simultaneous erosion of Medicaid and fluoridation could exacerbate a crisis of rural oral health and reverse decades of progress against tooth decay, particularly for children and those who rarely see a dentist.

“If you have folks with little access to professional care and no access to water fluoridation,” said Steven Levy, a dentist and leading fluoride researcher at the University of Iowa, “then they are missing two of the big pillars of how to keep healthy for a lifetime.”

Many already are.

Overlapping ‘Dental Deserts’ and Fluoride-Free Zones

Nearly 25 million Americans live in areas without enough dentists — more than twice as many as prior estimates by the federal government — according to that measured U.S. “dental deserts” with more depth and precision than before.

Hawazin Elani, a Harvard dentist and epidemiologist who co-authored the study, found that many shortage areas are rural and poor, and depend heavily on Medicaid. But many dentists do not accept Medicaid because payments can be low, Elani said.

The ADA has estimated that only treat patients on Medicaid.

“I suspect this situation is much worse for Medicaid beneficiaries,” Elani said. “If you have Medicaid and your nearest dentists do not accept it, then you will likely have to go to the third, or fourth, or the fifth.”

The Harvard study identified over 780 counties where more than half of the residents live in a shortage area. Of those counties, at least 230 also have mostly or completely unfluoridated public drinking water, according to a KFF analysis of . That means people in these areas who can’t find a dentist also do not get protection for their teeth from their tap water.

The ºÚÁϳԹÏÍø News analysis does not cover the entire nation because it does not include private wells and 13 states do not submit fluoride data to the CDC. But among those that do, most counties with a shortage of dentists and unfluoridated water are in the south-central U.S., in a cluster that stretches from Texas to the Florida Panhandle and up into Kansas, Missouri, and Oklahoma.

In the center of that cluster is the , which serves the Arkansas counties of Boone, Marion, Newton, and Searcy. It has refused to add fluoride ever since Arkansas enacted a statewide mandate in 2011. After weekly fines began in 2016, the water system unsuccessfully challenged the fluoride mandate in state court, then lost again on appeal.

Anderson, who has chaired the water system’s board since 2007, said he would like to challenge the fluoride mandate in court again and would argue the case himself if necessary. In a phone interview, Anderson said he believes that fluoride can hamper the brain and body to the point of making people “get fat and lazy.”

“So if you go out in the streets these days, walk down the streets, you’ll see lots of fat people wearing their pajamas out in public,” he said.

Nearby in the tiny, no-stoplight community of Leslie, Arkansas, which gets water from the Ozark system, the only dentist in town operates out of a one-man clinic tucked in the back of an antique store. Hand-painted lettering on the store window advertises a “pretty good dentist.”

James Flanagin, a third-generation dentist who opened this clinic three years ago, said he was drawn to Leslie by the quaint charms and friendly smiles of small-town life. But those same smiles also reveal the unmistakable consequences of refusing to fluoridate, he said.

“There is no doubt that there is more dental decay here than there would otherwise be,” he said. “You are going to have more decay if your water is not fluoridated. That’s just a fact.”

Fluoride Seen as a Great Public Health Achievement

Fluoride was first added to public water in an American city in 1945 and spread to half of the U.S. population by 1980, according to the CDC. Because of “the dramatic decline” in cavities that followed, in 1999 the CDC dubbed fluoridation as one of of the 20th century.

Currently more than 70% of the U.S. population on public water systems get fluoridated water, with a recommended concentration of 0.7 milligrams per liter, or about three drops in a 55-gallon barrel, according to the CDC.

Fluoride is also present in modern toothpaste, mouthwash, dental varnish, and — like raisins, potatoes, oatmeal, coffee, and black tea. But several dental experts said these products do not reliably reach as many low-income families as drinking water, which has an additional benefit over toothpaste of strengthening children’s teeth from within as they grow.

Two recent polls have found that the largest share of Americans support fluoridation, but a sizable minority does not. Polls from and found that 48% and 40% of respondents wanted to keep fluoride in public water supplies, while 29% and 26% supported its removal.

Chelsea Fosse, an expert on oral health policy at the , said she worried that misguided fears of fluoride would cause many people to stop using fluoridated toothpaste and varnish just as Medicaid cuts made it harder to see a dentist.

The combination, she said, could be “devastating.”

“It will be visibly apparent what this does to the prevalence of tooth decay,” Fosse said. “If we get rid of water fluoridation, if we make Medicaid cuts, and if we don’t support providers in locating and serving the highest-need populations, I truly don’t know what we will do.”

