Hello. This is Arianna Portallatin with the Becker's
Dental and DSO review podcast. I'm thrilled to
be joined today by Matt Steele, the director
of state and local advocacy for the CareQuest
Institute for Oral Health. Matt, thank you so
much for being here today. It's great to
have you. Thank you so much for having
me. Honored to be here.
Great. To start us off, can you introduce
yourself for our listeners and tell us a
little bit about your background?
Absolutely.
I am Matt Steele, the director of state
and local advocacy at CareQuest
Institute for Oral Health.
Prior to this,
I had worked for the Association of Dental
Support Organizations,
also doing advocacy work. So I've been in
the oral healthcare space
for about the last,
little over four years and have really grown
to love it and see how it's connected
to total body health.
And as we'll talk about here in a
little bit,
it's kind of become front and center in
a lot of the policy conversations across the
country today.
Great. Thank you so much for that intro.
First question here. What are some of the
biggest issues that you're following in the dental
industry right now? Yeah, there's two major ones.
The first and probably to no one's surprise
is Medicaid
with the passage
of HR1 or the one big beautiful bill
in Congress.
Recently,
several state houses have been responding
or beginning to plan how they're going to
respond in 2026,
to the sweeping Medicaid cuts.
For those who just want a quick,
briefer on how severe some of these cuts
are, the Congressional Budget Office is projecting that
these changes could leave about 10,000,000 people uninsured
over the next decade. So
the cuts are going deep and,
usually in these conversations
from a policy perspective at the state
level on the chopping block first when it
comes to Medicaid is often oral health. So,
it's become front and center for us,
and we're in a little bit of protection
mode,
to make sure that these benefits are still
available for the most vulnerable parts
of our society.
In addition to that, we're also focusing heavily
on fluoride.
To no surprise, even,
prior to President Trump getting elected to office,
fluoride was a conversation with RFK Jr. In
the race,
and has kind of been
an exponentially
increasing issue of attention,
within media and local policy decisions for a
few years actually now.
But this, in this last legislative session cycle
in 2025,
it became front and center.
We had 27 states introduce legislation
around
fluoride this year.
22 states were trying to restrict fluoride. Seven
were trying to protect it in their water
systems in some way, shape, or form. So
clearly state houses are really honing in on
this. And it's something that we're planning to
engage on,
seeing that fluoride,
is often a first line of defense,
for oral health care.
A lot to cover there. So thank you
so much for for starting us off. Wanted
to dig a little bit deeper into the
Medicaid issue as well. I know I've spoken
with other dental leaders about how dental benefits,
are, like you said, you know, kind of
first on the chopping block when it comes
to these cuts.
You mentioned that you're in protection mode. What
does protection mode look like for your organization,
as of right now?
Right now, it's looking like,
connecting with different oral health care stakeholder groups
and networks
at,
states that we feel like the cuts are
going to be most severe. We're
having conversations with them to develop advocacy plans
and strategies to best protect
the possibility of cuts in those states,
when it comes to
the next session cycle.
And so,
we're hoping that these conversations can develop a
plan that will result in
the essential nature of this care being maintained
for,
not just the next cycle, but years to
come.
There's been a lot of data that's come
out recently showcasing,
in some states where cuts have happened before
how detrimental they were to,
those who needed the oral health care the
most. For instance, in Illinois,
cutting adult dental benefits in 2012 led to
one hundred and twenty eight percent spike in
hospital admissions
for dental issues. And in California,
there was a rollback in 2009 that cost
about 4,500
jobs
and about $500,000,000
in lost economic activity. So we're trying to
prevent that specifically,
from happening again,
within those states, but also more broadly as
they consider their budgets moving forward.
Okay.
And to touch on, fluoride a little bit
more as well, I know you mentioned definitely
the conversation on fluoride has been happening for
quite some time now, even before,
President Trump was elected to office.
What do you think sparked those,
discussions, I guess, and the skepticism around fluoride?
