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Oral care access problems highlighted in California news collaborative project Date: 10/25/19

Yesenia Amaro

By Mary Otto

In the years since the passage of the Affordable Care Act, the state of California has employed Medicaid expansion and the state health insurance marketplace – Covered California – to dramatically increase health care coverage. Yet, in spite of such efforts roughly 3 million state residents remain medically uninsured. Even more – an estimated 5.2 million Californians – are dentally uninsured.

In communities throughout the state, retirees and workers at small businesses are facing particular challenges in finding dental services, reported Yesenia Amaro of The Fresno Bee and Nicole Hayden of the (Palm Springs) Desert Sun in a recent story.

“The severe pain struck when Christian Ortega’s lower left molars decayed, causing one molar to break,” they wrote. “The pain was so bad that one day he had to skip his shift as a cook.”

Amaro and Hayden’s piece is one of more than two dozen stories included in a comprehensive reporting project called Uncovered California. The venture led by the University of Southern California Center for Health Journalism News Collaborative offers print and broadcast journalists the opportunity to reach across newsroom walls to report on the plight of the state’s uninsured.

In this Q and A, Amaro offers insights into her coverage of dentally-uninsured Californians and her participation in the Uncovered California project. She also shares some wisdom with colleagues on how to explore the shortage of dental coverage in their communities.

Q: As your story highlighted, oral health is an essential part of overall health, but for millions of Californians, obtaining dental coverage and care can be more difficult than finding other health benefits and services. How did you and Nicole decide to explore this topic for the California Uncovered series?

A: Nicole and I decided to tackle this issue for the USC Annenberg Center for Health Journalism's News Collaborative. We initially had a slightly different focus, but we felt that this topic/angle fell under the scope of the project, which is dubbed California Uncovered. California Uncovered is a series of stories focusing on the uninsured throughout California. Dental care doesn't often make the headlines, yet as we found out through our reporting, dental problems can have significant consequences for a person's overall health. Avoidable emergency room visits for dental problems can also add to the burden of the emergency system. We found out that throughout the state, from 2005 to 2016, the 11 percent of emergency room visits that were for dental issues could have been avoided.

Q: You spoke with Californians who had faced the pain of untreated disease. In many ways, oral health is a very intimate subject.  There can be a lot of shame and stigma associated with dental problems. How did you find people willing to tell their moving stories?

A: Oral health can be a very personal topic, and not having the money to be able to access care can place a person in a very difficult position. Not many people are willing to open up and talk about their experiences. We worked with some of the clinics that provide free dental care in our local areas to find people who were willing to share their stories. It wasn't easy, and it took time and a lot of persistence to find these individuals.

Q: As you did your reporting, what did you learn that surprised you most?

A: As we did our reporting, what surprised me the most was how expensive it can be to get dental care if you don't have any dental care insurance, and how difficult it can be for someone in need of dental work. I was also surprised to see that the percentage of those without dental coverage in the state was almost double the rate of those without medical insurance. In California, there are an estimated 5.2 million Californians, or about 14 percent of the state's population, without any dental benefits. Also, some people with Medicaid, or Medi-Cal in California, didn't even know they had access to dental benefits under their coverage. (The state spends very little money on outreach to make people aware of their dental benefits, compared to the amount it spends on outreach for Medi-Cal.)

Q: As you wrote, seniors and workers at small businesses are at particular risk for being dentally-uninsured. Medicare has never included coverage for routine dental care; small businesses may not include dental coverage in the health care benefit packages they offer to their employees. People on fixed or low incomes may not feel like they can afford to purchase dental coverage or to pay out-of-pocket for expensive procedures. In your reporting, did you find any signs of hope in terms of efforts to address such needs in California?

A: One of the experts did mention some hope, at least with Medicare, to address this need, given the number of seniors who lack dental benefits. (That part of the interview didn't make it into the story). It will be interesting to see if anything is done to address this need, at least in California.

Q: Do you have advice to fellow journalists who might want to tackle a story like this in their states or communities? Where should they start?

A: My advice to fellow journalists hoping to tackle a similar story in their states would be to begin by reaching out to local clinics in their areas that might offer free dental care to gauge how big the need might be. If there are indications that there's a big need and worthy of a story, then they can follow by looking into data so see if numbers back up or support the local need.

Q: One last thing: the California Uncovered project is producing a steady stream of in-depth creative pieces. Can you tell us a little more about how it has been for you to be part of the team? Do you have more stories planned as part of the project?

A: For me, I think it has been both a really good opportunity to be a part of the collaborative, but also challenging. I feel very fortunate to be taking part in the collaborative because the project editors have pushed me and challenged me in a good way. For example, my most current editor for the project always has some really good questions that I would have never thought of asking. His knowledge, guidance and editing have been extremely valuable for me, and I have learned much from him. Not to mention his patience. He's been very patient, especially with the dental care story, which was a beast at the beginning.

It has been wonderful to be able to collaborate on stories with other journalists in the team as well. But it was challenging as well because I had to balance my time between writing stories for the collaborative and for The Fresno Bee at the same time. We have a couple of more stories that are in the works as part of the collaborative, but not in dental care. I hope I can share them soon!

Yesenia Amaro covers immigration and diverse communities for The Fresno Bee in California's Central Valley. She has worked for the Phnom Penh Post in Cambodia and The Las Vegas Review-Journal.