PORTLAND, Ore. -- Coronavirus is speeding up a project already underway to integrate dental care into primary care in an Oregon clinic.

Dentists and primary-care doctors face barriers to interacting, even though a person's dental health is integral to their overall health. While the collaboration was already going on, Virginia Garcia Memorial Health Center Dental Director Lisa Bozzetti said her staff was redeployed to the primary-care side when COVID-19 hit.

"It has helped to strengthen the relationships between departments," Bozzetti said. "I mean, we have never, ever been in this position where we worked so closely together. And our staff have actually been working together towards a common cause now."

CareOregon invested $2 million in five safety-net clinics in the Portland metro area to help dental and primary-care staff coordinate their services. The organization supported the clinics with learning collaborations, on-site team engagement and webinars.

Chief dental officer for CareOregon Alyssa Franzen said oral hygiene is linked to pregnancy outcomes, heart disease and chronic diseases like diabetes. And she said for kids, it's also linked to social determinants of health, like school attendance.

"It's now part of the kindergarten readiness work that's going on throughout the state," Franzen said. "So, we know that at various stages, oral health is an integral part of overall health, and a piece that we need to be addressing."

Laura Bylerly is medical director at Virginia Garcia. She said CareOregon has provided critical support to overcome other barriers, like lining up primary and dental health coverage for patients. She said it's becoming more common to think of dentists as partners, in the same way physicians partner with specialists like cardiologists.

"We're each becoming more aware of what the other side is trying to accomplish," Bylerly said. "And we're, sadly, more aware of the silo effect that has happened."

To pay for the priorities of President Donald Trump's administration, like mass deportations and tax cuts, Republicans in Congress are considering cuts to a host of programs supporting people living paycheck to paycheck.

Potential cuts include $880 billion to Medicaid over the next decade.

Adam Fox, deputy director of the Colorado Consumer Health Initiative, said 1.2 million Coloradans rely on Medicaid, including pregnant mothers, people with disabilities, working families and nearly six in 10 people in nursing facilities.

"It provides coverage to so many in our communities, it is really the foundational block in our health care and health coverage systems," Fox pointed out. "If Medicaid gets cut, it puts the entire health care system at risk."

Republicans have said cuts to Medicaid could be made without reducing benefits by overhauling and improving the program, which, according to analysis by Reuters, serves 35 million Americans in states President Donald Trump won in the 2024 election. In a recent survey, seven in 10 Trump voters said cutting Medicaid is unacceptable.

Colorado faces a $1.2 billion budget deficit, largely due to the state's tax code under the Taxpayer Bill of Rights, or TABOR. Fox acknowledged in many ways, the state's hands will be tied if Congress cuts Medicaid funding.

"Colorado cannot raise revenue, because of TABOR, to make up the difference," Fox noted. "Any cuts at the federal level will mean that Colorado has to reduce benefits, or strip people of coverage."

America's for-profit health system costs more than twice as much as other wealthy nations per capita. Fox argued what is needed is a health system covering every American and controlling costs. Compared to all other current health programs, Fox stressed Medicaid is the most efficient at meeting those goals.

"What we probably should be focusing on is really expanding Medicaid to everyone -- who is not eligible for Medicare, at least -- rather than cutting the program," Fox urged.

Wildfires are creeping closer and closer to health care facilities in California, including hospitals and nursing homes, according to a new study.

Researchers with the nonprofit Direct Relief looked at 23 years worth of data and found the distance between wildfire and the facilities is decreasing by an average of 628 feet per year.

Andrew Schroeder, vice president for research and analysis at Direct Relief and the study's coauthor, said they are seeing a steady pattern of increasing proximity.

"That raises a lot of policy issues," Schroeder pointed out. "A lot of pragmatic issues about how we operate the health care system in California, how we choose to locate health facilities and what it means to operate a truly resilient health care system."

The data also show the number of inpatient beds and acute care facilities within five miles of a wildfire zone is increasing, as development increases on and near dry hillsides in the urban-wildland interface.

Neil Singh Bedi, research scientist with CrisisReady, a collaboration between Direct Relief and the Harvard Data Science Initiative, said long-term care facilities like nursing homes are most vulnerable.

"This might mean that we need to invest more resources for those facilities to be able to evacuate more safely," Singh Bedi suggested. "Or better filtration systems, if wildfires are going to be closer to those facilities."

The Direct Relief report is the second in a three-part series. The first examined the medical implications of the state's power outages on people who rely on electricity to run lifesaving machines and refrigerate medicines. The next report will look at how medically vulnerable people in Mariposa County communicate during wildfire emergencies.

Rural communities in Missouri are bracing for a tough reality as they plan ahead for the possibility of federal cuts to programs such as Medicaid.

The poverty rate in rural Missouri stands at more than 16%, compared with a little more than 11% in urban regions of the state.

Bryan Stallings, co-founder and CEO of the rural charity Elevate Branson, said they don't get their resources directly from federal funding, but primarily from donations. However, he warned that his nonprofit will feel the ripple effects of these cuts as donors who are directly impacted will be forced to give less.

"You end up having to reduce staff - and with these cuts, you're going to see the demand go up," he said. "So, here you're going to have this big gap in staffing to be able to serve the increased need."

In Missouri, one in five children faces hunger, and in Branson, the poverty rate tops 22%. Stallings said his nonprofit serves 4,000 to 5,000 people each year.

Support includes Medicaid-funded mental-health counseling, food, clothing, housing and even assistance with obtaining birth certificates or Social Security cards. Stallings noted that transportation is a major barrier for rural residents seeking these types of services - and when one-stop charities such as his lose resources, the entire community feels the impact.

"Rural communities have very little resources for transportation," he said, "which means individuals who are in that underserved population, they really need to be able to access services all in one location."

He said the local economy in Taney County is affected by Branson being a tourist destination, with a high number of residents who work in low-wage, service-industry jobs. The county's median income is about 17% less than that of the state as a whole.


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