Multiple peer-reviewed studies have shown what ending water fluoridation could look like. In the past few years, studies of cities in and have shown that communities that stopped fluoridation saw significant increases in children’s cavities when compared with similar cities that did not. A 2024 reported a “two-fold increase” in dental treatments for kids within five years after the country stopped fluoridating in 2014.

Despite the benefits of fluoridation, it has been fiercely opposed by some since its inception, said Catherine Hayes, a Harvard dental expert who advises the American Dental Association on fluoride and has studied its use for three decades.

Fluoridation was initially smeared as a communist plot against America, Hayes said, and then later fears arose of possible links to cancer, which were refuted through extensive scientific research. In the ’80s, hysteria fueled fears of fluoride causing AIDS, which was “ludicrous,” Hayes said.

More recently, the anti-fluoride movement seized on international research that suggests high levels of fluoride can hinder children’s brain development and has been boosted by high-profile legal and political victories.

Last August, a hotly debated report from the National Institutes of Health’s found “” that exposure to levels of fluoride that are higher than what is present in American drinking water is associated with lower IQ in children. The report was based on an analysis of 74 studies conducted in other countries, most of which were considered “low quality” and involved exposure of at least 1.5 milligrams of fluoride per liter of water — or more than twice the U.S. recommendation — according to the program.

The following month, in a long-simmering lawsuit filed by fluoride opponents, a the possible link between fluoride and lowered IQ was too risky to ignore, then ordered the federal Environmental Protection Agency to take nonspecified steps to lower that risk. The EPA started to appeal this ruling in the final days of the Biden administration, but the Trump administration could reverse course.

The EPA and Department of Justice declined to comment. The White House and Department of Health and Human Services did not respond to questions about fluoride.

Despite the National Toxicology Program’s report, Hayes said, no association has been shown to date between lowered IQ and the amount of fluoride actually present in most Americans’ water. The court ruling may prompt additional research conducted in the U.S., Hayes said, which she hoped would finally put the campaign against fluoride to rest.

“It’s one of the great mysteries of my career, what sustains it,” Hayes said. “What concerns me is that there’s some belief amongst some members of the public — and some of our policymakers — that there is some truth to this.”

Not all experts were so dismissive of the toxicology program’s report. Bruce Lanphear, a children’s health researcher at Simon Fraser University in British Columbia, in January that said the findings should prompt health organizations “to reassess the risks and benefits of fluoride, particularly for pregnant women and infants.”

“The people who are proposing fluoridation need to now prove it’s safe,” Lanphear . “That’s what this study does. It shifts the burden of proof — or it should.”

Cities and States Rethink Fluoride

At least 14 states so far this year have considered or are considering bills that would lift fluoride mandates or prohibit fluoride in drinking water altogether. In February, Utah lawmakers passed the nation’s first ban, which Republican he intends to sign. And both Florida Surgeon General Joseph Ladapo and Texas Agriculture Commissioner Sid Miller have called for their respective states to end fluoridation.

“I don’t want Big Brother telling me what to do,” Miller in February. “Government has forced this on us for too long.”

Additionally, dozens of cities and counties have decided to stop fluoridation in the past six months — including at least 16 communities in Florida with a combined population of more than 1.6 million — according to news reports and the , an anti-fluoride group.

Stuart Cooper, executive director of that group, said the movement’s unprecedented momentum would be further supercharged if Kennedy and the Trump administration follow through on a recommendation against fluoride.

Cooper predicted that most U.S. communities will have stopped fluoridating within years.

“I think what you are seeing in Florida, where every community is falling like dominoes, is going to now happen in the United States,” he said. “I think we’re seeing the absolute end of it.”

If Cooper’s prediction is right, Hayes said, widespread decay would be visible within years. Kids’ teeth will rot in their mouths, she said, even though “we know how to completely prevent it.”

“It’s unnecessary pain and suffering,” Hayes said. “If you go into any children’s hospital across this country, you’ll see a waiting list of kids to get into the operating room to get their teeth fixed because they have severe decay because they haven’t had access to either fluoridated water or other types of fluoride. Unfortunately, that’s just going to get worse.”

Methodology: How We Counted

This ºÚÁϳԹÏÍø News article identifies communities with an elevated risk of tooth decay by combining data on areas with dentist shortages and unfluoridated drinking water. Our analysis merged Harvard University research on dentist-shortage areas with large datasets on public water systems published by the U.S. Centers for Disease Control and Prevention.

