1 00:00:00,080 --> 00:00:02,480 Hello. This is Arianna Portallatin with the Becker's 2 00:00:02,480 --> 00:00:04,879 Dental and DSO review podcast. I'm thrilled to 3 00:00:04,879 --> 00:00:06,960 be joined today by Matt Steele, the director 4 00:00:06,960 --> 00:00:09,199 of state and local advocacy for the CareQuest 5 00:00:09,199 --> 00:00:11,199 Institute for Oral Health. Matt, thank you so 6 00:00:11,199 --> 00:00:12,559 much for being here today. It's great to 7 00:00:12,559 --> 00:00:14,400 have you. Thank you so much for having 8 00:00:14,400 --> 00:00:15,619 me. Honored to be here. 9 00:00:16,214 --> 00:00:18,054 Great. To start us off, can you introduce 10 00:00:18,054 --> 00:00:19,734 yourself for our listeners and tell us a 11 00:00:19,734 --> 00:00:20,875 little bit about your background? 12 00:00:21,574 --> 00:00:22,074 Absolutely. 13 00:00:22,454 --> 00:00:24,775 I am Matt Steele, the director of state 14 00:00:24,775 --> 00:00:26,635 and local advocacy at CareQuest 15 00:00:27,494 --> 00:00:29,595 Institute for Oral Health. 16 00:00:30,454 --> 00:00:31,379 Prior to this, 17 00:00:31,859 --> 00:00:33,939 I had worked for the Association of Dental 18 00:00:33,939 --> 00:00:34,759 Support Organizations, 19 00:00:35,939 --> 00:00:37,939 also doing advocacy work. So I've been in 20 00:00:37,939 --> 00:00:39,239 the oral healthcare space 21 00:00:39,699 --> 00:00:40,920 for about the last, 22 00:00:41,379 --> 00:00:44,340 little over four years and have really grown 23 00:00:44,340 --> 00:00:46,100 to love it and see how it's connected 24 00:00:46,100 --> 00:00:47,354 to total body health. 25 00:00:48,554 --> 00:00:50,634 And as we'll talk about here in a 26 00:00:50,634 --> 00:00:51,274 little bit, 27 00:00:51,594 --> 00:00:53,354 it's kind of become front and center in 28 00:00:53,354 --> 00:00:55,274 a lot of the policy conversations across the 29 00:00:55,274 --> 00:00:56,174 country today. 30 00:00:56,554 --> 00:00:58,254 Great. Thank you so much for that intro. 31 00:00:58,554 --> 00:00:59,914 First question here. What are some of the 32 00:00:59,914 --> 00:01:01,674 biggest issues that you're following in the dental 33 00:01:01,674 --> 00:01:04,500 industry right now? Yeah, there's two major ones. 34 00:01:04,500 --> 00:01:06,840 The first and probably to no one's surprise 35 00:01:06,900 --> 00:01:08,120 is Medicaid 36 00:01:08,819 --> 00:01:09,640 with the passage 37 00:01:10,420 --> 00:01:12,979 of HR1 or the one big beautiful bill 38 00:01:12,979 --> 00:01:13,799 in Congress. 39 00:01:14,500 --> 00:01:15,000 Recently, 40 00:01:15,379 --> 00:01:17,239 several state houses have been responding 41 00:01:17,795 --> 00:01:19,394 or beginning to plan how they're going to 42 00:01:19,394 --> 00:01:20,935 respond in 2026, 43 00:01:21,715 --> 00:01:23,655 to the sweeping Medicaid cuts. 44 00:01:24,114 --> 00:01:26,134 For those who just want a quick, 45 00:01:26,674 --> 00:01:28,515 briefer on how severe some of these cuts 46 00:01:28,515 --> 00:01:31,469 are, the Congressional Budget Office is projecting that 47 00:01:31,469 --> 00:01:34,849 these changes could leave about 10,000,000 people uninsured 48 00:01:35,230 --> 00:01:36,849 over the next decade. So 49 