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- It is pretty typical here in the dead heat of the Carolina Summer that many don't pay a lot of attention to the business at hand.

Welcome again to the most widely watched and longest running source of Carolina business, policy and public affairs scene every week across North and South Carolina.

I'm Chris William.

In a moment, we unpack some of these issues that are still very real, still very important in going on from healthcare to education, to business, to current economy.

And we will try to take a look at these issues and bring them back to the fore.

And later on, we are joined again by the Secretary of the Department of Health and Human Services in North Carolina, the Honorable Kody Kinsley, stay with us.

- [Announcer] Major funding also by Blue Cross Blue Shield of South Carolina, an independent licensee of the Blue Cross and Blue Shield Association.

And Martin Marietta, a leading provider of natural resource-based building materials, providing the foundation on which our communities improve and grow.

On this edition of "Carolina Business Review," Dr. Mary Ann Wolf from the Public School Forum of North Carolina, Antjuan Seawright of Blueprint Strategy, and special guest, Kody Kinsley, secretary of the North Carolina Department of Health and Human Services.

- Happy Summer.

We're getting] close to the end of it, but Dr. Wolf, welcome to the program.

Good to have you here.

- Thank you so much.

- You say that now, but after you interact with this guy next to you, you might feel differently.

I'm kidding with you, we love Antjuan.

So here we are in the dead heat of the summer, or more than halfway through the summer.

What's still more important for you?

What is primary on your radar, Mary Ann?

- Teachers.

I have to say that when we look at education across North Carolina, but I would say across South Carolina, across the country, we know that we're experiencing shortages that we've never seen actually.

And in North Carolina, at the beginning of last year, we had 3,600 vacancies.

And that doesn't sound like a huge number, but when you think about every classroom in an elementary school would be 25 students, in a high school, 150 students, it's a big number.

And not only that, we had another 3,600 slots that were filled by teachers that were not fully certified.

And so we know that there is a lot going on with these shortages, we're seeing increases, and we are very concerned because we know that teachers are the number one school related factor that impact student outcomes.

We need highly effective teachers.

And so our districts are working hard to hire.

But in North Carolina specifically, our pipeline has really reduced over the last decade, colleges of education undergraduate enrollment is down 44%, so that's over the last 10 years.

So we know we have a lot of work to do, and at the same time, we have great things happening in our schools, but teachers matter tremendously to ensure that those continue to happen for our students and our families.

And I know South Carolina is doing a lot as well to try and work on that.

And there's a couple of issues involved with that.

- Yeah.

And not surprisingly.

Antjuan, what's your number one thing during the summer?

- Well, I absolutely have to agree about teachers and education.

As a first generation college student and only a second generation high school graduate, I know the importance of a good foundational education and what it means for a long-term bill of health for the entire community, whether you're black, brown, rich or poor regardless.

And so I think that's so important, but I'll probably wrap that all up because I tend to suffer from political nearsightedness.

I can't see too far in the future, but I do see what's right in front of me.

And I think we have to get back focus as a community on bread and butter issues, barbershop and beauty salon, kitchen table issues, whether it's education, whether it's infrastructure, whether it's healthcare, whether it's the environment, those things that really project what the future, not just what this region looks like, but what this country looks like.

And if we solidify those things and not get distracted from a personality standpoint and focus on a policy standpoint, I think we're all better regardless of what labor we may subscribe to.

- Well let, let's bring this into the dialogue.

So since 2020, the Southeast has been responsible for two thirds of the job growth, and all of a sudden there's been this huge wealth leverage policy shift to the south from the northeast.

This is not unmeaningful, this is a big deal.

So back to this idea that, okay, the Carolinas have had now at least two years, maybe three years of budget surpluses, and they've done it through discipline of course.

But these are good problems to have, I'm assuming, but you talk about the, and not to say that they're not right, but you talk about education as if we're almost a third wheel country when it comes to this.

Are we?

I mean, is there enough funding?

Are we just not doing policy right?

- Yeah, so there's many different areas of funding for education that we need to work on, but a couple that I think we just have to point out, a beginning teacher in North Carolina, the state has set the salary at $37,000 that is below a livable wage.

And over many years it has not increased dramatically.

Comparatively, South Carolina made a big stand last year and increased it to 40,000, and it'll be up another 2,500 this year.

- In South Carolina?

- In South Carolina.

So in North Carolina we find it very hard to attract educators into the field because they know they're making a sacrifice and people go into education because they wanna help kids, but they have to be able to live in the communities.

And when you talk about this growth in business and where we rank and all these advantages.

- You think that doesn't square?

- It doesn't square - What's the average teacher pay in- - The average teacher pay is in the low to mid fifties- - Okay.