The determined that nearly 25 million Americans live in dentist-shortage areas that span much of rural America. The details the populations served and fluoridation status of more than 38,000 public water systems in 37 states. We classified counties as having elevated risk of tooth decay if they met three criteria:

More than half of the residents live in a dentist-shortage area identified by Harvard.

The number of people receiving unfluoridated water from water systems based in that county amounts to more than half of the .

The number of people receiving unfluoridated water from water systems based in that county amounts to at least half of the total population of all water systems based in that county, even if those systems reached beyond the county borders, which many do.

Our analysis identified approximately 230 counties that meet these criteria, meaning they have both a dire shortage of dentists and largely unfluoridated drinking water.

But this total is certainly an undercount. Thirteen states do not report water system data to the CDC, and the agency data does not include private wells, most of which are unfluoridated.

ºÚÁϳԹÏÍø News data editor Holly K. Hacker contributed to this article.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

Medi-Cal’s annual spending now stands at , serving low-income residents, more than a third of Californians. Of those, about 1.5 million are immigrants living in the U.S. without authorization, costing an estimated $6.4 billion, according to the Department of Health Care Services. They have been gradually added to the program as the state lifted legal residency as an eligibility requirement for , in 2020, in 2022, and all in January.

As California’s public insurance roll swells, advocates for immigrants praise the Golden State for an expansion that has helped reduce the uninsured rate to a . Providers and hospitals, however, caution that the state hasn’t expanded its workforce adequately or increased Medi-Cal payments sufficiently, leaving some enrollees unable to find providers to see them in a timely manner — if at all.

“Coverage does not necessarily mean access,” said Isabel Becerra, CEO and president of the Coalition of Orange County Community Health Centers, during an Oct. 2 in Los Angeles. “There’s a workforce shortage. We’re all fighting for those doctors. We’re fighting with each other for those doctors.”

Though the state has raised Medi-Cal payments for primary care, maternity care, and mental health services to 87.5% of what Medicare pays, private insurance still tends to pay more, according to the .

A ballot initiative approved this month guarantees that revenue from a tax on managed-care plans goes toward raising the pay of health care providers who serve Medi-Cal patients.

Some believe the next chapter for covering immigrants will require more than Medi-Cal.

Democratic state Assembly member Joaquin Arambula in 2022 proposed legislation to allow uninsured unauthorized residents who earn more than 138% of the federal poverty level to apply for state-subsidized health coverage through Covered California, the state’s health exchange. The bill, however, died in committee this year.

The final installment of the “Faces of Medi-Cal” series looks at how Medi-Cal has affected its newest enrollees. They include Vanessa López Zamora, who is finally getting treated for hepatitis and cirrhosis but has trouble seeing a gastroenterologist close to home; Douglas Lopez, an entertainment park worker who credits dental coverage for boosting his well-being; and Daniel Garcia, who suffers from gout but has given up his search for a primary care provider. All spoke to ºÚÁϳԹÏÍø News in Spanish after recently becoming eligible for Medi-Cal.

‘Started Feeling Sick a Long Time Ago’

In March, Vanessa López Zamora’s stomach had swollen so much it looked like she was pregnant. She had been vomiting and in pain for days.

She went to her local emergency room, at Kaweah Health Medical Center, but it didn’t have a specialist available, she said. So, the 31-year-old was transferred by ambulance to Adventist Health Bakersfield, about 80 miles from her home in Visalia.

Doctors diagnosed her with hepatitis A and C and cirrhosis, which had caused internal injuries to her liver and esophagus, she said. She spent four days in the hospital and for further treatment got a referral to a gastroenterologist, whom she can see as a new Medi-Cal enrollee — an option she couldn’t afford in the past when she had stomach pains and nausea.

“It’s been a very long process because I started feeling sick a long time ago.” said López Zamora, an accountant at a local radio station in Visalia in the San Joaquin Valley. “My girls are very little, and if I can’t get the necessary treatment, I won’t know how much time I have left.”

López Zamora, who came to California from Mexico City when she was 8 years old, is grateful for the care she initially received.

But she’s also frustrated.

The gastroenterologist the hospital referred her to is in Bakersfield — a tough journey for López Zamora, who doesn’t drive and can’t afford to travel to another city.

Limited access to specialists — from gastroenterologists to cardiologists — has been a long-standing challenge for many Medi-Cal patients, especially those in rural areas or regions facing staff shortages. The San Joaquin Valley, where López Zamora lives, has the in the state, according to the California Health Care Foundation.

