Wednesday, August 27, 2008

Away from the city


Theresa Fowler was up and dressed for work early Aug. 15, the day the mobile food pantry from Second Harvest Gleaners of West Michigan rumbled into the parking lot of Fifth Reformed Church on M-120 to pass out free food.

Fowler, who had a 10-hour work day ahead of her at the Wesco gas station on Maple Island Road outside Fremont, was in the Gleaners' line by 7 a.m.

The 46-year-old works 40 hours a week, extra if she can, and always on holidays when the pay is higher. Yet, to make ends meet, she has to rely on charity once a month to help put food on the table.

"I'm standing in line because I need help," Fowler said.

She had taken special care to get dressed that morning. Her shirt was pressed; her blue jeans rolled to capri-length; her hair already moussed and spiked into place.

"Can't be late for work," she said.

Her presence, the fact she was in a work uniform, waiting for food, preached a sermon all its own about the plight of Muskegon County's working poor -- people who have jobs but are struggling financially.

"Everyone here's got a story," Fowler said.

She looked up and down the line growing in number, everyone clutching a basket or empty box to fill with food. Some had been in line since before 5 a.m. Fowler was No. 61 in a line that grew to 218 by 10 a.m.

Gleaners trucks, filled with free food, make as many as 10 stops each month in Muskegon County -- but the one on Aug. 15 was unique. Most of the August sites were in the county's urban core. The one at Fifth Reformed Church, located at 2330 Holton not far from the U.S. 31 interchange, was "the farthest out" geographically. It drew residents from Dalton and Cedar Creek Townships, Twin Lake, Holton and homes considered on the "outskirts" of Muskegon County.

"It's tough," Fowler said. "Look around, nobody's job is safe anymore. People are struggling in the city, and out here, too."

Suddenly overcome with emotion, standing in the midst of so much apparent need, Fowler leaned on the shoulder of her next-door neighbor, Diane Blondeel, with whom she had come to the food truck -- and, for a few minutes, she cried her heart out. Her tears prompted a stranger to give up her place in line ahead of Fowler in order to comfort her.

"It's OK. You're a good person," the stranger said, patting Fowler on the shoulder.

Fowler worked to regain her composure, find her voice again.

"That's hard to say; hard to admit. I've always worked, always taken care of myself and my family," she said. "Saying it out loud: I need help. That's hard."

Fowler is caught, squeezed, forced by circumstances into a growing population of the "near" or "working poor." At least one-fifth of Muskegon County residents find themselves in a similar situations, unable to stretch paychecks already strained to the breaking point in precarious economic times.

Fowler, who has two adult children and a grandchild living with her, brings home about $250 a week. Her job includes health, dental and vision insurance "which keeps me going. I don't know what I'd do without that," she said.

"But I'm caught in the middle," Fowler said. "I work, so I don't qualify for (public assistance) from the state, but I don't make enough to get what I need, either."

Like a reliable vehicle, for instance, to get back and forth from work.

Fowler lives in a subdivision in Cedar Creek Estates on River Road in northeastern Muskegon Township on the border of Cedar Creek Township -- "where it's not quite city, but it's not country, either," she said. She doesn't have access to public transportation where she lives. No Muskegon Area Transit System buses go anywhere near her house. She has to drive wherever she goes -- to the grocery store, the drug store, the doctor, to work, even to the Gleaners truck delivery -- which quickly drains her pocketbook in an era of $4 a gallon gas prices.

She drives 30 miles round-trip to her job in an aging, unreliable Jeep she cannot afford to replace, even though the gas gauge is broken, and the engine is suspect. She cannot shift the car into reverse, so she has to carefully plot out her day's travels, or else waste time and gas.

At the same time, she cannot afford to move from her duplex in Creekwood Estates because her rent is determined on a sliding pay scale, "otherwise I don't know what I'd do," she said.

Divorced after 20 years of marriage, Fowler worked three jobs -- a 14-hour day was commonplace -- when her children were younger, just to support them.

"I've always stood on my own two feet," she said. "It's my pride that's hurt ... to have to ask for help now. I've never had to rely on anyone. I always said no matter what it took, even if it meant living in a tin can, I was going to support me and my kids. That's my job. I'm the mom."

Jane Johnson, director of Muskegon County's Department of Human Services, who has worked in the social service sector for more than 30 years, hears stories similar to Fowler's every day. They are the stories behind the statistics of a "nation in crisis," Johnson said. The majority of DHS clients receiving food, day care or emergency utilities assistance are employed.

