Support for Arkansas Week provided by the Arkansas Democrat-Gazette.

The Arkansas Times and Little Rock Public Radio.

Thanks for being with us.

I'm Dawn Scott.

Welcome.

A new ranking places Arkansas near the bottom yet again when it comes to women's maternal health.

A report from the Commonwealth Fund ranked Arkansas 47th overall on its scorecard for women's health and reproductive care.

Joining me is Dr. Joe Thompson.

He is the president and CEO of the Arkansas Center for Health Improvement, also referred to as ACCI.

And we really appreciate you being here.

Dr. Thompson, thank you so much.

This issue is so important to so many of us here in Arkansas.

You're also a trained pediatric mission, but you now lead the center at ACCI.

And I just want to know your first initial reaction to this scorecard.

Well, I think this is yet again a call to action, a wake up call.

Maternal mortality is a real challenge for our whole nation.

I mean, our nation does not do well by its delivering moms.

We have twice the maternal mortality rate of the next developed country.

Our state is twice that of the national rate.

And for women of color, particularly African-American women, it's twice that of white women in the state of Arkansas.

So these are really damning statistics that are a call to action.

Well, it's embarrassing, too, that we are, you know, a leading nation of the world, obviously, and that we're having these problems and spend more than any other nation on our health care system.

So what's the problem?

Well, I think, you know, births are the number one reason people go to the hospital in the United States, and it's become much more technically oriented, much more monitoring, much more invasive.

You know, we've had births for millennia and without some of the interventions.

But now we're having moms that have more health risks before they get pregnant.

Hypertension, diabetes, weight issues, then then lead to more complications during their pregnancy and unfortunately, may not recognize when they get in trouble after they deliver.

And so what is that?

Are we not addressing these problems then on the front end before pregnancy even comes into the picture?

I think we have recognized, but not maybe acknowledged, how much of a risk women have before they get pregnant.

We've done some analyzes both on the number of women who have C-sections, also the number of women who have maternal mortality, morbidity or near-misses on mortality and hypertension and diabetes before they become pregnant.

Obesity issues before they become pregnant are consistently one of the predictors associated with one of those bad outcomes.

Oh, wow.

Our maternal mortality rate in another study put us at the very bottom, the highest in all 50 states.

Why are we at the bottom there?

Well, we have a high rate of maternal mortality.

We also have the third highest rate of infant mortality in the United States.

So we are not doing well by our young families as we launch them on their way.

Maternal mortality is a pretty rare event.

It's unfortunate, but about 33 women a year end up having a death within a year after they delivered their baby.

45% of those during the delivery process itself.

Another 20% in the first six weeks, 35% beyond six weeks, but before the first year.

But that's just the tip of the iceberg.

We have about 430 severe events in the hospital.

These are near-misses that a mom almost died.

It's called morbidity as opposed to mortality.

But we have about 430 severe maternal morbidity events in the first year after women deliver.

Those are the near-misses that we really need to pay attention to and look for ways to intervene to lower the death rate.

Well, a couple of other things that have been pointed out throughout, not only this Commonwealth Fund report, but other studies as well, socioeconomic factors and also rural versus urban.

So let's just start with socioeconomic.

We were a poor state in many regards and that puts us at a disadvantage.

I imagine it does both as a state but also as families.

Clearly, education and income are related to your health status and your ability to engage with the health care system, to take care of yourself, to seek care when you need it.

You also mentioned we're a rural state, so we have 49 counties that do not have a birthing hospital, which means that mom has to have transportation to get to prenatal care, visit visits, as well as transportation.

When she starts going into labor to get to the hospital in a timely way.

Well, it seems socioeconomic combined with rural and the lack of birthing centers is just a perfect storm to put us where we are.

It is.

And our health care system is under duress also.

We've had four rural hospitals that were birthing centers cease delivering babies in their hospitals.

If you think about it from a hospital's perspective, if you're going to offer deliveries, it's 24 hours a day, seven days a week, 365 days a year, one of the more expensive units that a rural hospital tries to maintain.

Every community wants their hospital to be a birthing hospital, but it's financially very difficult and increasingly challenging for many of our rural hospitals to be able to support that service.

