By Rose Hoban
Legislators from both sides of the aisle found points of agreement on health care issues Saturday as they discussed Medicaid, child services and mental health care, and the need for better community psychiatric services in North Carolina.
A capacity crowd of 400 filled UNC-Chapel Hill’s Friday Center for the 39th annual Legislative Breakfast on Mental Health, which featured a panel of two Republicans and four Democrats who agreed that more uninsured people in North Carolina need health coverage.
Legislators on the panel also found common ground on the idea that 16- and 17-year-olds in the justice system should not be automatically charged as adults and that there’s a need for more community-based mental health services.
“Every year, when it comes time to register for this program, I hesitate,” said former Rep. Marilyn Avila, who will take a new position this year as the policy adviser to the House Speaker Pro Tempore’s Office after losing her Raleigh-based seat in November.
“I know when I come in here, I’m going to feel so ignorant… but I always learn from you guys when I come here.”
In the past, the breakfast has been focused on legislators and residents of the Triangle, but organizers said they opened the event to people statewide in an effort to be more inclusive.
“We hope to get more people to the table to talk about these issues,” said Jenny Gadd, one of the morning’s organizers. She also said it’s likely the breakfast will move to a larger venue next year.
Agreement around Medicaid
So much around North Carolina’s Medicaid program is uncertain right now: Gov. Roy Cooper and legislative leadership are locked in a legal battle over expanding the program; the new Congress in Washington is talking about changing the funding mechanism for the program; and North Carolina’s leaders are preparing to convert the state’s program from a fee-for-service system to one run by commercial managed care.
Even with all the question marks, Republicans and Democrats in a bipartisan panel discussion found common ground, even on the contentious issue of expansion.
“I have a son who was diagnosed many, many years ago as paranoid schizophrenic,” said Rep. Carla Cunningham (D-Charlotte), a nurse. “When ACA came along, Medicaid expansion was going to eliminate pre-existing conditions. That meant the world to a lot of parents who have children with mental illness.”
Cunningham said the state should expand to cover as many as 500,000 currently uninsured people.
Rep. Greg Murphy (R-Greenville), the legislature’s only physician, agreed. It’s a stance that’s been unusual for a Republican in the General Assembly.
“I’m a practicing physician. I see folks on Medicaid. This is a vulnerable population that we cannot abandon,” Murphy said to applause.
Murphy also inserted a dose of reality about the future of the ACA and what it would mean for expanding Medicaid.
“You can be on different sides of whether you expand Medicaid or not,” he said, noting that the Republican-controlled Congress is determined to repeal the law. “I’m a realist… I want everybody in this state to have accessible affordable health care, but we have to put a system together where it’s going to happen.“
Pushing for childhood services
In the past few years, more research and attention has been paid to issues of early childhood experiences and their effects on later life, psychologist Betty Rintoul told the gathering.
Rintoul described what’s being learned about “adverse childhood experiences,” traumatic events such as emotional neglect, violence in the home or familial substance abuse that are often experienced by young children. She said new research is finding that children as young as infancy can suffer from “toxic stress” induced by such events.
“From birth to 3, the brain gains about 80 percent of its adult weight,” she told the audience “That weight is largely in connections that form to help the brain communicate and to lay the foundation for everything that comes in the future.”
In the wake of stress, though, those connections can be lost, research indicates.
A large and detailed database of tens of thousands of children studied over decades has yielded surprising information about what happens to children exposed to such childhood trauma. Not only do these children display more behavioral problems as they reach adulthood, they experience more physical health problems.
“Think for a minute about the cost to society. Think about our skyrocketing health-care costs,” Rintoul said. “There’s estimates about 80 percent of our health care costs are due to avoidable physical problems. These are right there with them.”
She said it was a “no-brainer” to put more resources to ensuring children get the best start possible, whether it be programs such as the Nurse-Family Partnership, enhanced foster care services or more Smart Start and pre-K programs.
Changing the status of teens in the justice system
North Carolina is one of only two states in the country (the other is New York) where 16- and 17-year-olds arrested for felonies and some misdemeanors are automatically treated as adults.
An attempt to raise the age where offenders are treated as adults made it through the state House of Representatives in 2013, but died in the Senate the following year.
“I think 2017 will be the year it passes,” Avila said. She worked on the measure when she was elected and promised the audience she would continue to build coalitions around passage in her new position.
She told the group that last year’s Governor’s Task Force on Mental Health and Substance Use recommended raising the age. The task force was lead by state Chief Justice Mark Martin, who has been pushing the judicial branch to support the measure and this past year, the state sheriffs’ association finally dropped its opposition.
Only the state’s district attorneys are not on board, Avila said.
“And one of their biggest concerns was where the money was going to come from to shift that 16-year old,” Cunningham said. “There’s going to be an influx, so we handle that new change, where do we put them, how do we house them and who gets to see them, and do we have enough of the programs in place to assist them.”
Both women encouraged audience members to advocate to their local district attorneys to support the measure, and said they were confident they eventually would.