Ep. 84: The KIDS Health Act - Whole Child Health for the Nation (Part 2 of 2)

In part 2 of The KIDS Health Act series, U.S. Senators Tom Carper and Dan Sullivan discuss ways in which the bill aims to integrate mental and physical health services for children eligible for Medicaid and Children’s Health Insurance Program (CHIP). Senator Carper (D-DE) highlights his focus on early childhood development and access to healthcare in Delaware, while Senator Sullivan (R-AK) addresses Alaska's unique healthcare challenges and emphasizes the need for innovative, localized solutions.

Both senators stress the importance of breaking down bureaucratic barriers and increasing funding to improve children's health outcomes. Part 2 of the series underscores the bipartisan effort to address youth mental health and the holistic approach proposed by the KIDS Health Act.

Listen to Part 1 and learn more about the KIDS Health Act.

Guests:
Tom Carper, U.S. Senator, D-Delaware, co-sponsor of the KIDS Health Act
Dan Sullivan, U.S. Senator, R-Alaska, co-sponsor of the KIDS Health Act

Host/Producer: Carol Vassar

Views expressed by guests do not necessarily reflect the views of the host or management.

Subscribe, review or let your voice be heard at NemoursWellBeyond.org.

Transcript

Carol Vassar, podcast host/producer:

Welcome to Well Beyond Medicine, the Nemours Children's Health podcast. Each week we'll explore anything and everything related to the 80% of child health impacts that occur outside the doctor's office.

I'm your host, Carole Vassar, and now that you're here, let's go.

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U. S. Senator Tom Carper (D-DE):

I'm Tom Carper. I'm a recovering governor, the last Vietnam veteran serving in the United States Senate. I've been Delaware's Treasurer, congressman, governor, and senator, father of three sons.

Carol Vassar, podcast host/producer:

And Senate Democrat lead sponsor of the KIDS Health Act. Senator Tom Carper joins us in conversation on this episode as we continue to examine this important piece of bipartisan, bicameral legislation now before Congress. In a few minutes, we'll talk with Senator Carper's KIDS Health Act co-lead, Republican Senator Dan Sullivan, about the importance of this legislation to his geographically enormous and culturally diverse home state of Alaska.

The full name of this legislation is Kickstarting Innovative Demonstration Supporting KIDS Health Act and it would establish a holistic approach to children's healthcare by integrating mental and physical health services for children and youth who are eligible for both Medicaid and the Children's Health Insurance Program, or CHIP. It focuses on providing better care coordination and better outcomes for children, all children. Children's health has been a hallmark of Senator Tom Carper's long political career and an impetus for his co-sponsoring of the KIDS Health Act as he outlined when we talked recently.

U. S. Senator Tom Carper (D-DE):

When I ran for governor a million years ago, my wife and I were just starting a family. Within about 18 months of each other, two sons. I ran for governor, and she said, "What are you going to do?" And I said, "I want to focus on families." Again, we were just starting our family.

As it turned out, our sons had access to excellent healthcare. They're well-fed. They ended up going to kindergarten. They actually knew their ABCs. They knew their numbers. They could actually read when they were starting the first grade. There were other kids who couldn't do that until third, fourth, or fifth grade, and I said, it's just not fair. What we want to do is make sure that we strengthen families, we make sure that we focus on early childhood development and we focus on the basics.

I've been a root cause guy for as long as I can remember. I focus not on the symptoms of problems but on the root causes of problems, and we need to do that more. We do that in Delaware. We put a school nurse in every public school in Delaware and put a wellness center in every high school in Delaware. We now have wellness centers in our middle schools, and we're starting to put some in our elementary schools as well for kids who need help, including challenges, mental health challenges that kids bring to the schools these days.

A year ago, the Congress passed, President Biden signed into law, a gun safety legislation had a provision in there that Republican Senator Bill Cassidy, Dr. Bill Cassidy, a physician from Louisiana. He and I were the co-authors of it, but it basically said that schools and school districts could use Medicaid money, federal Medicaid money, schools and school districts could use CHIP money, Children Health Insurance Program money for wellness centers for school nurses within our school. Provide healthcare, including mental health care. So those are things that I've done, that I've done in concert with my colleagues in the Senate.