So what do we do?

I mean, how can we get services to those people in the rural areas, to the people who seem to need it the most?

You know, I think our center's coming in with recommendations.

The governor has a new effort underway to try to focus on this.

And I know she's got a broad group that we are working with also Under Secretary Mallory and Secretary Putnam's leadership.

I think there's several opportunities and several really needs.

One is on our health care provider side.

We need to sustain those providers that are out there and delivering.

Now we need to help them stay in the delivery mode, help those hospitals that are birthing centers maintain that could be different financing strategies, it could be different support strategies, it could be, you know, adding new types of providers.

There's a discussion underway about, you know, adding a nurse midwife program to actually enhance the number of providers that can help our physicians in delivering.

From a patient's perspective, We need to recognize those risk factors that women have and monitor them very closely after they deliver so that we avoid those near misses and the maternal deaths that we experience each year.

Well, it's interesting.

You mentioned the midwife program.

Dr. Patricia Cowan was on our program about a month ago talking about wanting to expand that.

And also Representative Aaron Pilkington sponsored a law requiring physicians really to offer postpartum screenings to the to the new moms and also requiring Medicaid to cover the screenings.

So how important is that as well?

Talk about insurance coverage, Medicaid for services like midwives, etc.. Let me first start with the importance of women being screened not only for medical conditions, but importantly also for mental health conditions, specifically depression.

Almost 30% of pregnant moms go through depression within the year after they deliver a baby.

It's part of the hormonal challenges and the rebalancing and the stress and strain of having a new baby.

I don't know what your experience was that, but many of those that I know have had that.

We've got about 2% of women that actually go to the emergency room or are hospitalized with depression and issues after they deliver.

So screening for medical conditions, high blood pressure, diabetes, depression is critically important.

But to get screened, you've got to have insurance coverage.

And our state is the last state really to have a limit of 60 days of Medicaid coverage for women after they deliver.

Now, we have mechanisms to offer those women coverage through our Medicaid expansion, but we've got to help women transit across for Medicaid coverage, which covers most pregnancies in the state, into the qualified health plans that we cover in the Medicaid expansion.

That's a transition.

That's a new enrollment.

That's a process that six weeks after you've delivered a baby, may not be the top thing on your priority list.

We've got to help moms transit that much more successfully.

Well, and just on a very basic level, if you're telling me that birthing centers aren't existing in several counties, then there's an access issue, too, to even get to a health care provider who can monitor you while you're going through this.

We really need to support our family physicians that are really statewide, even in areas that don't have birthing centers to do the prenatal care, to do the follow on care.

It doesn't have to be the physician that delivered the baby at the birthing hospital.

But we need to wrap those services around.

The health department does a great job with prenatal care early in pregnancies, but we really need to all those providers start working together and really wrap around moms as they go through this birthing journey.

You know, we've just kind of hated on our state about this.

Is there anything that we're doing well right now when it comes to maternal health?

I think Arkansas has a history of coming together to solve problems.

We did it with the trauma system.

We've done it with heart attacks and strokes to have a system that responds quickly.

I think we have an opportunity now to put that in place for moms in their pregnancies.

It will look different because we have some emergencies during the delivery itself, but we have many more challenges in the year following the delivery, and we need to pay attention to that.

I think we've we've looked at moms is a healthy, you know, aspect and assumed everything is going to be okay.

We have resources that we need now to deploy to make sure make sure that they're okay, not just assume that they're okay and to find those that are in a difficult situation.

If we as a nation and Dr. Thompson are not in a great position when it comes to maternal health, how much as a state can we count on our federal government to help, or is this just going to have to be a grassroots ground, you know, from the ground up effort here in Arkansas to make this better?

Well, you're correct.

Nationwide, the federal government, either through Medicare for seniors or through Medicaid for many of our pregnant moms or poor families is the primary financial source for health care.

Then we have commercial insurance and we have self-insured large companies that provide insurance.

But almost all health care is determined locally.

We license providers locally.

We run our Medicaid program locally.

We have our insurance programs that are local.