Michael Bowman, a spokesperson for Anthem Blue Cross, her Medi-Cal plan, said in an email that Anthem has a broad network of specialists that serve Medi-Cal beneficiaries, including more than 100 gastroenterologists within 20 miles of Visalia.

She is treating her cirrhosis with medication and diet, but in August her gastroenterologist in Bakerfield discovered signs of a precancerous condition in the stomach.

López Zamora said she is searching for a specialist closer to home. For now, she relies on her mother, who must take the day off work, to get to appointments or she takes the bus. She tried using transportation provided by Medi-Cal but was left stranded at the hospital. And she has rescheduled her appointments twice.

“They drove me up but didn’t take me back because they couldn’t find an Uber,” she said.

‘A Very Simple Process’

Medi-Cal gave Douglas Lopez the dental treatment he couldn’t afford.

The 33-year-old earned minimum wage as a cleaner in an entertainment park in 2022, and the emergency Medi-Cal plan he signed up for covered only emergency extractions.

That year, Lopez experienced a sharp pain in his back teeth when he ate his beloved coconut-and-tamarind candy balls from his native Guatemala.

A dentist told him that he needed several filings and three root canals. He began treatment, but the bills became more expensive: $150 the first session, then $200, then $300.

“I couldn’t afford it,” recalled Lopez, who lives in Fullerton. “I had to pay rent and food.”

Worried he would lose teeth, he stopped eating anything that would cause him pain.

In January, Orange County automatically enrolled Lopez in Molina Healthcare’s Medi-Cal plan when the state expanded insurance eligibility for unauthorized residents ages 26-49. The coverage has transformed his care, he said.

So far, Lopez has seen a dentist six times, for a cleaning, three root canals, two filings, and X-rays. And Medi-Cal has footed the bill.

Lopez’s experience contrasts with that of many other Medi-Cal enrollees, to get the care they need. The UCLA Center for Health Policy Research found that saw Medi-Cal patients of all ages, according to data from 2019 to 2021. Often those dentists limit the number of Medi-Cal patients they will see; only 15% of adult enrollees might get dental care in a given year.

Lopez said Medi-Cal has come through for him.

“It was a very simple process. I was so excited to search for a dentist,” Lopez said. “The fear of losing my teeth because I wasn’t getting treatment disappeared.”

‘Something That You Can’t Even Use’

Last year, the stabbing pain in Daniel Garcia’s arm and foot got so bad that the 39-year-old went to the ER.

Garcia has gout, a type of inflammatory arthritis that can cause intense pain and swelling in his joints. When he became eligible for Medi-Cal coverage this year, he thought he could finally see a doctor for treatment.

But the Los Angeles County resident said he hasn’t been able to find a primary care provider willing to take his Molina Healthcare insurance.

“It’s frustrating because you have something that you can’t even use,” said Garcia, who has been unable to get an annual physical. “I’ve called, and they say they don’t take my insurance.”

Molina declined to comment on Garcia’s case and didn’t respond to questions about its primary care network.

Nearly people in California live in a total of 611 primary care shortage areas, according to a KFF analysis, which found the state would need to add 881 practitioners to close this gap.

Garcia, a construction worker, said he read that he could manage his arthritis by changing his eating habits. He now eats healthier and has cut back on sugar and Coke. As for the pain, he eases it with ibuprofen. He has given up looking for a provider.

Keeping patients out of the ER, which can be as primary care, is one of the arguments for expanding Medi-Cal. Studies have shown that not only does expanding health coverage lead to lower rates of ER visits, but expanding coverage also leads to patients using preventive care more, said Drishti Pillai, immigrant health policy director at KFF, a health information nonprofit that includes ºÚÁϳԹÏÍø News.

“It can help save health care costs because conditions are no longer going untreated for a long time, in which case they may become more complex and expensive to treat,” Pillai said.

This article is part of “,” a series exploring the impact of the state’s safety-net health program on enrollees.

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

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

Then Carroll saw a TV commercial for another path: ClearChoice Dental Implant Centers. The company advertises that it can give patients “” by surgically replacing teeth instead of fixing them.

So Carroll saved and borrowed for the surgery, she said. In an interview and a lawsuit, Carroll said that at a ClearChoice clinic in New Jersey in 2021, she agreed to pay $31,000 to replace all her natural upper teeth with pearly-white prosthetic ones. What came next, Carroll said, was “like a horror movie.”