- In North Carolina.

And pretty similar in South Carolina, although I anticipate that will grow.

And so when you look at that and what we're investing, not only does education matter for all the reasons Antjuan just shared for individuals, for families, and for communities, but businesses need a workforce that's prepared well and educators matter so much for that.

But businesses also wanna be bringing employees and attracting them to communities that can thrive and schools matter for that.

- Okay, I wish we could unpack more of our education.

- Yes, I know.

- But Chris, can I say this quickly?

Yeah, I think the reason we have our challenges because we've allowed folks to politicize education and I think that's where we've hit the danger zone.

We've brought into the conversation of education of saying that we should be teaching this and ignoring certain parts of history.

We've tied funding to whether it's a public school conversation or private school education, when we know the fundamental strength of every state's education system should be built around a strong public education system.

And that impacts every other thing that happens within the community.

And it has long-term impact on that community's bill of health.

And so we have to pay teachers, we have to make sure that we're training our students to meet the needs of tomorrow, not necessarily today.

And we have to make certain that we put our children on track to meet their future needs.

Because every child is not a college graduate, every child will not go to the military, some people are career ready, we have to define that a little more, and we have to make certain that they're trained for the jobs who will come that you mentioned in your introduction about the jobs coming south.

- Yeah.

- Yeah.

Okay, quickly, I want to touch on a couple things.

Mary Ann, North Carolina was tops in business, again according to CBC poll, and education is certainly a measure of that.

So I don't want to go down the education thing again, but what does that mean as an educator for you, maybe economic development or community development, but you're also sat on a school board, so you know a little bit of something about that.

So as you see these things about North Carolina, are you encouraged about that?

- So I think it's exciting that North Carolina's attracting business and all of this.

My worry is that's a lagging indicator to share a conversation, I know we've had in that if we're not having educators in the classroom, and investing solidly, and taking the surplus you referenced, and investing that into our schools, I mean, we are $3,000 at least below the national average of how much we spend on students.

- Right.

- And we had $6 billion in surplus last year.

And so my worry is that that looks great right now, but if we can't continue to build this strong workforce, invest in what kids need, and support that workforce for the companies that are coming in.

But also we want people to want to live in South Carolina, in North Carolina, and the schools are the hubs of these communities.

- Okay, let's go to South Carolina quickly.

If the economy slows down, what's the worry for you?

- I think the worry is that rural South Carolina on the rural south, and those who may not be able to afford to keep up, can't keep up.

And that means the least of these suffer.

So the Antjuan Seawrights of the world whose grandparents are sharecroppers, mother and father work two jobs, forget about trying to make ends meet, they were putting two ends together hoping to meet.

Those are the people who suffer the most when the economic situation begins to change in any community.

And that's what I worry about because the people at the top, they're gonna be okay.

So I think collectively we have to focus on a bottom up, middle out strategy and recruit jobs, industry and business into the communities that have been left out and left behind for a very long time.

And if we strengthen those communities, I think everything else will calcify itself and it'll take care of itself long term.

- Good term Antjuan in about 30 seconds.

So South Carolina, the State House has had also a budget surplus in the Palmetto state.

Do you think legislators would be sympathetic in a slowdown in the economy to bring to bear some of that surplus for those that would be at risk?

- I think the politics of South Carolina will not necessarily allow that to change.

But what has happened traditionally in our state is the tectonics plate shift, and we are forced to do certain things that we should do without any necessary push or pull.

And I worry that sometimes when that happens, our state suffers and lags further behind North Carolina, Georgia, and some of our neighbors who are full steam ahead of trying to compete for the top spot.

- Okay, thank you.

Talk about politics, coming up on our program, actually next week.

He's considered by many that one of the most powerful men, if not one of the most politically powerful men in North Carolina.

He is the president pro TEM of the North Carolina Senate.

His name is Phil Berger.

No doubt you have most likely heard him.

He will be a guest on our program.

And then also coming up, she's the chairman and chief executive officer of one of the largest utilities in this country, Lynn Good from Duke Energy joins us again as well right here on our program.

Our guest now though, came on board in North Carolina in a healthcare and policy leadership role a few years ago with the idea that mental health was going to be his sole focus.

Then he got the top job as the secretary of North Carolina DHHS, and now he's balancing behavioral health with many other priorities across the Tarheel state.

We welcome back again the Secretary of Health and Human Services in North Carolina, the Honorable Kody Kinsley.

Your Honor, welcome back to the program.

- It's great to be here.

- We wanna get into mental health, no doubt, sir.

But let's start with Medicaid expansion.

It was a big day in North Carolina, right, sometime earlier this year, except we don't have the budget yet to backstop that.