So this is really about our state figuring out what the problems are, putting solutions in place, and then monitoring and monitoring to make sure that those solutions address than the.

Mm hmm.

Any other research that you've come across that we haven't discussed so far?

You know, we talked about duals, which I think are not clinical providers, but but coaches for moms, you know, we have first time moms that we don't have the multi-generational family relationships anymore.

So that duals can be an important source of information and guidance for our moms.

We talked about coverage.

We also have an incredible challenge with teen pregnancy.

We have 600 teens, less than 17 years of age or 17 or under that delivery tier, more than 115 or under that delivery each year.

About 50% of those have another baby within the next 2 to 3 years.

So this really takes them out of their educational path, takes them out of their, you know, economic, you know, stair step path.

Long acting contraceptives, once an individual has proven that they are sexually active, is an incredibly important opportunity for us to break that pattern.

And of course, I would encourage families across our state.

We need to talk to our young teens, boys and girls about how contraception works and how reproduction happens.

We're not having enough of those conversations.

Wow.

Any final thoughts as we wrap this segment up?

Dr. Thompson with a chi, we want to hear just what your final thoughts are.

I would just encourage not only our clinical community, but our faith based community, others across our state.

If a mom is expressing concerns, if a mom doesn't feel good, listen to them and take action.

This is about not wrecking rising when moms are getting into trouble and getting them to resources that can help them avert bad outcomes.

Great advice.

Dr. Jo Thompson with the ACCI or the Arkansas Center for Health Improvement.

We sure appreciate you being here.

Thank you so much for your thoughts and for your information today.

Thank you.

All right.

And we'll be right back with more after this.

Welcome back to the program again.

I'm Don Scott.

Three proposals for a new farm bill are under consideration by Congress, though passage this year is considered a long shot.

The omnibus bill provides key policy provisions for federal agriculture and for food programs.

And joining us for the latest is economist Hunter Byrum.

He is with the University of Arkansas Division of Agriculture.

And we appreciate you once again joining us.

Happy to be here.

Well, you joined us on the program six weeks ago, in the days after Senator John Bozeman unveiled his own proposal.

And it's been essentially ten years since a new farm bill was passed.

So a new one typically approved, isn't it?

Every five or six years, Every five years tends to be the target.

So what's the latest of the three competing proposals right now?

So the latest is there has been practically no movement since I was here six weeks ago.

That seems to be part of a standstill right now.

So just as a quick, quick update, you know, the the House committee were able to pass the Chairman Thompson proposal out of committee.

So it's ready to go to the floor now.

On the Senate side, we have these two proposals, you know, one from our senior senator from Arkansas, John Bozeman.

And then we have Debbie Stabenow from Michigan.

And Senator Stabenow is the chairwoman while the senior senator from Arkansas is the ranking member.

And so they have two different proposals, which, you know, more or less, I guess, the buzz, the buzzwords.

And so proposals that have come out of more or less more like frameworks, because at least on the House side, we've seen some we have seen that language.

But on the on the seven said we've seen a percentage change in some of these programs and in the Bozeman framework, we've got a framework.

We've also seen a few proposed percentage changes, not not as much that explicit writing out compared to the House proposal for well, for viewers who may not have been with us six weeks ago.

Let's go over a little bit of the proposals, just the key differences between the three.

Sure.

So in my area, I work more in production economics for agriculture.

So I'll focus more on the farm safety net.

And that's where the key differences, I think, arise.

So in the in the House version, like I mentioned with Chairman Thompson, he is proposing anywhere from a 10 to 20% increase in the statutory reference price.

Not all you got to know is this is going to just think of this as a farm support.

So when those input costs get really high and farmers aren't able to cover them with the crop prices that we currently have, which the market, by the way, right now is not very great.

These support these these target prices or these price supports will help these farmers continue to far more or less.

So that's all me whenever I'm talking about that reference price.

So the so the Thompson proposals anywhere from a 10 to 20% increase in that target price whereas on with Senator Stabenow is proposal it's about a 5% increase and that's all that I've seen is 5%.

And then on the Boozman proposal, they're talking about maybe about a 15% increase for all the crops.

