Now that the great health care reform effort is over—or just beginning, depending on your point of view—the media face a challenge: How to keep the health care story alive and more important, fresh? Awhile back, Sarah Varney, the fine health reporter for KQED, the NPR station in northern California, e-mailed asking for advice on how to continue covering the dental story. It’s no secret dental care is a huge problem for millions of Americans who have no way to pay for care, or even have access to it. “It seems many of us do these pieces on the dreadful state of dental coverage every year or so but it’s challenging to advance the story,” she told me.
The dental mess is one of those stories about which editors like to say “We’ve done that.” And in the run-up to reform, some media outlets did report on how hard it was for Medicaid recipients to get dental care. As Varney pointed out in a recent piece, Medicaid considers dental coverage an optional benefit that states don’t have to provide—and many don’t, including Virginia, Texas, Colorado, and Missouri. In California, some three million poor and disabled adults have lost their dental coverage, a victim of the state’s budget crisis.
Varney’s very good piece told about Medicaid recipients with swollen gums and infected teeth flocking to community clinics offering dental care, only to find that dentists could no longer do root canals to save their teeth. Since they couldn’t pay the $600 discounted fee on their own for the procedure, the only option was to pull their teeth. That raises a new set of health and nutritional issues, not to mention aesthetic ones.
Her assessment was a grim one: the mouth is essentially an orphaned organ. The problem of dental care for the poor is not likely to be fixed anytime soon. Even if states were able to raise taxes, other services have higher priority, like filling potholes and giving kids more time in the classroom. So where does that leave the story for reporters who care about the subject? Molly Hennessy-Fiske of the Los Angeles Times recently wrote a good piece showing how the need for dental care had overwhelmed a free mobile health clinic that was offering services for people needing care. But where do reporters go from there?
I caught up with Varney at the recent meeting of the Association of Health Care Journalists to chat about the question she posed: “How do you continue to follow the story when you’ve told the meta issue and framed the larger story that a lot of working class people don’t have access to routine dental care?” The more we talked, some threads emerged for dental story follow-ups.
Recall that prevention was a biggie during the health reform debate. But the prevention that reformers talked about did not include dental care, the lack of which has been linked to heart disease, diabetes, and strokes. It was easier and cheaper to make insurers provide free mammograms and colonoscopies than to find money to provide root canals for millions of poor people. The inequities here shout out for exploration, especially since one of the country’s health goals is to incease the number of residents who have all of their teeth.
Varney raised another question: What happens when state budget shortfalls wipe out the health progress other government agencies have funded? To wit: the Bush administration increased funding to the nation’s community health care centers, and some of them began to build out their preventive dental services. “We really felt we were making some progress,” Varney said. When the budget cuts hit, she observed that “preventive dental services stopped on a dime.”
Stories that point out the contradictions in health policy—and in funding initiatives that get eliminated—are ripe for reporters all across the country. The reform legislation served up $11 billion over the next five years to federally-funded community health centers and to the National Health Services Corps. A really good story would be to track the money and see what happens to services, including dental care, as the money filters down and health centers fiercely compete for it.
Then, too, reporters might consider a comprehensive consumer guide showing where people can get free or reduced-fee dental services in their communities. This is a real service that news outlets could provide. In California, Varney says, a lot of seniors are walking around with broken dentures because Medicaid doesn’t pay for them. The longer we talked, it became clear that there are lots of important stories here for enterprising reporters. While dental care might not be the world’s sexiest story, it’s an important one, and it needs to be told.Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.