"We're seeing people asking for help who've never been here before," Johnson said.

Fowler makes too much money to qualify for government assistance, but she cuts corners wherever she can, shopping yard sales. And once a month when the Gleaners' truck is scheduled to stop at Fifth Reformed Church, not far from where she lives, she stands in line for three hours -- or more -- with Blondeel, who is on disability, to receive whatever surplus food they have.

On Aug. 15, she went home with a laundry basket filled with bread and fresh cabbage, surplus sweet corn and tubs of sour cream, lettuce and a carton of soy milk. It is the only Gleaners' stop Fowler frequents. The others are simply too far away to seek out.

Living outside of Muskegon's urban center presents what Johnson called "complicators of distance," challenges that go beyond the skyrocketing cost of propane gas or fewer food pantries in the country.

Think of all the kids who take school buses home -- because there is no other transportation in the family -- and so they can't take part in after school activities. Think of the kids whose parents are having a tough time paying the electric bill, let alone finding the money for field trips, pay-for-play sports or driver education classes.

Saturday, August 23, 2008

Steve Danielsen


Delta Dental of Oklahoma, the state’s first, largest and leading provider of group dental programs, announces the addition of Steve Danielsen as director of sales.
Danielsen has extensive experience in the dental benefits industry. He previously served as regional vice president with Delta Dental of Missouri, and was also a founding partner of an insurance brokerage firm in Kansas City.

A native of Independence, Missouri, Danielsen holds a degree in business management and marketing from Northwest Missouri State University.

“We are very pleased to welcome Steve to the Delta Dental of Oklahoma team,” Delta Dental of Oklahoma Vice President of Sales and Marketing Ken McGuire, said. ”There is no doubt that our growing base of broker representatives, clients and subscribers will benefit greatly from his breadth of knowledge and background in the insurance industry.”

Monday, August 18, 2008

Pennsylvania Farm Bureau Offers Wide Variety of Activities during Ag Progress Days


CAMP HILL — Pennsylvania Farm Bureau (PFB) has planned numerous activities, including the popular kiddie tractor pull contests, along with information and displays on a wide variety of agricultural issues and programs as part of Ag Progress Days, which takes place from August 19-21. PFB’s exhibit building is located at East Fifth and Main Street on the Ag Progress Days cite in Rock Springs, Pennsylvania.

PFB is also hosting a special comprehensive session focusing on oil and gas leasing issues in Pennsylvania. The session entitled: “Natural Gas Leasing: Legal, Tax and Business Aspects for Property Owners” will take place on Tuesday, August 19 from 12:15 p.m. to 1:30 p.m. in the College of Agricultural Sciences Exhibits Building Theatre located on West 10th Street on the Ag Progress Days grounds.

The session will include a general overview of the typical oil and gas lease for those landowners contemplating signing a lease along with practical and technical suggestions that can be used in the lease negotiation process. Meanwhile, landowners who have already signed leases can receive information on income tax, estate tax, inheritance tax and real estate tax issues focusing on oil and gas leases. Finally, planning alternatives for the distribution of land subject to an oil and gas lease will be discussed in the context of the succession planning process for a landowner who wants to transfer real estate to the next generation of farm and non-farm children. Gary J. Heim, an attorney servicing the PFB Legal Service Plan for more than 25 years, will host the session.

Listed below is a breakdown of all the activities at PFB’s exhibit building:

Governmental Affairs and Communications Staff – Pennsylvania Farm Bureau staff will be on hand to answer questions on current issues impacting state agriculture.

Gas Leasing – Exploration and leasing of blocks of land for drilling has heated up in Pennsylvania as energy companies hope to tap into huge reserves of natural gas believed to be contained in the Marcellus shale formation beneath the state. Information on landowner rights and the leasing process will be available at the PFB exhibit building.

Health Insurance – A PFB Health Services representative will be at the show with information on group health care insurance available to members. Options include PPO (Preferred Provider Organization) plans, comprehensive major Medical plans, Health Savings Accounts, Medicare plans and Dental and Vision insurance. Veterinarians in some areas of the state and dog breeders and boarders statewide are now also eligible for PFB’s health care coverage.

MSC Business Services – Farm Management Service account supervisors will be available to discuss the many business services available through PFB including recordkeeping, tax planning and preparation; farm accounting software and computer leasing; and a no-hassle payroll service that takes the headaches out of payroll preparation.