Carol Vassar, podcast host/producer:

It sounds like you've made some inroads in this work, making lives better for kids. How does the KIDS Health Act do you think, work towards that?

U. S. Senator Tom Carper (D-DE):

I think the KIDS Health Act builds on what we already have done. I'll give you a good example. We have three counties in Delaware. We have Northern Delaware, where most of our people live, Wilmington. Central Delaware is fairly less populated. Southern Delaware, one of the largest counties in America, Sussex County. People are spread out all over the place. A lot of farms, we raise a lot of chicken, corn, soybeans, have beaches. When families...when kids need access to healthcare, they can get it in some cases at their schools, but frankly, not as easy when you have to reach out across one of the largest counties in America, one of the least populated counties in America and access, provide children and families access to a wide variety of healthcare needs.

And one of the things we want to be able to do is enable states not to be dictated by the federal government to get them access to funding that would enable them to bring those services to where the families are, where the kids are, and make them more accessible and real. I like to say if a tree falls in the forest and there's nobody there to hear it, is it really a noise?. By the same token, if there's healthcare providers in a particular county, even a large county like Sussex County, there's no way to get there to access them, that healthcare is it really a benefit?.

Carol Vassar, podcast host/producer:

But having it right there in the school, it's a benefit, isn't it?

U. S. Senator Tom Carper (D-DE):

Oh, that's great. That makes all the sense in the world. Kids come there, hopefully every day, and it just makes all the sense in the world.

My dad used to say to my sister and me when we were growing up, we'd pull some boneheaded stuff, and he'd say, "Just use some common sense." He said that a lot. We must not have had any, but one of the things we tried to do is use some common sense here and a lot of love, and a lot of love.

Carol Vassar, podcast host/producer:

So, tie it all together for me with regard to the KIDS Health Act. This is going to allow more collaboration, is it not?

U. S. Senator Tom Carper (D-DE):

The bill ideally helps us to address the barriers that exist to support kids and also to support their families. For example, some families, they don't have a car, they don't have a driver's license, and they don't have the ability to get to a doctor, a nurse, or a healthcare center in their county or their community. They maybe don't have enough to get food on the table, and maybe their kid is having to deal with bullying at school, and they need mental health services. Through Medicaid, through the Children's Health Insurance Program, we can actually fund programs to remove these barriers and also help kids get the mental health care they deserve and the physical healthcare that they deserve.

No piece of legislation is perfect. I've yet to write a perfect bill, and even with somebody as smart as Dan Sullivan as my wingman on this, but the KIDS Health Act helps, I believe, enacted, I think is going to help us build a stronger health system that does support healthy children. And because we know that healthy children grow into healthy adults who create a more vibrant economy where people can go to work and be a good employee. And also, Dan Sullivan and I are both retired military. We're always concerned, making sure that we have a strong, capable military and frankly, provide a future for our nation so that maybe the next generation can have a better life than we've enjoyed ourselves.

Carol Vassar, podcast host/producer:

To broaden the lens just a little bit, I'm curious how you envision or what do you envision to be the most critical challenges facing our nation's kids, and how can we get to the whole child health approach that we've envisioned in this bill to meet those challenges?

U. S. Senator Tom Carper (D-DE):

Let me give you an example of what we did in a little state. I mentioned earlier I became governor, my wife Martha and I was just having a family and we saw firsthand how much those little baby, toddlers could learn. And they ended up in kindergarten, they ended up in first grade. They ended up there, they could read, they knew their numbers, they could do addition, subtraction. They'd sit next to kids in their classes, in public schools, they went to public schools, who in some cases they didn't have that opportunity, didn't have it. And so I just said, we're going to make sure to do a better job of making sure that kids, when they walk into kindergarten at the age of four or five, they're ready to learn.