I think part of what sparked the discussions
was just,
higher and higher profile
policy leaders within our country beginning to
raise their own awareness
about community water and
the role that it plays
in health in general.
And,
we're hoping
that we can keep the conversation going. It's
not that we don't mind the conversation,
but we just want the conversation to be
rooted in
the data
that shows the benefit
of safe levels of community water fluoridation,
but also kind of peels back the curtain
on some of the drawbacks to taking,
those safe levels out of our public water
systems. One example I'll just mention real quick,
in Calgary, Canada,
where they removed community water fluoridation,
they, the antibiotic use for kids' dental infections
rose 700%
after fluoride was removed.
They reinstated
safe levels of community water fluoridation actually after
removing it because
the health consequences were so severe. So we're
hoping to avoid that,
as awareness continues to be raised on these
issues from public health leaders
at a national level and at a local
level.
Right. Yeah. That makes a lot of sense.
Thank you for for sharing more about that
also. And next question here, you might have
some similar responses here as well, but what
are you most excited about when it comes
to dentistry right now, and what makes you
nervous about the industry?
Yeah. I'm excited
on one end from some of the proactive
policy responses
I'm seeing in these two areas.
Some of those responses at the state level
have been very encouraging. One example I'll just
mention
off the top of my head is in
Connecticut.
The, there was,
of all the bills introduced this past legislative
session cycle, as I mentioned earlier, there was
a few states that introduced legislation,
to protect community water fluoridation. Connecticut was one
of them. And it was the oral,
healthcare network within that state,
that helped spearhead a bill to protect safe
levels of community
water
fluoridation, within the state and
and really insulating that from any federal or
national,
activity. So I'm excited to see
local oral health care coalitions
partnering with their policy makers,
to protect these data driven and science backed
approaches to,
oral health care.
We're carefully watching
a lot of
policy makers who still are reading through all
the implications,
understanding what that means for their own states,
and are kind of in the early
gestation phases of what it will mean for,
their budgets coming into 2026
and 2027
with states that are doing budgets on a
biannual cycle.
And so,
we're really watching that closely, watching how they're
engaging publicly,
about the topic and
seeking to really insert ourselves into those conversations
early, so we can make sure that oral
health care and preserving it for our most
vulnerable populations is at the front of their
mind.
Okay, great. And last question for you here.
What will the most effective healthcare leaders need
to be successful in the next two to
three years?
Yeah, that that's a great question. I think
they'll need to do a couple things. One
is they'll need to embrace prevention.
I personally believe it's always cheaper,
smarter, and healthier to prevent problems than to
treat them later in an emergency room. And
emergency rooms,
often are where oral health care
goes,
once some of these benefits are cut or
drawn back. And,
it's always more surgical in those spaces. They're,
in an emergency room, they're trying to just
filter through as many people who are having
emergency
issues as possible. So
taking care of them and taking care of
oral healthcare issues in a more nuanced and
patient centered fashion isn't always the case in
these contexts. So
hoping that through focusing on prevention,
oral health care leaders can stop the
consequences of of really seeing a lot of
this care
siphoned off to emergency rooms when the access
to care,
is stifled.
In addition to that, hoping that they'll protect
the safety net. Medicaid,
and community health centers are true lifelines, especially
in oral health. And
undermining them only shifts the costs
elsewhere
in the system.
And
the last thing I'll just mention beyond that
is leaders,
will need to be willing to take a
stand against any
politically
motivated attacks on public health measures,
like fluoride.
Data and science,
need to kind of win the day here.
And then thankfully there's decades of it that
support these kind of basic and fundamental public
health protections
that we hope to see remain in place,
for the next several years.
Great. Thank you so much for the engaging
and interesting conversation today. That is all I
have for you today, Matt. So thank you
again so much for joining our podcast. Been
a pleasure speaking with you and looking forward
to connecting with you again in the future.
Thank you so much for having me on
today and looking forward to it as well.