Carroll alleged that her anesthesia wore off during implant surgery, so she became conscious as her teeth were removed and titanium screws were twisted into her jawbone. Afterward, Carroll’s prosthetic teeth were so misaligned that she was largely unable to chew for more than two years until she could afford corrective surgery at another clinic, according to a sworn deposition from her lawsuit.

ClearChoice has denied Carroll’s claims of malpractice and negligence in court filings and did not respond to requests for comment on the ongoing case.

“I thought implants would be easier, and all at once, so you didn’t have to keep going back to the dentist,” Carroll, 52, said in an interview. “But I should have asked more questions … like, Can they save these teeth?”

Dental implants have been used for more than half a century to surgically replace missing or damaged teeth with artificial duplicates, often with picture-perfect results. While implant dentistry was once the domain of a small group of highly trained dentists and specialists, tens of thousands of dental providers now offer the surgery and place millions of implants each year in the U.S.

Amid this booming industry, some implant experts worry that many dentists are losing sight of dentistry’s fundamental goal of preserving natural teeth and have become too willing to remove teeth to make room for expensive implants, according to a months-long investigation by ºÚÁϳԹÏÍø News and CBS News. In interviews, 10 experts said they had each given second opinions to multiple patients who had been recommended for mouths full of implants that the experts ultimately determined were not necessary. Separately, lawsuits filed across the country have alleged that implant patients like Carroll have experienced painful complications that have required corrective surgery, while other lawsuits alleged dentists at some implant clinics have persuaded, pressured, or forced patients to remove teeth unnecessarily.

The experts warn that implants, for a single tooth or an entire mouth, expose patients to costs and surgery complications, plus a new risk of future dental problems with fewer treatment options because their natural teeth are forever gone.

“There are many cases where teeth, they’re perfectly fine, and they’re being removed unnecessarily,” said William Giannobile, . “I really hate to say it, but many of them are doing it because these procedures, from a monetary standpoint, they’re much more beneficial to the practitioner.”

Giannobile and nine other experts say they are combating a false public perception that implants are more durable and longer-lasting than natural teeth, which some believe stems in part from advertising on TV and social media. Implants require upkeep, and although they can’t get cavities, that patients can be susceptible to infections in the gums and bone around their implants.

“Just because somebody can afford implants doesn’t necessarily mean that they’re a good candidate,” said George Mandelaris, a Chicago-area periodontist and member of the American Academy of Periodontology Board of Trustees. “When an implant has infection, or when an implant has bone loss, an implant dies a much quicker death than do teeth.”

In its simplest form, implant surgery involves extracting a single tooth and replacing it with a metal post that is screwed into the jaw and then affixed with a prosthetic tooth commonly made of porcelain, also known as a crown. Patients can also use “full-arch” or “All-on-4” implants to replace all their upper or lower teeth — or all their teeth.

For this story, ºÚÁϳԹÏÍø News and CBS News sought interviews with large dental chains whose clinics offer implant surgery — ClearChoice, Aspen Dental, Affordable Care, and Dental Care Alliance — each of which declined to be interviewed or did not respond to multiple requests for comment. The Association of Dental Support Organizations, which represents these companies and others like them, also declined an interview request.

ClearChoice, which specializes in full-arch implants, did not answer more than two dozen questions submitted in writing. In an emailed statement, the company said full-arch implants “have become a well-accepted standard of care for patients with severe tooth loss and teeth with poor prognosis.”

“The use of full-arch restorations reflects the evolution of modern dentistry, offering patients a solution that restores their ability to eat, speak, and live comfortably — far beyond what traditional dentures can provide,” the company said.

Carroll said she regrets not letting her dentist try to fix her teeth and rushing to ClearChoice for implants.

“Because it was a nightmare,” she said.

‘They Are Not Teeth’

Dental implant surgery can be a godsend for patients with unsalvageable teeth. Several experts said implants can be so transformative that their invention should have contended for a Nobel Prize. And yet, these experts still worry that implants are overused, because it is generally better for patients to have their natural teeth.

Paul Rosen, a Pennsylvania periodontist who said he has worked with implants for more than three decades, said many patients believe a “fallacy” that implants are “bulletproof.”

“You can’t just have an implant placed and go off riding into the sunset,” Rosen said. “In many instances, they need more care than teeth because they are not teeth.”

Generally, a single implant costs a few thousand dollars while full-arch implants cost tens of thousands. Neither procedure is well covered by dental insurance, so many clinics partner with credit companies that offer loans for implant surgeries. At ClearChoice, for example, loans can be , according to the company’s website.