And one of the things that we've done in Delaware is to make available parenting training for parents so that they would understand how to be a better parent and being a better partner to the teacher of where their kids are going to school. We actually put together it looked like a calendar, like a 12-month calendar, of what you should be doing with your kid with respect to ABCs and different things. So just making sure that a kid's getting started, how a parent be the first teacher for their child.

We took a program out in Missouri. Like I said, finding what works, do more of that in Missouri. We had a program called Parents as Teachers, and they actually had parenting trainers that would go to the homes of new parents, one-on-one training for the new parents. And one of the things that we did in Delaware, when somebody's bringing a child into the world, we'd actually have the parenting training to go to the hospital and meet with the parent, provide that calendar that I talked about. It's in English, it's in Spanish, to get the kids off on the right foot. You never start too soon. You never start too soon. So we try to start early, early on, and provide a good roadmap and counseling and advice for parents. No parent wants to be a lousy parent. No parents wants their kids to fail, they want them to do well, they want to feel proud of their involvement in it. I'd like to think we are pretty good at that in Delaware.

Carol Vassar, podcast host/producer:

Democratic Senator Tom Carper of Delaware is a lead sponsor of the KIDS Health Act.

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Carol Vassar, podcast host/producer:

Senator Carper noted that there is a Delaware County, Sussex County, that faces additional challenges when it comes to healthcare delivery due to its rural nature, and that the KIDS Health Act could provide innovative opportunities to better serve this region. That's an underlying theme of the act that also appeals to Republican Senator Dan Sullivan of Alaska, who you just heard Senator Carper refer to as his wingman on this legislation and with whom we also spoke about it.

Here's Senator Dan Sullivan, giving us a vision of the enormity of the state of Alaska and the unique challenges it faces when it comes to providing healthcare to its more than 733,000 residents.

U.S. Senator Dan Sullivan (R-AK):

We're a huge state, almost three times the size of Texas. Senator Cruz and Senator Cornyn from Texas don't like it when I mention that. We have a little joke in Alaska: if you split Alaska in half, Texas would be the third-largest state in the country, right? The Texans don't like that either.

But we don't have a lot of infrastructure. What do I mean by that? We have less road miles than Connecticut, and yet we're almost 120 times bigger than Connecticut. We have over 230 communities in Alaska that are not connected by roads. Now, most Americans think, heck, every town and every state is connected by road, not in Alaska. So you have challenges that way. Even the hospitals...we don't have a lot of hospitals. We have 26 hospitals across the state responsible for serving the entire population. A lot of these are small. Think about it again, Texas, in comparison, has about over 400. So those are some of the big challenges.

We have a wonderful Alaska native population that's about 20% of our population, and they actually have, in many ways, their own healthcare system, which in many ways is a very innovative healthcare system, but it just adds complexity to the overall delivery of healthcare. So, those are some of the challenges.

I'll mention one other, which it's not easy to talk about. It's a topic that I've been focused on in my entire career, particularly when I was attorney general and now as a U.S. Ssenator. We have really high rates of domestic violence and sexual assault, which, of course, leaves scars and intergenerational trauma for families throughout the state. And it's something I've been working on, in terms of trying to change the culture, in terms of legislation, but it's also something that really, let's face it, negatively impacts our outlook, our wellbeing. And so those are some of the challenges.

But I would also say we're proud of our innovations. In many ways we're big innovators because of these challenges with regard to healthcare. As I mentioned, the Alaska Native healthcare system, very different from the Lower 48 Indian reservation system, is very innovative. So that's very helpful, and that system can actually help natives and non-natives. We were the first state in the country to get a 1332 waiver, and we've used that really, really effectively. A lot of other states have looked at some of the innovations that we've undertaken.

And again, because of the challenges, there's no doubt we were the front-of-the-line innovators really starting about 30 years ago under the leadership of Senator Ted Stevens, who was our great senator for about 40 years, in terms of telehealth delivery. We have been on the forefront of innovations in terms of telehealth. So, that's a bit of an outlook on the challenges and innovations, but every state's unique. Alaska is pretty darn unique, though, relative to everybody else.