00:01:37,150 --> 00:01:38,849 the cuts are going deep and, 50 00:01:39,390 --> 00:01:41,329 usually in these conversations 51 00:01:41,709 --> 00:01:43,984 from a policy perspective at the state 52 00:01:44,444 --> 00:01:46,204 level on the chopping block first when it 53 00:01:46,204 --> 00:01:48,784 comes to Medicaid is often oral health. So, 54 00:01:49,325 --> 00:01:51,245 it's become front and center for us, 55 00:01:51,645 --> 00:01:53,825 and we're in a little bit of protection 56 00:01:53,885 --> 00:01:54,385 mode, 57 00:01:54,765 --> 00:01:56,365 to make sure that these benefits are still 58 00:01:56,365 --> 00:01:58,260 available for the most vulnerable parts 59 00:01:58,740 --> 00:01:59,719 of our society. 60 00:02:00,340 --> 00:02:02,819 In addition to that, we're also focusing heavily 61 00:02:02,819 --> 00:02:03,480 on fluoride. 62 00:02:04,500 --> 00:02:05,939 To no surprise, even, 63 00:02:06,340 --> 00:02:09,639 prior to President Trump getting elected to office, 64 00:02:09,939 --> 00:02:12,740 fluoride was a conversation with RFK Jr. In 65 00:02:12,740 --> 00:02:13,455 the race, 66 00:02:13,935 --> 00:02:15,715 and has kind of been 67 00:02:16,175 --> 00:02:16,835 an exponentially 68 00:02:17,775 --> 00:02:19,235 increasing issue of attention, 69 00:02:20,094 --> 00:02:22,735 within media and local policy decisions for a 70 00:02:22,735 --> 00:02:24,115 few years actually now. 71 00:02:24,974 --> 00:02:27,939 But this, in this last legislative session cycle 72 00:02:27,939 --> 00:02:29,219 in 2025, 73 00:02:29,219 --> 00:02:30,759 it became front and center. 74 00:02:31,219 --> 00:02:33,639 We had 27 states introduce legislation 75 00:02:33,939 --> 00:02:34,439 around 76 00:02:34,740 --> 00:02:35,960 fluoride this year. 77 00:02:36,419 --> 00:02:39,539 22 states were trying to restrict fluoride. Seven 78 00:02:39,539 --> 00:02:41,985 were trying to protect it in their water 79 00:02:41,985 --> 00:02:43,745 systems in some way, shape, or form. So 80 00:02:43,745 --> 00:02:46,224 clearly state houses are really honing in on 81 00:02:46,224 --> 00:02:48,064 this. And it's something that we're planning to 82 00:02:48,064 --> 00:02:48,965 engage on, 83 00:02:49,425 --> 00:02:50,724 seeing that fluoride, 84 00:02:51,344 --> 00:02:53,125 is often a first line of defense, 85 00:02:53,905 --> 00:02:55,284 for oral health care. 86 00:02:56,169 --> 00:02:57,849 A lot to cover there. So thank you 87 00:02:57,849 --> 00:03:00,330 so much for for starting us off. Wanted 88 00:03:00,330 --> 00:03:01,689 to dig a little bit deeper into the 89 00:03:01,689 --> 00:03:03,370 Medicaid issue as well. I know I've spoken 90 00:03:03,370 --> 00:03:06,590 with other dental leaders about how dental benefits, 91 00:03:07,689 --> 00:03:09,050 are, like you said, you know, kind of 92 00:03:09,050 --> 00:03:10,569 first on the chopping block when it comes 93 00:03:10,569 --> 00:03:11,389 to these cuts. 94 00:03:11,905 --> 00:03:13,664 You mentioned that you're in protection mode. What 95 00:03:13,664 --> 00:03:16,084 does protection mode look like for your organization, 96 00:03:16,544 --> 00:03:17,525 as of right now? 97 00:03:18,465 --> 00:03:20,564 Right now, it's looking like, 98 00:03:21,664 --> 00:03:24,944 connecting with different oral health care stakeholder groups 99 00:03:24,944 --> 00:03:25,685 and networks 100 00:03:26,629 --> 00:03:27,129 at, 101 00:03:27,750 --> 00:03:29,189 states that we feel like the cuts are 102 00:03:29,189 --> 00:03:31,129 going to be most severe. We're 103 00:03:31,509 --> 00:03:34,550 having conversations with them to develop advocacy plans 104 00:03:34,550 --> 00:03:36,490 and strategies to best protect 105 00:03:36,949 --> 00:03:39,370 the possibility of cuts in those states, 106 00:03:39,990 --> 00:03:41,129 when it comes to 107 00:03:41,514 --> 00:03:42,894 the next session cycle. 108 00:03:43,275 --> 00:03:44,094 And so, 109 00:03:45,674 --> 00:03:48,955 we're hoping that these conversations can develop a 110 00:03:48,955 --> 00:03:50,735 plan that will result in 111 00:03:51,194 --> 00:03:54,094 the essential nature of this care being maintained 112 00:03:54,314 --> 00:03:54,814 for, 113 00:03:55,354 --> 00:03:57,490 not just the next cycle, but years to 114 00:03:57,490 --> 00:03:57,990 come. 115 00:03:58,610 --> 00:04:00,689 There's been a lot of data that's come 116 00:04:00,689 --> 00:04:02,150 out recently showcasing, 117 00:04:02,930 --> 00:04:05,349 in some states where cuts have happened before 118 00:04:05,810 --> 00:04:07,990 how detrimental they were to, 119 00:04:08,849 --> 00:04:10,610 those who needed the oral health care the 120 00:04:10,610 --> 00:04:11,909 most. For instance, in Illinois, 121 00:04:12,735 --> 00:04:15,134 cutting adult dental benefits in 2012 led to 122 00:04:15,134 --> 00:04:17,134 one hundred and twenty eight percent spike in 123 00:04:17,134 --> 00:04:18,115 hospital admissions 124 00:04:18,574 --> 00:04:20,274 for dental issues. And in California, 125 00:04:21,615 --> 00:04:24,254 there was a rollback in 2009 that cost 126 00:04:24,254 --> 00:04:25,454 about 4,500 127 00:04:25,454 --> 00:04:25,954 jobs 128 00:04:26,860 --> 00:04:28,460 and about $500,000,000 129 00:04:28,460 --> 00:04:30,540 in lost economic activity. So we're trying to 130 00:04:30,540 --> 00:04:32,160 prevent that specifically, 131 00:04:33,180 --> 00:04:34,319 from happening again, 132 00:04:35,339 --> 00:04:37,980 within those states, but also more broadly as 133 00:04:37,980 --> 00:04:40,000 they consider their budgets moving forward. 134 00:04:40,654 --> 00:04:41,154 Okay. 135 00:04:41,535 --> 00:04:43,454 And to touch on, fluoride a little bit 136 00:04:43,454 --> 00:04:45,634 more as well, I know you mentioned definitely 137 00:04:45,694 --> 00:04:47,854 the conversation on fluoride has been happening for 138 00:04:47,854 --> 00:04:49,555 quite some time now, even before, 139 00:04:49,935 --> 00:04:51,794 President Trump was elected to office. 140 00:04:52,095 --> 00:04:54,194 What do you think sparked those, 141 00:04:55,399 --> 00:04:58,139 discussions, I guess, and the skepticism around fluoride? 142 00:04:59,240 --> 00:05:01,399 I think part of what sparked the discussions 143 00:05:01,399 --> 00:05:02,139 was just, 144 00:05:02,839 --> 00:05:04,219 higher and higher profile 145 00:05:04,919 --> 00:05:08,060 policy leaders within our country beginning to 146 00:05:08,764 --> 00:05:10,144 raise their own awareness 147 00:05:11,245 --> 00:05:13,185 about community water and 148 00:05:13,964 --> 00:05:15,345 the role that it plays 149 00:05:15,724 --> 00:05:17,185 in health in general. 