Young Farmer & Rancher ¬– Members of PFB State Young Farmer & Rancher Committee will be at the exhibit area to discuss the leadership development and fellowship opportunities available to young farm families through YF&R programs.

Nationwide Insurance ¬– Find out about the member discounts available to PFB members on farm insurance from Nationwide. Agents will be present to also discuss savings for members on auto, ATV, motorcycle, snowmobile and boat insurance, plus discounts on long-term care insurance.

Women’s Leadership Committee – An interactive display on farm safety and other safety information will be featured at the Women’s Leadership Committee booth.

Member Benefits—Beltone will be offering free hearing screening to visitors. Members can receive a 15% discount on hearing aids. Amerigas will have a representative on hand to talk about the five-cents per gallon discount and other benefits available to members. Members can save 10 – 50% on products, supplies and repair parts from Grainger with free shipping on Internet purchases. A representative will be at the show to talk about products available. Representatives will also be at the show to talk about savings to members on internet services through PA Online, no-annual-fee credit cards through Farm Bureau Bank with credit rebates on purchases. In addition, you can find out more about savings on select Dodge vehicles and Case IH tractors as well as other member benefits.

For the youngsters: Kiddie Tractor Pulls and the “Dairy Dare” – The “kiddie tractor pull” contests will take place daily on Tuesday, Wednesday and Thursday, beginning at 10:30 a.m. and 1:30 p.m. Youngsters between the ages of five through ten will compete in three age categories, with prizes for tractor pull winners sponsored by PFB’s Young Farmer & Rancher Committee. Meanwhile, the Pennsylvania Friends of Agriculture Foundation will host a “Dairy Dare” learning booth for young visitors to PFB’s Ag Progress Days building. Children will learn to identify parts of a cow in a fun, interactive exercise.

Pennsylvania Farm Bureau’s exhibit building at Ag Progress Days will be open from 9 a.m. to 5 p.m. on Tuesday, August 19 and Wednesday, August 20; and from 9 a.m. to 4 p.m. on Thursday, August 21. Pennsylvania Farm Bureau is the state’s largest farm organization with a volunteer membership of more than 44,000 farm and rural families, representing farms of every size and commodity across Pennsylvania.

Tuesday, August 12, 2008

Losing sight


By Bill Coates, bill.coates@azcapitoltimes.com

Shortly before noon, diners line up at the Capitol Café. On busy days, the line spills out into the hallway of the Executive Tower basement. The daily special is written in grease pencil on a small portable sign.

On this day, it’s roast turkey for $4.59.

One of the cashiers is Mike Feeney, wearing wraparound sunglasses. He runs the business.

He’s also legally blind. And that’s no coincidence. Feeney operates the Capitol Café under a federal law known as the Randolph-Sheppard Act. In Arizona, this is administered through the Arizona Business Enterprise Program, part of the Department of Economic Security.

As Feeney rings up the customers, he’s pleasant. He’s efficient.

But, under the surface, not all is well with AzBEP. Among its 30 or so blind operators, some complain DES runs the program with a heavy hand. Others say agency red tape makes it difficult for them to make simple repairs or replace worn-out equipment. And, they say, DES has dragged its feet in opening up new sites — including inside state prisons.

DES has its own side of the story. Kathy Levandowsky, program administrator for Rehabilitation Services Administration — AzBEP’s parent division — says she is just asking operators to follow state procurement policies. And that new business sites will be available soon.

As for the operators, the undercurrent of dissatisfaction surfaced last April, when they met as the Arizona Participating Operators Committee (APOC), a representative group required by federal law. At the meeting, members voted to seek the removal or reassignment of two DES administrators, both of whom work for Levandowsky. The vote was non-binding. It was also unanimous.

Henry Grijalva recalls the atmosphere in the room leading up to the vote. It transcended the usual business of discussing new inventory controls and hearing from wholesalers — including one who gave a Starbucks coffee taste test.

“In the back of our minds, we knew something was going to hit the fan,” says Grijalva, 55.

One day he sat at the dining table of his Glendale home, sporting a T-shirt soaked in sweat. He had just finished mowing his lawn, which he does blind. He has been visually impaired from birth. Under AzBEP, Grijalva services vending machines at interstate highway rest stops. An employee drives.