Despite the price, implants are more popular than ever. Sales increased by more than 6% on average each year since 2010, culminating in more than 3.7 million implants sold in the U.S. in 2022, according to a 2023 report produced by iData Research, a health care market research firm.

Some worry implant dentistry has gone too far. In 10 interviews, dentists and dental specialists with expertise in implants said they had witnessed the overuse of implants firsthand. Each expert said they’d examined multiple patients in recent years who were recommended for full-arch implants by other dentists despite their teeth being treatable with conventional dentistry.

Giannobile, the Harvard dean, said he had given second opinions to “dozens” of patients who were recommended for implants they did not need.

“I see many of these patients now that are coming in and saying, ‘I’ve been seen, and they are telling me to get my entire dentition — all of my teeth — extracted.’ And then I’ll take a look at them and say that we can preserve most of your teeth,” Giannobile said.

Tim Kosinski, who is a representative of the and said he has placed more than 19,000 implants, said he examines as many as five patients a month who have been recommended for full-arch implants that he deems unnecessary.

“There is a push in the profession to remove teeth that could be saved,” Kosinski said. “But the public isn’t aware.”

Luiz Gonzaga, a periodontist and prosthodontist at the University of Florida, said he, too, had turned away patients who wanted most or all their teeth extracted. Gonzaga said some had received implant recommendations that he considered “an atrocity.”

“You don’t go to the hospital and tell them ‘I broke my finger a couple of times. This is bothering me. Can you please cut my finger off?’ No one will do that,” Gonzaga said. “Why would I extract your tooth because you need a root canal?”

Jaime Lozada, director of an elite dental implant residency program at Loma Linda University, said he’d not only witnessed an increase in dentists extracting “perfectly healthy teeth” but also treated a rash of patients with mouths full of ill-fitting implants that had to be surgically replaced.

Lozada said in August that he’d treated seven such patients in just three months.

“When individuals just make a decision of extracting teeth to make it simple and make money quick, so to speak, that’s where I have a problem,” Lozada said. “And it happens quite often.”

When full-arch implants fail, patients sometimes don’t have enough jawbone left to anchor another set. These patients have little choice but to get implants that reach into cheekbones, said Sohail Saghezchi, an oral and maxillofacial surgeon at the University of California-San Francisco.

“It’s kind of like a last resort,” Saghezchi said. “If those fail, you don’t have anywhere else to go.”

‘It Was Horrendous Dentistry’

Most of the experts interviewed for this article said their rising alarm corresponded with big changes in the availability of dental implants. Implants are now offered by more than 70,000 dental providers nationwide, two-thirds of whom are general dentists, according to the iData Research report.

Dentists are not required to learn how to place implants in dental school, nor are they required to complete implant training before performing the surgery in nearly all states. This year, Oregon started of hands-on training before placing any implants. Stephen Prisby, executive director of the Oregon Board of Dentistry, said the requirement — the first and only of its kind in the U.S. — was a response to dozens of investigations in the state into botched surgeries and other implant failures, split evenly between general dentists and specialists.

“I was frankly stunned at how bad some of these dentists were practicing,” Prisby said. “It was horrendous dentistry.”

Many dental clinics that offer implants have consolidated into chains owned by private equity firms that have bought out much of implant dentistry. In health care, private equity investment is sometimes criticized for overtreatment and prioritizing short-term profit over patients.

Private equity firms have spent about $5 billion in recent years to buy large dental chains that offer implants at hundreds of clinics owned by individual dentists and dental specialists. ClearChoice was bought for an estimated $1.1 billion in 2020 by , which is owned by three private equity firms, according to , a research firm focused on the private equity industry. Private equity firms also bought Affordable Care, whose largest clinic brand is , for an estimated $2.7 billion in 2021, according to PitchBook. And the private equity wing of the Abu Dhabi government bought , which offers implants at many of its affiliated clinics, for an estimated $1 billion in 2022, according to PitchBook.

ClearChoice and Aspen Dental each said in email statements that the companies’ private equity owners “do not have influence or control over treatment recommendations.” Both companies said dentists or dental specialists make all clinical decisions.

Private equity deals involving dental practices increased ninefold from 2011 to 2021, according to an published in August. The study also said investors showed an interest in oral surgery, possibly because of the “high prices” of implants.

“Some argue this is a negative thing,” said Marko Vujicic, vice president of the association’s Health Policy Institute, who co-authored the study. “On the other hand, some would argue that involvement of private equity and outside capital brings economies of scale, it brings efficiency.”