So you can already see that 10 to 20% versus 5% and 15% versus 5%.

Some pretty big difference.

Pretty big differences for farmers here in the state.

The Division of Agriculture has been evaluating.

You're assessing each.

Is there one that you favor more than the other or you just want as much support as you can get?

So I think that we don't want these programs to be just straight income transfers.

At the heart, these programs are risk management programs.

And these programs, originally they were intended and still are, should be intended to just help farmers continue to farm.

We're not trying to line pockets, you know, people that are running policy.

It's not about lining pockets.

It's about farmers continuing, continuing to farm.

And so what I look at in the analysis that that that we do is, okay, here's our net farm income situation by county for each crop enterprise.

Here are these three proposals and here are the changes in the in the in the payments under these proposals given where net farm income currently lies.

And so we look at the differences and how these payments are greater than or less than compared amongst one another.

But what about at the state level?

What about by county and by crop?

So what we found that just more or less what we find is the Chairman Thompson proposal from the House and the Senator Boozman proposal from the Senate committee, those are going to be those offer the strongest farm safety net for Arkansas producers.

So we're talking about rice, long grain and medium grain.

We're talking about corn, talking about soybeans, winter wheat, peanuts and cotton.

Well, you talk about this net farm income, but why not just a payment per acre?

That's a that's a great question.

I get that all the time.

So when we think about just the payments, that's what CBO, the CBO, they are trying to score these policies.

What I'm looking at is do these programs achieve that goal of helping to stabilize farm income?

Can these farmers continue to farm, given these safety net proposals?

And so in light of revenue minus cost, you know, revenue needs to be at least zero, you know, revenue minus cost, but also, what about revenue slightly above cost?

We therefore don't want to be looking at anything below cask as that can drive people out of business.

So the end of the day, we want to look at how these proposals fare in light of net farm income and keeping farmers farming.

And do you account for the difference between planted acres and base acres?

Yeah, we absolutely do.

And so for those who are less familiar with Plan Acres and base Acres, Plan Acres are what we see year to year.

So there's gonna be a farmers going to go out, say, I'm going to plant 200 acres of corn.

You're going to see that.

But basically, as you might not see, so base acres are just a measure of acreage.

It's based on historical plantings.

And so those base acres are acres upon which these payments are going to be made.

They're not always going to be the same as planted.

So that's why this is such an important question is is because planted acres, maybe 200, but base acres may only be 100, or it could be 300 or 400 just based on those historical plantings.

And those base acres don't change when the plan on acres can change year to year.

But those base acres, once they're established, they're established and so we we account for that in this.

We do account for that.

Is there a proposal, in your opinion, with a stronger safety net for Arkansas producers?

Say so.

Overall, Chairman Thompson's proposal offers a stronger safety net, but I answer that with a caveat.

So the Bozeman proposal, just in light of how we do this, offers, you know, is following very closely behind Thompson.

But that's only because in the framework, the budget proposal offers that 50% increase across all the crops, whereas we actually have by crop with Thompson's legislation what those changes look like.

So, you know, we look at ten 20% with Thompson versus 15% across all across for four for Senator Bozeman and so depending on that by crop increase versus this increase across all crops, you're going to see some differences.

But I mean, they're pretty much I mean, they are very similar.

I will say they're are very similar with Thompson from what I'm seeing, showing to be just slightly stronger than senator.

But so interesting, both of Arkansas senators said last week that the passage this year is really unlikely.

It's a key safety net for agriculture, though, and it's Arkansas is, of course, largest industry.

So I'm curious, in your opinion specifically what the ramifications are if it's not passed?

I think it's very serious.

This year, crop prices are very low.

I mean, a couple of years ago we could say that crop prices were relatively good and even in light of costs, they were relatively good.

But I mean, we're looking at historically low prices this year and no signs of, you know, will demand drop prices up.

If anything, I'm looking at how much supply we're going to have, how much production are we going to have that may drive that price down.

So it's very serious.

So what are some things that could be done?

There could be an extension of the current 2018 farm bill, which to me is just in essence a version of the 2014 Farm bill.