So Mr. Secretary, how do you plan the deployment of Medicaid expansion in North Carolina with North Carolina's budget still not being fully solidified?

- So March 27th, governor Cooper signed into law Medicaid expansion, and that law was tied to the budget passing.

But let's start here, Medicaid expansion is not, there's no financial investment from the state taxpayer, it is self-standing.

And so we could also decouple it from the budget and keep moving forward.

I leave that to our partners in the legislature to figure out, meanwhile at the department, we're doing everything we can to be ready because we want the 600,000 people and the $8 billion that will come into North Carolina to get going as soon as possible.

And so we've set a go live date of October one, we'll do our external notice and comment stuff, we will work with our tribes in North Carolina as part of their consultation process because we want people to be able to get healthcare as soon as possible.

We know how important that is for them, we also know how important it's for the business community.

The vast majority of these people are in working families, 80%.

And so when you think about Medicaid expansion, think about vibrant small towns and small businesses that can't afford to give their employees healthcare, think about childcare where more than half of the people working in childcare can't afford health insurance and their businesses can't provide it to them.

We want them to be healthy, to keep our small towns, to keep childcare, to keep those things working.

This is a smart investment in North Carolina and I'm committed to getting it done as soon as possible.

- Dr. Wolf?

- Yes.

So we mentioned mental health, and I know in the work that I do in education and in the communities across our state, we know that mental health in our students has just become much more of a challenge.

And it was already on the rise and then the pandemic hit as you know.

And I'm just curious if you have thoughts on what we could be doing as a broader community, but also in schools to really support our students and then what it will it take from the state to make that happen.

- Yeah, I think we have to start here, which is understanding that mental health is not something that is special and only impacts a few people.

Five in five people have good mental health.

One in five people will have a mental illness in a given year.

We're seeing issues that are particularly acute in our younger North Carolinians, and we put out a strategic plan, the governor launched a billion dollar investment roadmap and it talked about taking the mental health solutions to where people are, and for children in particular that's in the schools.

We have to make trauma informed interventions that support teachers, support other school staff that look like mental health first aid training so that folks can recognize the problem.

Looks like peer training for other students because they're talking to each other whether we want them to or not, about their mental health and how they're feeling about things.

It also looks like resourcing access to healthcare and more outpatient providers because we have a lot of school counselors that try to refer with nowhere to go.

So at the end of last year we put out a school behavioral health action plan.

I'm hoping that in the budget we'll see some investments for what we called for for that.

And we also launched NC Powell, our psychiatric access line that allows teachers and other school staff to pick up a phone and be on the other line with a behavioral health specialist to try to coach them on what to do in the classroom to support things that are happening there.

- [Chris] Antjuan?

- First of all, thank you for what you do.

Healthcare, like many things are an investment, not an expense, so I appreciate your service.

But I want you to frame out or give background color to who a Medicaid expansion recipient may be.

'Cause there's conversations that there only certain demographics and only certain geographics.

What does that look like?

And then two, what does this mean for business economic development and the long-term economic bill of health for not just North Carolina, but for this region?

- Yep.

Healthcare is expensive, I think every person knows that, every business knows that, and I can talk a lot about what we need to do to control healthcare costs, but at the first place that we start is making sure people have coverage.

People that live in, well, I mentioned this earlier first, 80% of the people set to benefit from expansion are in working families, these are people who are often working poor.

You said earlier, it's not just about making ends meet, it's about having two ends and hoping they do, that's the situation that many of these families are in.

These are often single mothers with multiple jobs who are working incredibly hard and supporting their family members, but they can't take care of their own health.

In addition to that, it's people who live in rural communities.

People in rural communities are three to four times as likely to be uninsured as people in urban spaces.

So if you're opening a behavioral health company in a rural community in any place, and 30 to 40% of the people who walk through your door can't pay, how do you stay open?

First thing you do is drive up the cost for the other people.

And the second thing you do is eventually close.

And so this is why this is a huge investment that not only helps control cost across the board, but it helps lower cost over time.

- Secretary Kinsley, I know you thought about this, what's the cultural genesis of this spike in mental health issues?

It can't all be opioid.

I mean, is there one thing that it stems from?

- Well, I think that we have to all acknowledge that the last three years have been particularly traumatic and stressful for everyone.

Everyone experienced isolation and anxiety in ways they had never felt before.

The Carolinas have a familiarity with hurricanes and other events, we know and we see in our data that usually the peak of need for mental health after a massive coastal storm is usually about six months later.

Well, we had peak after peak after peak of a storm that never stopped, that put us in our homes and separated us from the things that drive overall health and wellbeing.

However, this is also just a moment where we have been ignoring mental health for a very long time.