Carol Vassar, podcast host/producer:

So it may be obvious from the conversation we've had this far, but I'm curious: what led you to be one of the lead sponsors of the KIDS Health Act? How do you envision it helping to support children across the nation and in your home state of Alaska?

U.S. Senator Dan Sullivan (R-AK):

Well, I think that everybody is seeing, if you just do a little bit of studying, what's happening with regard to the mental health of our children. I have three daughters, they're now in their 20s, very blessed man to have three wonderful daughters. But when you look out at the youth of America and there's a whole host of reasons for this, but starting about 10 years ago, the rates of depression, the rates of anxiety, unfortunately the rates of suicide have dramatically spiked. COVID certainly added fuel to the fire with regard to that, but there's been studies that have come out that we've never seen a generation of young Americans this anxious, this depressed, and in some ways, this fragile.

And so, what we wanted to do with the KIDS Health Act is to enable at the lowest in state level, a dramatic increase in FMAP funding that could come with regard to lump sums, focus on kids, focus on their health, focus on mental health, and then let the innovations that occur in different states lead the charge.

The one thing we have learned in Alaska, and I think it applies to all states, but we see it in our state all the time, is one-size-fits-all approaches from Washington D.C. almost always don't work. When you get the dramatic red tape from the bureaucracy in Washington D.C. and the siloed healthcare that often comes from the big bureaucracies here. By the time it gets to a state like Alaska that has many unique challenges, you're missing the target. So again, what we're trying to do here is innovations focused on kids, particularly focused on expanded mental health opportunities, and break down some of these barriers in the red tape that exist from Washington D.C. on young people receiving mental health services.

And again, it's going to be different in Alaska versus, for example, Delaware. Senator Carper and I are the two leads on this act in the Senate. We come from very different states, but the fact that we could agree on this and say, hey, lump sum, increase FMAP because this is such a priority. Look, when I mentioned the numbers, but it's particularly acute with regard to young girls in America. The CDC did this study, I'm sure you saw it pretty recently, that had almost one-third, almost one-third of young girls in America either depressed or even contemplating suicide. If you don't think that's a crisis, a lot of people talk about, hey, there's a crisis here or a crisis there. My view is if one-third of the young American girls in our country are contemplating suicide, that's probably one of the most important areas of crisis we collectively as Ssenators need to focus on.

Carol Vassar, podcast host/producer:

And again, it goes back to prevention, it goes back to addressing the social determinants of health, that those are two really big core parts of this particular bill. And the bill is also helping to support data sharing and service coordination across sectors so that we can address social needs, an issue that you helped bring to the forefront in the US Senate. What does that look like on the ground?

U.S. Senator Dan Sullivan (R-AK):

Yeah, so Carol, that was another big idea in my LINC Act, and that was the whole idea of trying to address the social determinants of health and breaking out of these silos that, I mean, nobody does this on purpose, but the fact that healthcare in many ways has become siloed and we're not able to treat healthcare challenges holistically is something that in many ways almost becomes embedded in bureaucracies as they think in bureaucratic means, not in terms of holistically treating the patient. So, it's both, as you mentioned. I appreciated that idea of sharing the data. That's an element of the KIDS Health Act, and it's an element of my LINC Act.

We actually have a LINC Act for veterans. This is another group that I care deeply about. Alaska has more veterans per capita than any state in the country. I'm on the Veterans Affairs Committee, which actually legislates a lot on healthcare. So, we're trying to take this idea of social determinants of health and breaking down the silos, and holistically addressing healthcare challenges, whether it's youth like in the KIDS Health Act, whether it's the LINC Act, which I co-sponsored with the Democrat Senator Chris Murphy from Connecticut, or whether it's the work we're trying to do with veterans, but we think it's a way in which you try to do it across the board with prevention and breaking down the silos. And I think that, by the way, we're going to find out that that's the least costly way to address these challenges, too.

Carol Vassar, podcast host/producer:

It sounds like cross-sector partnerships are really important to the work that's being done or will be done once we get the KIDS Health Act passed. How important are they for tracking and improving outcomes overall?