150 00:05:17,805 --> 00:05:18,305 And, 151 00:05:18,925 --> 00:05:19,664 we're hoping 152 00:05:20,560 --> 00:05:22,319 that we can keep the conversation going. It's 153 00:05:22,319 --> 00:05:23,779 not that we don't mind the conversation, 154 00:05:24,560 --> 00:05:26,079 but we just want the conversation to be 155 00:05:26,079 --> 00:05:27,139 rooted in 156 00:05:27,680 --> 00:05:28,419 the data 157 00:05:28,800 --> 00:05:30,100 that shows the benefit 158 00:05:30,479 --> 00:05:33,139 of safe levels of community water fluoridation, 159 00:05:33,759 --> 00:05:36,245 but also kind of peels back the curtain 160 00:05:36,245 --> 00:05:38,264 on some of the drawbacks to taking, 161 00:05:38,964 --> 00:05:41,764 those safe levels out of our public water 162 00:05:41,764 --> 00:05:44,165 systems. One example I'll just mention real quick, 163 00:05:44,165 --> 00:05:45,625 in Calgary, Canada, 164 00:05:46,245 --> 00:05:48,264 where they removed community water fluoridation, 165 00:05:49,160 --> 00:05:52,919 they, the antibiotic use for kids' dental infections 166 00:05:52,919 --> 00:05:54,540 rose 700% 167 00:05:54,680 --> 00:05:56,139 after fluoride was removed. 168 00:05:56,680 --> 00:05:57,979 They reinstated 169 00:05:58,759 --> 00:06:01,979 safe levels of community water fluoridation actually after 170 00:06:02,040 --> 00:06:03,339 removing it because 171 00:06:03,794 --> 00:06:05,954 the health consequences were so severe. So we're 172 00:06:05,954 --> 00:06:07,334 hoping to avoid that, 173 00:06:08,274 --> 00:06:11,154 as awareness continues to be raised on these 174 00:06:11,154 --> 00:06:12,935 issues from public health leaders 175 00:06:13,314 --> 00:06:15,235 at a national level and at a local 176 00:06:15,235 --> 00:06:15,735 level. 177 00:06:16,470 --> 00:06:18,250 Right. Yeah. That makes a lot of sense. 178 00:06:19,110 --> 00:06:20,870 Thank you for for sharing more about that 179 00:06:20,870 --> 00:06:23,110 also. And next question here, you might have 180 00:06:23,110 --> 00:06:25,189 some similar responses here as well, but what 181 00:06:25,189 --> 00:06:26,790 are you most excited about when it comes 182 00:06:26,790 --> 00:06:28,629 to dentistry right now, and what makes you 183 00:06:28,629 --> 00:06:29,770 nervous about the industry? 184 00:06:30,895 --> 00:06:32,115 Yeah. I'm excited 185 00:06:33,055 --> 00:06:35,795 on one end from some of the proactive 186 00:06:36,495 --> 00:06:37,555 policy responses 187 00:06:37,935 --> 00:06:39,875 I'm seeing in these two areas. 188 00:06:40,175 --> 00:06:41,775 Some of those responses at the state level 189 00:06:41,775 --> 00:06:44,095 have been very encouraging. One example I'll just 190 00:06:44,095 --> 00:06:44,595 mention 191 00:06:45,009 --> 00:06:46,930 off the top of my head is in 192 00:06:46,930 --> 00:06:47,430 Connecticut. 