There was little discussion about the vote, Grijalva says. The minutes of the meeting offered few specifics.

But there were undercurrents. And there was Robert Smith.

Smith, the riptide

Smith’s case was the riptide. For many operators, Smith was the victim of an agency that failed to play by the rules. AzBEP policy is set by DES with input from the operators.

The 61-year-old Smith runs Trebor’s, an AzBEP cafeteria at the Maricopa County court complex in Mesa. Trebor, he points out, is Robert spelled backward. He takes a visitor to a small office in the back. He is an outgoing, affable man, as well as a plain-spoken ex-Marine.

He lost his sight in an industrial accident.

“I’m blind as a bat,” he says.

His complaints against DES are both philosophical and personal. On the philosophical side, he says the Randolph-Sheppard Act comes with a built-in conflict.

Created in 1936, the New Deal program offered blind people a chance to run their own businesses on federal and state property. As amended, Randolph-Sheppard gives blind operators priority in setting up cafeterias and vending-machines in federal facilities. Under AzBEP, they also operate food services in state, county and city buildings. Arizona law also gives them priority.

Operators must first undergo six months of training. Right now, about half-dozen newly trained operators await an opening.

Like businessmen, operators hire employees, pay overhead and seek to make a profit.

But unlike most businessmen, they’re wedded to a state bureaucracy. For Smith, it’s like an unholy alliance between government and private enterprise.

For the most part, it works. He says AzBEP has given him a livelihood he would not have had otherwise. But there’s always room for improvement.

“I feel very strongly about this program, and I’m just irritated to death it is so screwed up,” he says.

Then he hands a visitor a stack of papers. He can’t read them, but he knows what order they’re in. They’re a record of his complaint against DES, which goes back to early in the year when Joni Spinka put in a bid to take over a snack bar at the Phoenix Indian Medical Center.

At the time, Spinka operated the Capitol Café in the Executive Tower basement. After she received the go-ahead for the Indian Center, Smith put in a bid for Capitol Café.

A winning bid requires approval from two committees. Each committee has four members, two from the agency and two operators. The first, the qualifying committee, screens applicants. The selection committee makes the final choice among qualified applicants. Candidates take a test and undergo a face-to-face interview.

“The final analysis is what your gut instinct is — who’s going to be the most successful in an operation,” Smith says.

The qualifying committee gave Smith a pass in his bid for the Capitol Café. The selection committee chose him over other candidates, including Mike Feeney, who operated a cafeteria at the Desert Schools Federal Credit Union in east Phoenix.

Randolph-Sheppard administrator Ed House, however, overturned the decision. The agency has final say, but Smith says House was wrong in this case. Smith filed a grievance against DES.

He says the case hinges on $50,000 he borrowed to make payroll after he took over a cafeteria about eight years ago at Fort Huachuca. Most operators — upon taking over a business — get a few a hundred dollars in the cash drawer, in addition to the inventory.

He had five years to pay off the debt, he says. But a massive heart attack put matters on hold. He doesn’t dispute the debt, and says he had paid off most of it. But he had no record of what he still owed, and couldn’t find out, he adds.

Grijalva was on Smith’s selection committee. No one from DES told the qualifying committee that Smith had stopped making payments, he says.

“Robert did do his homework, and he asked the office if he owed any money, if he was all right — if there were any issues. There were none,” Grijalva says.

Debt itself doesn’t disqualify an applicant. But the operator has to arrange payments. DES administrator Levandowsky says privacy issues bar her from discussing individual operators.

Sorting it out

The agency did make its case before Administrative Law Judge Richard Woodlock in early June, however. Woodlock held what amounted to a preliminary hearing to sort out the facts.

Assistant Attorney General Kevin Smith told Woodlock that House had acted properly in denying the bid. In addition, Robert Smith had a payment plan, but he wasn’t paying.

“If he had been in conformance with that payment plan, they would not have rejected the recommendation,” Kevin Smith said at the hearing.

Robert Smith acknowledged the debt, but says the agency never gave him an exact figure.

“I made every attempt to discover how much was owed,” Smith told Woodlock.

A full hearing on Smith’s case is set for Aug. 14.

Generally speaking, Levandowsky says, DES does not send out statements.

“Once they made that arrangement, then they’re responsible for just making monthly payments,” she says.

Most operators go into debt, she says, because they fall behind on payments to what’s known as a set-aside. Each operator pays the agency 20 percent of net profit. On a $50,000 profit, for example, the operator pays DES a $10,000 set aside. The money benefits the operators.