Edwin Zinman, a San Francisco dental malpractice attorney and former periodontist who has filed hundreds of dental lawsuits over four decades, said he believed many of the worst fears about private equity owners had already come true in implant dentistry.

“They’ve sold a lot of [implants], and some of it unnecessarily, and too often done negligently, without having the dentists who are doing it have the necessary training and experience,” Zinman said. “It’s for five simple letters: M-O-N-E-Y.”

Hundreds of Implant Clinics With No Specialists

For this article, journalists from ºÚÁϳԹÏÍø News and CBS News analyzed the webpages for more than 1,000 clinics in the nation’s largest private equity-owned dental chains, all of which offer some implants. The analysis found that more than 70% of those clinics listed only general dentists on their websites and did not appear to employ the specialists — oral surgeons, periodontists, or prosthodontists — who traditionally have more training with implants.

Affordable Dentures & Implants listed specialists at fewer than 5% of its more than 400 clinics, according to the analysis. The rest were staffed by general dentists, most of whom did not list credentialing from implant training organizations, according to the analysis.

ClearChoice, on the other hand, employs at least one oral surgeon or prosthodontist at each of its more than 100 centers, according to the analysis. But its new parent company, Aspen Dental, which offers implants in many of its more than 1,100 clinics, does not list any specialists at many of those locations.

Not everyone is worried about private equity in implant dentistry. In interviews arranged by the , which trains dentists to use implants, two other implant experts did not express concerns about private equity firms.

Brian Jackson, a former academy president and implant specialist in New York, said he believed dentists are too ethical and patients are too smart to be pressured by private equity owners “who will never see a patient.”

Jumoke Adedoyin, a chief clinical officer for Affordable Care, who has placed implants at an Affordable Dentures & Implants clinic in the Atlanta suburbs for 15 years, said she had never felt pressure from above to sell implants.

“I’ve actually felt more pressure sometimes from patients who have gone around and been told they need to take their teeth out,” she said. “They come in and, honestly, taking a look at them, maybe they don’t need to take all their teeth out.”

Still, lawsuits filed across the country have alleged that dentists at implant clinics have extracted patients’ teeth unnecessarily.

For example, in Texas, a patient alleged in a 2020 lawsuit that an Affordable Care dentist removed “every single tooth from her mouth when such was not necessary,” then stuffed her mouth with gauze and left her waiting in the lobby as he and his staff left for lunch. In Maryland, a patient alleged in a 2021 lawsuit that ClearChoice “convinced” her to extract “eight healthy upper teeth,” by “greatly downplay[ing] the risks.” In Florida, a patient alleged in a 2023 lawsuit that ClearChoice provided her with no other treatment options before extracting all her teeth, “which was totally unnecessary.”

ClearChoice and Affordable Care denied wrongdoing in their respective lawsuits, then privately settled out of court with each patient. ClearChoice and Affordable Care did not respond to requests for comment submitted to the companies or attorneys. Lawyers for all three plaintiffs declined to comment on these lawsuits or did not respond to requests for comment.

Fred Goldberg, a Maryland dental malpractice attorney who said he has represented at least six clients who sued ClearChoice, said each of his clients agreed to get implants after meeting with a salesperson — not a dentist.

“Every client I’ve had who has gone to ClearChoice has started off meeting a salesperson and actually signing up to get their financing through ClearChoice before they ever meet with a dentist,” Goldberg said. “You meet with a salesperson who sells you on what they like to present as the best choice, which is almost always that they’re going to take out all your natural teeth.”

Becky Carroll, the ClearChoice patient from New Jersey, told a similar story.

Carroll said in her lawsuit that she met first with a ClearChoice salesperson referred to as a “patient education consultant.” In an interview, Carroll said the salesperson encouraged her to borrow money from family members for the surgery and it was not until after she agreed to a loan and passed a credit check that a ClearChoice dentist peered into her mouth.

“It seems way backwards,” Carroll said. “They just want to know you’re approved before you get to talk to a dentist.”

CBS News producer Nicole Keller contributed to this report.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

referred the 75-year-old to a dentist about 20 miles away in San Francisco, but his tooth decayed while he waited months for authorization to cover the procedure. In the end, his tooth was pulled.

It was the sixth time in a decade Moske had lost a tooth for lack of dental care, he said. The behavioral health peer specialist wears a denture that must be removed at mealtime, making eating a chore. He often struggles to mash food between his gums, and he limits his diet to things he can easily chew. Nuts and steak, for instance, are off the table. It can be embarrassing to sit down for a meal with clients or colleagues.

