The Transylvania Times -

By John Lanier

Cohen Discusses Health, Early Childhood


Last updated 3/25/2019 at 12:08pm

Callie Horwath

After the N.C. Childhood Action Plan Presentation and Workshop, the Transylvania County Kindergarten Readiness Rally was held at the county Activity Center and featured a visit from Super Grover.

N.C. Department of Health and Human Resources (NCDHHS) Secretary Dr. Mandy Cohen discussed some of her major concerns, ranging from the plight of rural hospitals and the opioid crisis to expanding Medicaid and early childhood education, during a private interview and the N.C. Early Childhood Action Plan Presentation and Workshop last Thursday.

The presentation and workshop were held at Brevard College's Porter Center.

"We think about rural health a lot," said Cohen, whose department has more than 17,000 employees and a budget of roughly $20 billion.

Two major problems face rural communities regarding health: the inability to attract physicians and the difficulty of keeping rural hospitals open due to financial difficulties.

Cohen said NCDHHS is attempting to address the physician shortage by offering scholarship and loan repayment programs to physicians who will work in rural areas.

As for rural hospitals, since 2014 five rural hospitals in the state have closed and several more have filed for bankruptcy. Several rural hospitals facing financial difficulties also have been taken over by larger hospital systems. In the latter situation, some of the services that were offered at rural hospitals have been transferred to larger hospitals within the same system.

"Hospitals are businesses. They make business decisions. That's just the reality of health care," she said.

Cohen said the financial pressures on rural hospitals in North Carolina and the United States are due to having fixed costs but "less foot traffic."

Cohen said expanding Medicaid in North Carolina would help rural hospitals stay open, adding that 80 percent of rural hospitals in the U.S. that have closed in recent years are in states that have not expanded Medicaid.

"It's good for our rural communities," said Cohen of expanding Medicaid. "It's not a silver bullet. It does not fix all of the problems. It's just one piece of the puzzle."

If North Carolina were to expand Medicaid, an additional 500,000 people, including approximately 120,000 children, would have medical insurance.

Cohen said people who do not have insurance delay seeking medical care until it becomes an emergency. Instead of going to a doctor regularly and being treated for high blood pressure, for example, an uninsured patient would ignore minor symptoms and eventually end up going to the hospital for a stroke.

"They can't pay the hospital costs. They go into medical bankruptcy. We have one of the highest rates of medical bankruptcy," said Cohen.

As a result, hospitals are not financially compensated for these services. Cohen said North Carolina has $1 billion a year in uncompensated costs that hospitals write off annually.

Not only do those uncompensated costs hurt hospitals, but they also hurt people and businesses that purchase their insurance through the commercial marketplace.

"That cost is passed on to you and me," said Cohen.

Cohen said states that have expanded Medicaid have insurance premiums in the individual commercial marketplace that are 7 percent lower than the premiums in North Carolina.

She said if more people had Medicaid insurance, the insurance premiums would be lower for everyone and more rural hospitals would receive payments from their clients.

Cohen said some people are ambivalent about Medicaid expansion because they do not see how it directly affects them, but she said it does affect people, particularly those in rural communities, because without it insurance premiums are higher and access to hospitals is limited.

Cohen also said that people should be concerned about the opioid crisis, even if it does not affect them personally.

Cohen said the number of newborns exposed to illicit drugs during pregnancy has increased 900 percent in the last 10 years. Addicted newborns going through withdrawal are very irritable and have high pitched, incessant screams.

Some hospitals have moved the addicted newborns to another wing because they were being too noisy for the non-addicted newborns, who do better in a quiet atmosphere reminiscent of the womb.

Since North Carolina pays for the medical care of more than 50 percent of births, that cost of putting the newborn child in a neo-natal intensive care unit (NICU) is borne by the state.

"We're paying for the intensive care," said Cohen.

Cohen said the state wants expectant mothers to have good health care. She said a problem is Medicaid pays for only the health care for the few months before and after the birth of a child and "then they're falling right off of Medicaid."

She believes that if their coverage were extended before and after delivery that the chances of the child being healthier would greatly increase. According to Cohen, North Carolina is doing well in some areas for children, but "we aren't doing as well as we should," noting that there needs to be more comprehensive investment in helping children.

The infant mortality rate in North Carolina is 7.1 per thousand, but among African American children the infant mortality rate is 12.7 per thousand. Cohen said some areas in Western North Carolina are on a par with Vietnam and Egypt when it comes to infant mortality.

She also said more than 20 percent of the children in North Carolina live in poverty, with many of them going to bed and waking up hungry. She said a school might have exceptional facilities and excellent teachers, but that won't make much of a difference if a child comes to school hungry.

"If those kids show up hungry, they are not going to be learning," she said.

Cohen said children not only have to be well fed, but they also need to live in a stable nurturing environment. She said brain development begins before a child is born and that a million neural connections are made each second when a child is born. This development builds the foundation for rest of their lives.

However, children who are not nurtured daily and experience childhood trauma or have adverse childhood experiences (ACES) do not optimally develop synaptic connections, which inhibits brain development, and can create plaque build up in the arteries. These ACES can have negative effects well into adulthood.

"It all starts back when you are young," said Cohen.

She said her department has a goal of creating a "culture of health." Children and families are at the center of that plan, which is to be based on scientific data, especially that regarding brain development. Another goal is to alleviate the inequities in health that exist among certain areas and certain groups.

Cohen said that not just physicians and teachers but economists and military leaders also understand the importance of children having a good start in life and that early childhood education is "the pipeline of our future economic growth. This is how we become a successful state."

Cohen said North Carolinians need to look at health care, not just health insurance, and view how the state is using money to "buy health."

"Personal health is more than what happens in a hospital or clinic," said Cohen.

She said personal health is affected by nutrition, exercise, jobs, transportation, housing, interpersonal violence and early childhood development, and the state is attempting to address all of those components. One new program Cohen is excited about is NCCARE360, which will connect seemingly disparate aspects of health through the Internet. For example, with this program, health care providers would be able to coordinate their efforts with food banks. A physician would be able to refer a patient to a food bank to procure fresh fruits and vegetables. The physician would then be able to see if the patient received those items from the food bank.

The program has been implemented in three counties in the eastern part of the state with plans to roll out the program statewide within the next year. Cohen praised Transylvania County on two fronts: handling the opioid crisis and collaboratively working together on early childhood development.

She said the opioid crisis seems not to have hit Transylvania County as hard as other areas and the state is interested in what is occurring locally to stem the opioid crisis.

"What's going right here?" she asked. "Transylvania is a bright spot in the west."

Callie Horwath

Lots of children, parents and others got to have lots of fun and learn useful information during the annual readiness rally.

Cohen also praised those involved in Get Set Transylvania for building a collaborative effort to improve early childhood education.

"You all are already taking action. You guys are running ahead of the state," she said.

She praised the local group for getting the county commissioners, Smart Start and numerous other organizations involved in Get Set Transylvania. She encouraged those attending the early childhood workshop to commit to taking specific steps to enhance early childhood development.

"It is going to take commitment and leadership to do it," she said. "If it was easy, it would have been done already. This is a long-term investment."

Stories from the N.C. Early Childhood Action Plan Presentation and Workshop will appear in upcoming editions.


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