Use tobacco tax money as intended: to help fund dental program

When California voters overwhelmingly approved Proposition 56 to raise the tobacco tax last November, they were also speaking loudly about the need to address a disturbing trend and growing public health emergency: the crisis in obtaining dental care for the state’s most vulnerable patients.

Voters clearly understood the urgency and made the crucial connection: tobacco use causes big, expensive health problems, including long-term oral disease across our state. Given that nearly 14 million children, seniors and working families rely on the state’s Denti-Cal program, the lack of access to dental care for our most vulnerable residents is a problem that carries negative consequences for our physical and economic health, school attendance and workplace productivity.

The state began collecting these new revenues on April 1, but unfortunately, the Brown administration doesn’t currently intend to use the tobacco tax funds to address this crisis, which was described by the Little Hoover Commission as “a silent epidemic of tooth decay and disease.” That concern is shared by a statewide coalition that includes dental and health care providers.

But as lawmakers craft next year’s budget, they can do the right thing from a health care policy perspective by ensuring the state keeps its commitment to help a large under-served population by using tobacco tax revenues as voters intended. Lawmakers should resist the temptation to use these funds to pay for other programs and services.

The best way to carry out the promise detailed in Proposition 56 is to invest in improving access to dental care that will help hundreds of thousands of Californians and their families who are currently shut out of the services they need. To make this a reality, we must make it possible for more dentists to see more patients enrolled in Denti-Cal, the state program for Californians who can’t afford private coverage.

There are far too many pockets of the state without access to adequate care. As an example, less than half of children and fewer than 1 in 10 adults enrolled in Medi-Cal received any preventive dental care through the Denti-Cal program in 2015. The Central Valley is especially vulnerable to this shortage.

The Legislature should help correct this imbalance in order to address a broader health issue. When the state Senate and Assembly budget subcommittees meet to discuss Denti-Cal, they should take a serious look at proposals to use Proposition 56 revenues as voters intended.

Improving oral health is critically important, since dental problems can worsen chronic conditions such as diabetes or heart disease. Those with osteoporosis and HIV/AIDS or Alzheimer’s disease can also be more vulnerable to oral health issues. Poor oral health is ultimately costly and can lead to dependence on expensive emergency room visits.

In children, neglect of oral health also leads to excessive school absenteeism. According to a UCLA study, dental problems cause kids to miss 874,000 school days annually, with an estimated loss to schools of $29 million each year. For their parents, it’s a problem that affects productivity in the workplace.

Proposition 56 is projected to generate more than $1.2 billion in the 2017-18 fiscal year. A portion of those funds should appropriately be used to expand and improve access to dental care for the more than 1 in 3 Californians who depend on the state’s health safety net for their health needs.

Investing in these dental services involves no new state money, just a commitment to fix what’s wrong with Denti-Cal. It is a worthwhile investment that keeps the promise made by Proposition 56. That is truly something to smile about.

Dr. John Luther is the chief dental officer at Western Dental. He can be contacted at