Opinion: Use New Tobacco Tax Dollars to Provide Dental Care for Seniors
Despite public support for using revenue gained from the recently approved Proposition 56 tobacco tax for increasing access to medical and dental care, California Governor Jerry Brown wishes to use the money to backfill the existing expenses for Medi-Cal and Denti-Cal. The move would not address the public healthcare crisis the state is currently experiencing, with many older citizens being unable to get dental care due to the prohibitive cost of treatment. The $1.2bn in funding that Proposition 56 is due to create in the current fiscal year alone could help to provide better access to essential services for the over 13m people currently enrolled in the California safety net program, many of whom are unable to access providers.

Services at the Gary and Mary West Senior Dental Center. Photo courtesy West Health

By Shelley Lyford

California has an enormous and alarming problem when it comes to obtaining dental care for the state’s most vulnerable residents — children, seniors and others enrolled in the Denti-Cal program. We see this need firsthand every day at the Gary and Mary West Senior Dental Center, where we’ve experienced a wave of demand for care from seniors since we opened our doors last year in downtown San Diego, with some patients not having seen a dentist in decades.

Fortunately, voters sought to remedy this problem last fall when they approved Proposition 56 by an overwhelming margin and raised the tobacco tax. The state began collecting those revenues from tobacco sales on April 1. This money is intended, according to the ballot measure’s language, to be spent broadly to improve health and access to medical and dental care services. Now we just have to ensure that the funding is not diverted and used elsewhere.

In fact, Governor Jerry Brown wants to do just that. He wants to use the tobacco tax revenues to backfill existing expenses for Medi-Cal and Denti-Cal, instead of unlocking the barriers to access that prevent tens of thousands of Californians from getting the medical and dental services they desperately need. Brown’s proposal would not only thwart the intention of voters when they passed Proposition 56, it ignores a long-neglected public health care crisis that needs attention now.

Shelley Lyford

Lack of oral care is a serious problem for seniors around the country, and especially the ones we serve as we try to restore their health, hope and dignity. Most are on fixed incomes, and struggle to find affordable care. In California, one thousand people turn 65 each day, and lower-income seniors face particular challenges in gaining access to care. Almost three quarters of low-income Medicare recipients did not receive dental care in the past year, and 62 percent say cost was the leading issue, which is why our nonprofit dental center was created, with a focus on accessibility and affordability.

Good oral health is critically important, since it has such a bearing on overall health. Dental problems can worsen chronic conditions such as diabetes or cardiovascular disease, and can be a risk-factor for pneumonia and even arthritis. Lack of access to routine oral health may lead to the costly dependence on hospital emergency rooms for basic care that could have been prevented. According to San Diego County’s 2012 Survey of Older Americans, not being able to afford dental care was their greatest concern among eight health-related issues.

California has too few dental care providers that treat Denti-Cal patients. The existing payment rates for dental care services have been in place for the last 17 years, and these rates are only 29 percent of commercial rates, and are significantly lower than what other states’ Medicaid programs pay. Few dentists would be able to sustain their practices while treating significant numbers of Denti-Cal patients.

Rural and remote sections of the state are especially impacted. A 2014 state auditor’s report found that 11 counties had no Denti-Cal providers at all who were accepting new patients. For the more than 13 million people enrolled in the state’s safety net program, including an estimated 873,000 who live in San Diego County, the lack of access carries troubling implications for all of us. In the big picture, it affects workplace productivity, regular school attendance and the state’s overall economic health.

Proposition 56 is projected to generate more than $1.2 billion in the 2017-18 fiscal year. We believe the state Legislature is listening, and plans to direct the money as voters intended—to unlock doors to access for the one in three Californians who depend on Medi-Cal and Denti-Cal for essential services. I urge Governor Brown to do the right thing and deploy Prop 56 dollars as the voters intended. Given fresh uncertainty about access to health care stemming from the recent vote in Congress, this is something the state can do — and not with new money, but with funds already approved by voters. We have to ensure more dentists are willing to see those enrolled in Denti-Cal, helping Californian’s get the oral healthcare they need.

Shelley Lyford is President and CEO of San Diego-based nonprofit West Health and the Gary and Mary West Foundation.