This year’s total set aside comes to roughly $465,000. Of that, two-thirds goes toward operators’ health and dental insurance. About 10 percent guarantees a minimum wage for operators whose profits fall short. Another $108,000 draws in federal matching funds, totaling $400,000 to replace and repair equipment.

The set-aside varies from state to state. Arizona has one of the highest, says Kevan Worley, president of the National Association of Blind Merchants, an advocacy group headquartered in Colorado Springs, Colo.

He doesn’t see a problem, he adds, if it’s money well spent.

Levandowsky says it is.

“Some states require operators to pay for their own maintenance and repairs,” she says.

In Arizona, a new case-management system should make it easier to track set-aside debt, as well as inventory.

“That will help them to see what their balance is,” Levandowsky says.

What’s more, DES provides a debtor list at each APOC meeting. Smith says his name never appeared on that list.

Aside from Smith’s complaint, operators have other issues on their plates, including timely replacement and repair of equipment. Red tape has hampered that, they say.

Levandowsky says it’s not red tape; it’s policy. She insists that operators use DES contractors. It’s required by the procurement code, she says. She adds she understands operators’ frustrations, suggesting they were taken out on the two DES officials who report to her.

That would be RSA administrator House and AzBEP program manager Otis Stevenson, targets of the APOC no-confidence vote in April.

Despite the vote, Levandowsky has no plans to back down.

“I can’t go against policy. And I don’t want my staff to go against policy,” she says.

DES declined to make House or Stevenson available for comment.

No time to wait

Allan Curry, past APOC president, says operators don’t always have the luxury of waiting for DES to approve an equipment order.

“If you’re at the Capitol and your ice machine goes down, and you got to spend $9,000 on a new machine, and you have to wait several days or weeks for that, that puts a hardship on the operator,” says Curry, who runs the Rain or Shine cafeteria at the main Phoenix post office.

Curry, 44, has his own hardship story. His cafeteria could use a new sandwich-prep counter.

“The one I have is broken, and it costs too much to repair it. So they’ve got to replace it,” Curry says. “I’ve been waiting for that for six months.”

Levandowsky, however, says emergency repairs have been streamlined.

“They call it in, and then we request emergency procurement authority from our DES procurement office,” Levandowsky says.

Curry says the emergency plan is helpful, if not perfect. But he gives the AzBEP consultants — who advise the operators — an “A” for effort.

“They’re trying the best they can,” Curry says.

For Grijalva, DES remains heavy on the stick and light on the carrot.

“Here in this state, unfortunately, I think we got more of a police program than a proactive program,” he says.

For one thing, he’d like DES to do more to expand AzBEP’s reach. He cites the agency’s inability to set up vending machines in visitation rooms at state prisons.

“We should be able to do all the vending machines in the prisons,” he says.

Levandowsky says she has been talking to prison officials.

“We’re trying to work with the Department of Corrections,” she says.

But security arrangements don’t mesh easily with the requirements of Randolph-Sheppard, she adds. Among other things, operators need access to the machines.

“We’ve got to work through those, so we make sure the operators get behind the gates,” Levandowsky says.

A DOC spokesman had little to add, except to say no agreement has been reached.


More to come

Levandowsky says other facilities are opening up, however. In addition to a new snack bar at Phoenix parks senior center, a coffee shop is going inside Phoenix Burton Barr Central Library. AzBEP is spending about $450,000 to build and equip the facility, with the city paying for utility hookups.

“It should be open at the end of August, the first of September,” Levandowsky says.

In addition, DES seeks to set up more businesses outside the Phoenix and Tucson areas, Levandowsky says.

“We’re going to be sending out a letter that that says, ‘You may not be aware of the BEP program. We’d like you to know what our services are, and what our program is about,’ ” she says.

Even as AzBEP expands, Randolph-Sheppard has hit a rough patch nationwide, says Worley, president of the Blind Merchants Association.

“I think it’s no secret that the program nationally is struggling a bit,” he says.

Every state but Wyoming has a Randolph-Sheppard program.

But business for many of the nation’s 2,500 blind merchants is down for a number of reasons, Worley says. One is the outsourcing of federal work to the private sector. That means fewer employees in federal buildings, where cafeterias are located. Then there’s the growing popularity of the four-day workweek. Business might be good Monday through Thursday, but bad on Friday.