U.S. Senator Dan Sullivan (R-AK):

Well, I think it's really important, and that's a theme in all of this legislation. You talk about the cross partnerships, and it's also the cross-data sharing that really I think is important because when you're tracking these challenges if you keep it in silos, you're not going to be able to learn whether it's another nonprofit or whether it's another federal agency. So sometimes you have to mandate that, sometimes you just encourage it in terms of legislation, but I think that to your point, that's a really important way in which to address the data gaps. And once you address those, you have a better means to get at the end game of the problems that we're all trying to address. And right now, again, to me, the biggest one we're facing with our youth is the mental health and depression challenges that seem to be very ubiquitous all over the country.

Carol Vassar, podcast host/producer:

As we look at this bill and many others that are like it, we're talking about cultural change, we're talking about cross-sector partnerships. We're talking about being in this for the long term. How do we get across to the public that this is not a one and done?

U.S. Senator Dan Sullivan (R-AK):

Yeah, it's a great question, I think it's a really important question. And to me, the way in which you do that is you got to highlight the extent of the problem. And what we've tried to do is sounding the alarm on youth mental health.

I'll give you an example of someone who's doing a great job on this, in my view, and that's the Surgeon General of the United States. So I hosted him in Alaska last summer after he had published a number of these studies by the Surgeon General's office on the data showing depression, showing the challenges dealing with loneliness, all among America's youth. And what I wanted to do when I had him in Alaska was just bring him to the state. We did round tables, we did a town hall, we did some media, is just to get the word out and show that this is a challenge. And then, as you know, it's always important not just to lay out the challenge, but lay out the solutions because when you do that, you provide people hope and give them a sense that, hey, if I'm struggling with some of these big problems, which so many other Americans are struggling with, there is hope, there's a way out. And again, when you have legislation that tries to cut across many different siloed areas and focus on prevention, I think that's the best way to do it.

Carol Vassar, podcast host/producer:

Anything I haven't asked about the KIDS Health Act that you'd like to share? When can we see it passed? I know there are a lot of other things before the Senate right now, but I'm eager here.

U.S. Senator Dan Sullivan (R-AK):

Well, look, whenever you have bicameral and bipartisan support, there's always good prospects. The awakening that's happening right now in terms of Senators and Members of Congress, in terms of what they're seeing with regard to youth mental health, I think it's only going to increase. Everybody is dealing with this. Everyone has constituents who are seeing these challenges. And as I mentioned, if people don't think close to one-third of young American girls are depressed or contemplating suicide, if that's not a crisis that we shouldn't be focused on, I don't know what is. And so this is an element of that, and I think when people dig into it and see the rationale underlying it, I think it's going to get a lot more support.

Carol Vassar, podcast host/producer:

Republican Senator Dan Sullivan represents the state of Alaska and is a co-sponsor of the KIDS Health Act in the US Senate.

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Well Beyond Medicine.

Carol Vassar, podcast host/producer:

It's always an honor to have esteemed guests on the podcast, and we thank Senator Tom Carper and Senator Dan Sullivan for joining us in conversation about Whole Child Health and the KIDS Health Act.

Whole child health, including the 80% of healthcare factors that happen outside of a doctor's office or hospital, are what we talk about all the time on the Nemours Well Beyond Medicine podcast. What work are you seeing in this area that's promising and you'd like to learn more about? Your guest ideas are welcome. Leave us a voicemail on our podcast website, NemoursWellBeyond.org. That's NemoursWellBeyond.org. There, you'll also find all of our previous podcast episodes, including part one of our two-part KIDS Health Act series, which we'll also put in the show notes for your convenience.

Our production team for this episode includes Casey Osgood, Daniella Gratale, Che Parker, Cheryl Munn, Susan Masucci, and Lauren Teta. Join us next time as we discuss smoke, lead paint, pollution, and other environmental factors that affect the health of all of us, including our children and grandchildren. Until then, remember, we can change children's health for good, Well Beyond Medicine.

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 [OC7]Please remove Kate