“I feel like I give off the impression of somebody who doesn’t take care of himself, and I do take care of myself,” Moske said. “I try very hard. So, when I go out, I try not to smile.”

California is among a growing number of states that provide to adults enrolled in Medicaid, and some lawmakers want to add more dental cleanings, examinations, and implants to the safety-net program. Yet many dentists don’t accept Medi-Cal, the state’s Medicaid program, so new benefits would offer no guarantee that patients could get care.

The UCLA Center for Health Policy Research found that saw Medi-Cal patients of all ages, according to data from 2019 to 2021. Often those dentists limit the number of Medi-Cal patients they will see, meaning only 15% of adults might get dental care in any given year, said Elizabeth Mertz, a dentistry professor and medical sociologist at the University of California-San Francisco.

“The issue is you have coverage that is useless,” Mertz said. “The state does provide coverage, but almost no dentist will accept it.”

One of the through the California Legislature would expand Medi-Cal coverage of dental implants — artificial tooth roots implanted into the jawbone that support artificial teeth — and crowns, giving patients with broken or missing teeth more options.

Currently, Medi-Cal covers implants only when “exceptional medical conditions are documented,” according to the guide. It’s unclear how many private dental plans cover implants, but preliminary research has shown about half of individuals enrolled in a PPO plan nationwide have some type of coverage, said Mike Adelberg, executive director at the National Association of Dental Plans.

Under the bill, introduced by Democratic Sen. Aisha Wahab, Medi-Cal patients could qualify for an implant if their dentist determines it is the best option to replace a missing tooth.

“If you need an implant, you should be able to get it, especially our most vulnerable,” Wahab said. “The poorest of the poor in California deserve this.”

The Senate passed the bill unanimously in May, and a vote is pending in the Assembly Appropriations Committee. Elana Ross, a spokesperson for Democratic Gov. Gavin Newsom, declined to comment on the bill.

Four in 10 U.S. adults have had permanent teeth pulled, according to an . The that low-income older adults are at higher risk for tooth loss, which can cause discomfort and affect eating and speaking. The fix can be prosthetic devices, such as bridges and dentures, or replacement teeth, but they can be costly, especially for those without insurance or on government programs with limited benefits.

While the alternatives might be a better fit for some patients, implants are “the standard of care,” said Sohail Saghezchi, director of UCSF’s oral surgery residency program.

“They’re not able to eat everything that they want, and, a lot of times, foods like vegetables and fruits are harder to eat,” he said.

The Department of Health Care Services, which oversees Medi-Cal, estimates it would cost between $4 billion and $7 billion a year for about 1.5 million implants — a price tag Wahab fears could be problematic since Newsom in June signed a state budget closing an estimated .

The cost of an implant varies widely. DHCS estimates it would reimburse dentists between $3,000 and $4,500 for each implant surgery. FAIR Health, a national nonprofit that estimates health costs, reported a median charge for a typical implant in California between October 2022 and September 2023 ranged from about $4,000 to $4,800. Location matters, too. In San Franciso, for example, an implant is closer to $8,000, Saghezchi said.

“Reimbursement rates need to cover the costs of providing the service,” said Alicia Malaby, a spokesperson at the California Dental Association. “As with any Medi-Cal benefit, coverage is not meaningful unless the state is willing to fully invest in it to ensure people can actually access the care they need.”

The California Dental Association, which does not support the current bill, has raised concerns about the invasiveness of implant surgery, which requires regular follow-up appointments. It’s to require Medi-Cal to cover a standard two teeth cleanings and examinations a year for people 21 and older, as opposed to one.

DHCS spokesperson Leah Myers said the state has increased to dentists since the passage of Proposition 56 in 2016 and created a web-based app to enlist more dentists. More than 14,000 dentists — about 40% — were enrolled in the Medi-Cal program, as of July, according to the latest numbers published by the Dental Board.

But for people such as Moske, finding a dentist and getting needed care feels impossible. In most of California, 3 in 4 Medi-Cal patients 21 and up didn’t have a dental appointment in 2023, .

When Moske testified in support of the implant bill in June, he took out his denture, held it up to show lawmakers, and opened his mouth.

“I’m here to show you something,” Moske said. “Please don’t be offended. These are the teeth I lost.”

After Moske had finished speaking, Assembly member Reggie Jones-Sawyer (D-Los Angeles) turned to his fellow members and removed his own denture.

“I know exactly what you went through,” he said. “I have dental insurance from the city of Los Angeles and the state of California and still had problems getting things covered. I thank you for being brave enough to let people know.”

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

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