193 00:06:48,209 --> 00:06:49,189 The, there was, 194 00:06:49,569 --> 00:06:52,149 of all the bills introduced this past legislative 195 00:06:52,209 --> 00:06:54,610 session cycle, as I mentioned earlier, there was 196 00:06:54,610 --> 00:06:56,629 a few states that introduced legislation, 197 00:06:57,595 --> 00:07:00,314 to protect community water fluoridation. Connecticut was one 198 00:07:00,314 --> 00:07:02,095 of them. And it was the oral, 199 00:07:02,634 --> 00:07:04,574 healthcare network within that state, 200 00:07:05,355 --> 00:07:08,314 that helped spearhead a bill to protect safe 201 00:07:08,314 --> 00:07:09,375 levels of community 202 00:07:09,915 --> 00:07:10,199 water 203 00:07:11,000 --> 00:07:13,020 fluoridation, within the state and 204 00:07:13,400 --> 00:07:16,439 and really insulating that from any federal or 205 00:07:16,439 --> 00:07:16,939 national, 206 00:07:17,879 --> 00:07:19,819 activity. So I'm excited to see 207 00:07:20,199 --> 00:07:22,139 local oral health care coalitions 208 00:07:23,024 --> 00:07:24,964 partnering with their policy makers, 209 00:07:25,745 --> 00:07:28,944 to protect these data driven and science backed 210 00:07:28,944 --> 00:07:30,165 approaches to, 211 00:07:30,944 --> 00:07:32,084 oral health care. 212 00:07:34,225 --> 00:07:35,524 We're carefully watching 213 00:07:36,144 --> 00:07:36,779 a lot of 214 00:07:42,939 --> 00:07:46,060 policy makers who still are reading through all 215 00:07:46,060 --> 00:07:46,720 the implications, 216 00:07:47,579 --> 00:07:49,759 understanding what that means for their own states, 217 00:07:50,214 --> 00:07:51,675 and are kind of in the early 218 00:07:52,055 --> 00:07:54,795 gestation phases of what it will mean for, 219 00:07:55,495 --> 00:07:57,735 their budgets coming into 2026 220 00:07:57,735 --> 00:07:59,014 and 2027 221 00:07:59,014 --> 00:08:00,455 with states that are doing budgets on a 222 00:08:00,455 --> 00:08:01,514 biannual cycle. 223 00:08:01,894 --> 00:08:02,714 And so, 224 00:08:03,290 --> 00:08:05,930 we're really watching that closely, watching how they're 225 00:08:05,930 --> 00:08:06,990 engaging publicly, 226 00:08:08,490 --> 00:08:10,029 about the topic and 227 00:08:10,650 --> 00:08:13,310 seeking to really insert ourselves into those conversations 228 00:08:13,449 --> 00:08:15,370 early, so we can make sure that oral 229 00:08:15,370 --> 00:08:17,694 health care and preserving it for our most 230 00:08:17,694 --> 00:08:19,774 vulnerable populations is at the front of their 231 00:08:19,774 --> 00:08:20,274 mind. 232 00:08:21,055 --> 00:08:23,854 Okay, great. And last question for you here. 233 00:08:23,854 --> 00:08:26,095 What will the most effective healthcare leaders need 234 00:08:26,095 --> 00:08:27,615 to be successful in the next two to 235 00:08:27,615 --> 00:08:28,274 three years? 236 00:08:29,000 --> 00:08:30,920 Yeah, that that's a great question. I think 237 00:08:30,920 --> 00:08:33,320 they'll need to do a couple things. One 238 00:08:33,320 --> 00:08:35,100 is they'll need to embrace prevention. 