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By Taylor Knopf

When lawmakers arrive in Raleigh, even if they’re professionals with expertise in their own fields, they may be assigned to a committee where they need to get up to speed. That’s frequently the case for lawmakers trying to tackle the complicated world of health policy.

So, on Monday, a handful of state lawmakers took part in the first ever Legislative Health Policy Fellows Program aimed at providing policymakers with up-to-date health care data and resources in North Carolina.

The North Carolina Institute of Medicine is hosting 22 lawmakers for a three-part series exploring relevant issues such as insurance, rural health, mental health, opioids and chronic diseases. These are all topics lawmakers discuss and make policy on regularly.

Health care comprises about a quarter the state budget, with Medicaid taking up a large share of the dollars, but also prison health, school health, state facilities and other portions of state government where health care knowledge becomes important.

Michelle Ries, project director for the NC Institute of Medicine, said even though she invited all state lawmakers to participate, she wanted to limit the class size to cultivate good discussions and questions. About 10 people signed up immediately. To fill the rest of the 22-person class, Ries targeted legislators in their first three terms and those serving on health-related committees.

“We want to make sure we are helping the General Assembly get the resources they need to make effective decisions,” she said. “It’s often hard to keep all the health care acronyms straight and some things vary by state. And keeping up to date on the status of Medicaid transformation and all those things is a lot.”

The financial side and the human side

During a session on health insurance Monday, Sen. Rick Horner (R-Wilson) asked about  CHIP, the federally funded state Children’s Health Insurance Program which has become central in federal budget negotiations.

Sen. Paul Lowe (D-Winston-Salem) talks to Rep. Shelly Willingham (D-Rocky Mount)during a break between lectures. Photo credit: Taylor Knopf

Horner wanted to know who it covers and how people hear about it. Horner is a first-term senator and described himself as a “blank slate” when it comes to health care.

Though CHIP (also known in North Carolina as Health Choice) dates back to the Clinton Administration, it has generally received bipartisan support and no one really debates its value. That’s changed, however, in recent months, as Congress has dragged its feet in reauthorizing the program.

Sarah Collins, from the Commonwealth Fund, explained that CHIP covers a lot of kids of teachers and state employees in NC, anyone whose family earns up to about 210 percent of the federal poverty level (that comes to about $42,300 for a family of three). These are people who make too much to qualify for Medicaid or other subsites for their children, but who might struggle to afford traditional health insurance.

Adam Zolotor, CEO and president of the NC Institute of Medicine, encouraged Horner’s questions, saying as a first-term lawmaker with no health care background, his questions proved that holding these classes is useful.

“As a layman, I want to learn about this,” Horner said afterward. “Health care is not an area that really interests me. I like education and business and things like that. But it’s really important to my district, so I want to learn as much as I can and build a foundation of knowledge.

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“The Medicaid issue is a big budgetary thing and you can’t just do everything by the numbers,” he added. “Sometimes you have to understand the human side of it.”

Getting ahead of the curve

The remaining two sessions will be in February and March before the “short” legislative work session begins in the spring.

Ries said she looked closely at Georgia and South Carolina who have been holding these classes for lawmakers for a few years and designed this program to be similar to ones in those states. She also talked to North Carolina legislative staff about the training they already do for incoming legislators to find out what health policy topics would be most useful.

Former HHS Sec. Lanier Lanier Cansler addresses the lawmakers in the health policy class. Cansler was a Republican lawmaker at the General Assembly, and then Secretary of Health and Human Services. Photo credit: Taylor Knopf

Former state lawmaker and Health and Human Services Secretary Lanier Cansler ended the day by telling lawmakers what he wished he knew back when he served in the General Assembly.

When making health care policy, he urged his audience to really consider social determinants of health — housing, income, transportation and nutrition — essentials for a person to live a healthy lifestyle.

“This is the problem I felt when I was in the legislature, sitting in your shoes,” Cansler said. “We spend a lot of time trying to figure out how to do the next two-year budget and we don’t spend so much time trying to figure out how to create a better long-term plan.

“Try to get ahead of that curve so that we are eventually reducing the cost of care and keeping people healthier because dealing with problems before they become crises is going to save us money in the long term,” he said. “As government, and I saw it the whole time I was involved, we spend all our time reacting to the next crisis rather than try to prevent crisis.”

Sen. Angela Bryant (D-Rocky Mount) said she really enjoys health care policy and the chance to interact with her colleagues on the topic.

“I think the landscape is changing so quickly and I was feeling stuck in Medicaid expansion,” she said. “I think now we are moving to a new arena.”

“I think we are going to be faced with new models. This [class] was a way to be fed by somebody else inviting experts and getting the most updated information and being able to advocate from that place.”

Bryant said the class also allowed her to meet some members of the House for the first time.

“People are often surprised, but we don’t really get to build relationships with each other that much,” she said.

2018 Legislative Health Policy Fellows:

Representative Cynthia Ball, D, District 49 – Wake
Representative MaryAnn Black, D, District 29 – Durham
Senator Angela Bryant, D, District 4 – Halifax, Nash, Vance, Warren, Wilson
Representative Deb Butler, D, District 18 – Brunswick, New Hanover
Representative Carla Cunningham, D, District 106 – Mecklenburg
Representative Josh Dobson, R, District 85 – Avery, McDowell, Mitchell
Senator Chuck Edwards, R, District 48 – Buncombe, Henderson, Transylvania
Senator Rick Horner, R, District 11 – Johnston, Nash, Wilson
Representative Pat Hurley, R, District 70 – Randolph
Senator Joyce Krawiec, R, District 31 – Forsyth, Yadkin
Senator Paul Lowe, D, District 42 – Forsyth
Representative Graig Meyer, D, District 50 – Durham, Orange
Representative Greg Murphy, R, District 9 – Pitt
Senator Paul Newton, R, District 36 – Cabarrus, Union
Senator Louis Pate, R, District 7 – Lenoir, Pitt, Wayne
Representative Larry Potts, R, District 81 – Davidson
Senator Jeff Tarte, R, District 41 – Mecklenburg
Representative Evelyn Terry, D, District 71 – Forsyth
Senator Terry Van Duyn, D, District 49 – Buncombe
Representative Donna White, R, District 26 – Johnston
Representative Shelly Willingham, D, District 23 – Edgecombe, Martin
Senator Mike Woodard, D, District 22 – Durham, Person, Caswell

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Taylor Knopf

Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...