Many state employees already have “flex time,” allowing them to work longer days in exchange for Friday, or every other Friday, off. This appeared to hit home in the cafeteria at the Department of Education, run by Joy Winston. Ordinarily, the lunch business is brisk and booths are hard to come by. On a recent Friday, though, the seating was wide open.

What’s become a frustrating trend for AzBEP operators — there are more than a half-dozen in the Capitol area — could get worse. Gov. Janet Napolitano is looking into a four-day workweek for many state employees to cut commuting costs and pollution.

All the same, AzBEP operators have to make a profit to stay in business. At minimum, an operator is expected to make a profit of $25,000 yearly. Below that, an operator could not make a living, Levandowsky says. For any operation, net revenue should run 12 percent above expenses.

When Grijalva earned only 6 percent on his own operation, he was disqualified for a bid on another site in 2007. He filed a grievance. The administrative law judge found in his favor, ruling out negligence and mismanagement as possible reasons for Grijalva’s poor showing. His business suffered from circumstances beyond his control, the judge wrote.

Grijalva says he had trouble finding labor and had asked AzBEP for help.

“I had multiple requests for assistance, and it wasn’t coming,” he says.

Despite the battles with bureaucracy, Grijalva has no plans to give up on Randolph-Sheppard anytime soon. It has given him steady, stable work since 1979. Many, if not most, operators have been in the program job for years.

“It has been the most effective employment tool ever devised,” says Worley, who operates a cafeteria on a Colorado military base.

Emilio Mosca, 59, agrees, in a measured, low-key way while sitting across from a visitor in a booth at his cafeteria, Emilio’s — on the second floor of the Arizona State Compensation Fund building near uptown Phoenix.

Mosca says simply that AzBEP is a good program. And, though he understands the complaints against it — in his 18 years as an operator, he’s heard them all before.

With a memory that stretches beyond experience, he adds: “They’re the same issues we’ve been hearing for 25 years.”

Sunday, August 10, 2008

Dental benefits widen, waiting lines grow


Two years into the state's bold healthcare experiment, its early success in expanding dental coverage may be threatened by a shortage of dentists willing to treat newly insured patients.

Since getting free or subsidized dental coverage in 2006, more than 200,000 low-income adults have climbed into Massachusetts dentists' chairs for work on their long-neglected teeth. But increasing numbers of patients are expected to seek care, and advocates fear the wait for appointments, now three months at community health center clinics, will grow.

The problem is that just 17 percent of dentists statewide have been willing to see these newly insured patients, despite reforms intended to boost their ranks. Even some of these dentists are limiting the number of state-subsidized patients they will treat.

Dentists say the state's reimbursement rate for adults covers only about half their costs, and they also cite payment delays and burdensome paperwork.

Without more dentists, said Kerin O'Toole, spokeswoman for the Massachusetts League of Community Health Centers, patients will not be able to get timely preventive care and "we risk treating people with more expensive and serious health issues."

As part of the healthcare law's goal of extending insurance to nearly everyone, dental benefits were restored to roughly 540,000 low-income adults who had lost nearly all dental coverage under Medicaid budget cuts in 2002. The law also expanded eligibility, prompting another 140,000 to sign up through Medicaid or the newly created Commonwealth Care subsidized program for the previously uninsured.

Suddenly, thousands of patients who had not opened wide in years were calling for appointments, and the number of Medicaid patients who saw a dentist more than doubled in the first full year, from about 15 percent of adults to 35 percent, state data show.

Among the newly insured is Pam Anasoulis, a 48-year-old telemarketer from Beverly who has also wired helicopter engines and fixed conveyor belts to make ends meet. For her, entree to the dentist after years of oral neglect was bittersweet. The mother of two grown children, she had broken a front tooth in 2004 and had gone to a dentist who filed down several of her front teeth to make a temporary bridge.

But Anasoulis said she couldn't afford health insurance and could not afford to go back to have the work completed. The bridge broke, decay set in, and Anasoulis was left with stubs for front teeth.

"You really don't think, when you look at someone with missing teeth, how much they're hurting inside," she said. "I got so depressed I didn't go out."

When she finally found her way to the Lynn Community Health Center dental clinic in 2006, many of Anasoulis's front teeth had to be extracted. But Dr. Herlivi Linares, the clinic director, was able to save some of her teeth and make her a partial denture.