So we could get another extension of the 18 farm bill, but there could also be some opportunity to get into the Sea of the Commodity Credit Corporation funds to be able to help farmers continue to farm while the current farm bill is being debated.

Well, you talk about these historically low prices.

Is that just an issue of supply and demand, or is there more at play there?

It's largely upon demand.

I mean, we we we saw these price increases in 2022, one because of COVID and the and the Ukraine invasions and more notably in corn and wheat.

We saw that with the with the Ukraine invasion.

And I won't get into all that right now.

But there was a there was a price spike then, but now production is stabilizing and we've had some really good crop years and no signs of any demand that's going to shift that price upward.

Hmm.

You know, the farm bill provides funding for non-farm programs to the Supplemental Nutrition Assistance Program, which was formerly known as food stamps.

And, you know, that's another dynamic altogether.

But surely it's at play here.

Oh, absolutely.

So the snap is also considered in the in the reauthorization of a farm bill.

So SNAP or nutrition conservation.

And then these Title one farm programs are all three at play whenever we're talking about reauthorizing or in this case, you know, do we just do we continue to reauthorize for this year or do we need to go and pass this new piece of legislation?

Either way, those programs need to be authorized through legislation.

So are they accounted for in each of these proposals?

Yes, they are kind of for in each one of the proposals.

As far as I know, there are no cuts in any of the proposals.

There's only a slight boost coming from the from the Senator Stabenow proposal.

That's what I was going to ask, what the differences were in each of the proposals related to SNAP.

And hers is the only that provides any type of increase.

Are we okay with that?

Like in the other bills, for example?

Well, that's a that's a good question.

Are we okay with it?

You know, what are what I want to point toward is the farm bill was the first word there.

It's farm.

And so if we cannot provide a farm safety net for these producers to continue to provide this stability in our in our food supply, which then translates into typically lower prices aside from the inflation.

So accounting for inflation, you know, we typically say that these prices will be lowered within with an efficient food supply chain.

If we don't have that.

It's to me it's we need to consider both sides.

So what if we what if we only had this nutrition title?

What if we only had this nutrition program?

But there was no there was no food.

There was nothing There was no food on the supply side for these programs to be utilized for.

It almost seems like it's pointless in a way.

So I think it's important to think about these jointly.

I think it's important to think about that.

At the heart of this piece.

This legislation stems back all the way to 1933, all the way to the farm.

The farm bill started in 1933, and every year we have to try to figure out how can we continue to keep our farmers farming.

And through that and just through the political process and the policymaking process, you know, we've seen the the food portion of that get larger over time, but we're seeing that you need both to pass the farm bill to pass the farm bill.

You know, you mentioned some contingency plans.

If if the bill doesn't pass, just maybe they extend 2018, maybe they don't.

I mean, what then?

What then?

Well, worst case scenario, if there's no 2018 Farm bill, there's just no farm bill.

There's there's no legislation authorizing these farm support programs or these nutrition programs.

Interesting.

Wow.

What else, in your opinion, is worth watching as the debate plays out on Capitol Hill?

Well, we need to see what happens with the election.

You know, every House seat is open.

There are 33 Senate seats with seven or eight that are more of a toss up right now.

But there are three Senate seats open.

This has to happen.

I can't remember what year it was, has been several years since we've had this many Senate seats open and every House seat open.

And so you have those two those two events happening.

But then we also have the race for the White House.

And we know what's been going on with all that.

We don't have time to talk about that today.

But just I would say for all the listeners, for all those that are watching to keep tabs on what's happening in the policymaking process, what's happening in the political process, because it impacts all of us, and especially here in AG, we have their implications for agriculture, for the farm bill passing as we keep an eye on this.

All right.

Hunter Byrum, thank you so much, with the University of Arkansas Division of Agriculture, our economist here giving us great information on the farm bill.

We so appreciate your time.

Appreciate you.

And that does it for this edition of Arkansas Week.

Thanks for being here.

We'll see you next.

Support for Arkansas Week provided by the Arkansas Democrat-Gazette, The Arkansas Times and Little Rock Public Radio.