239 00:08:36,279 --> 00:08:37,899 I personally believe it's always cheaper, 240 00:08:38,600 --> 00:08:41,284 smarter, and healthier to prevent problems than to 241 00:08:41,284 --> 00:08:43,524 treat them later in an emergency room. And 242 00:08:43,524 --> 00:08:44,565 emergency rooms, 243 00:08:45,365 --> 00:08:47,945 often are where oral health care 244 00:08:48,725 --> 00:08:49,225 goes, 245 00:08:49,845 --> 00:08:52,084 once some of these benefits are cut or 246 00:08:52,084 --> 00:08:53,625 drawn back. And, 247 00:08:54,230 --> 00:08:56,629 it's always more surgical in those spaces. They're, 248 00:08:56,950 --> 00:08:58,789 in an emergency room, they're trying to just 249 00:08:58,789 --> 00:09:00,549 filter through as many people who are having 250 00:09:00,549 --> 00:09:01,049 emergency 251 00:09:01,509 --> 00:09:03,289 issues as possible. So 252 00:09:03,669 --> 00:09:05,429 taking care of them and taking care of 253 00:09:05,429 --> 00:09:09,024 oral healthcare issues in a more nuanced and 254 00:09:09,024 --> 00:09:11,024 patient centered fashion isn't always the case in 255 00:09:11,024 --> 00:09:12,485 these contexts. So 256 00:09:13,105 --> 00:09:15,445 hoping that through focusing on prevention, 257 00:09:16,065 --> 00:09:19,044 oral health care leaders can stop the 258 00:09:20,549 --> 00:09:22,789 consequences of of really seeing a lot of 259 00:09:22,789 --> 00:09:23,450 this care 260 00:09:23,830 --> 00:09:25,990 siphoned off to emergency rooms when the access 261 00:09:25,990 --> 00:09:26,730 to care, 262 00:09:27,350 --> 00:09:28,090 is stifled. 263 00:09:29,190 --> 00:09:32,230 In addition to that, hoping that they'll protect 264 00:09:32,230 --> 00:09:33,769 the safety net. Medicaid, 265 00:09:35,054 --> 00:09:38,415 and community health centers are true lifelines, especially 266 00:09:38,415 --> 00:09:39,955 in oral health. And 267 00:09:40,335 --> 00:09:42,674 undermining them only shifts the costs 268 00:09:42,975 --> 00:09:43,475 elsewhere 269 00:09:44,095 --> 00:09:45,075 in the system. 270 00:09:45,455 --> 00:09:45,955 And 271 00:09:46,415 --> 00:09:48,335 the last thing I'll just mention beyond that 272 00:09:48,335 --> 00:09:49,154 is leaders, 273 00:09:50,090 --> 00:09:51,690 will need to be willing to take a 274 00:09:51,690 --> 00:09:53,549 stand against any 275 00:09:53,929 --> 00:09:54,429 politically 276 00:09:54,970 --> 00:09:57,230 motivated attacks on public health measures, 277 00:09:57,929 --> 00:09:58,830 like fluoride. 278 00:10:00,009 --> 00:10:01,230 Data and science, 279 00:10:01,929 --> 00:10:03,610 need to kind of win the day here. 280 00:10:03,610 --> 00:10:06,585 And then thankfully there's decades of it that 281 00:10:06,585 --> 00:10:09,225 support these kind of basic and fundamental public 282 00:10:09,225 --> 00:10:10,044 health protections 283 00:10:10,504 --> 00:10:12,345 that we hope to see remain in place, 284 00:10:12,585 --> 00:10:13,965 for the next several years. 285 00:10:14,585 --> 00:10:16,585 Great. Thank you so much for the engaging 286 00:10:16,585 --> 00:10:18,610 and interesting conversation today. That is all I 287 00:10:18,610 --> 00:10:20,209 have for you today, Matt. So thank you 288 00:10:20,209 --> 00:10:22,450 again so much for joining our podcast. Been 289 00:10:22,450 --> 00:10:23,970 a pleasure speaking with you and looking forward 290 00:10:23,970 --> 00:10:25,750 to connecting with you again in the future. 291 00:10:25,889 --> 00:10:27,169 Thank you so much for having me on 292 00:10:27,169 --> 00:10:28,789 today and looking forward to it as well.