And- - No champion for mental health basically.

- Right, exactly.

- Yeah.

- And we have got to change that.

- Okay, just a quick follow up on that.

It seems like, and this is my term sir, it seems like that mental health has been in triage mode.

Is it still in that crisis mode in your opinion?

- We're still in crisis mode right now.

We've got, on any given day, about 350 North Carolinians that are sleeping in emergency departments waiting for more higher levels of psychiatric care.

At the same time, we have dozens of kids that are sleeping in DSS offices across North Carolina because they need, say, psychiatric care.

We are working hard, again, the governor's investment roadmap that we need the general assembly to fund, to build the places for those people to go, but at the same time, we have to get upstream and try to prevent people from getting in that place in the first place.

That's why we need more outpatient care, more preventative wellness.

I'm actually looking to my colleagues in South Carolina who are doing some really great work here in changing the way services are available, starting by increasing behavioral health rates.

Lemme say this, in North Carolina, behavioral health rates have not been increased in the Medicaid program since 2012.

Now I can't buy eggs today for what I used to pay in 2012, and so we have got to invest the resources necessary, and an investment in behavioral health drives down costs for local governments, for sheriffs and their jails when 60% of people have a substance use disorder for homelessness experience.

It also drives down costs for businesses.

People show up to work, they're healthier, they're happier.

It's a smart investment.

- Yeah.

- I Think so.

- [Chris] Mary Ann, question.

- So with, you mentioned trauma, right, and trauma informed practices in our schools.

And we do a lot of work with schools and the need is just growing.

We're being asked to come in, but food insecurity falls into that in a lot of ways, even though I don't know that it's been documented for as long in terms of an adverse childhood experience.

I'm just curious around school and nutrition, we did see some glimmers of hope, oddly during the pandemic where we were providing more in terms of school nutrition that I think helped all of our communities.

And I'm just curious what your thoughts are going forward.

How do we kinda see some of those positives so that we don't go backwards?

- Yep.

So food is an essential building block to health, and the department has invested in a lot of new programs to try to expand reach to food or healthy opportunities pilot allows us to essentially use Medicaid healthcare dollars to give people access to food that key building block.

But I'm pretty excited about this new effort that we have as well, which is for the first time ever, I can tell you that a lot of the folks that we have in our Medicaid program are not also in our snap food supplemental food program and are also not in our WIC program, which is so key for women and young children.

Now these are three foundational programs, why can't I have told you before.

And we are now building some nudges, some technology pushes that help people get enrolled in these programs at the same time.

And let me tell you that North Carolina is actually one of the first states in the country that has built the capability to do this analysis between these programs, 'cause I'm not just interested in scaling and building new things, we gotta make good use of what we have today and food is a no-brainer place to start.

- Mr. Secretary, no one retires and moves up north.

So people are moving south to North Carolina and there's jobs and industry, and with your efforts to expand Medicaid expansion, that means there's gonna be more weight on the healthcare ecosystem in the state.

What does that mean for your role in the long-term projections of healthcare in the state?

- Well, I created three priorities when I took on the role of secretary.

And we've talked about both of them, two of the three so far, child and family wellbeing, behavioral health, the third is a strong and inclusive workforce.

Look no further than the direct care workforce crisis, we have an aging state, people need direct care workers that can take care of them either in their home or in facilities.

COVID pushed that over the edge, we now have people that are leaving important direct care jobs to go get paid two and three dollars an hour more in retail roles that are significantly less stressful but don't align to their passions.

We have got to continue to invest in a direct care workforce that meets that need because we are aging, and we're not gonna be- this is something we should all care about.

- Yeah.

- What tole does AI play in the healthcare system going forward in a place like North Carolina, considering you all are one of the technology capitals of the world.

One of.

- Yeah, obviously AI is an incredibly exciting opportunity to try to help diminish the work that can be done automatically.

I think the place that we have to really start, that's a big problem in healthcare, is just getting our data more transparent.

We have a health information exchange in North Carolina that is still not heavily utilized by a lot of our health systems in North Carolina.

A lot of patients don't have access to their own data and they should.

And so before we unleash the power of AI to transform some of those patient experiences to find where the quality is to drive the cost down, we've gotta also make sure that we have access to that data and that we have patients having access to that data.

- When do you think that we will have AI at a deployable place where it really can start to make a difference so, especially in your world - You know, frankly many health systems are already starting to use it.

I mean, they're already starting to pilot efforts to when your patients are writing questions to their providers to try to say, well this is exactly what you could say, but it requires that provider to kind of green light moving forward.

I think we're in that trial period now in many places, I think on the macro data side that's more anonymous and not patient reaction.

Machine learning and AI can help understand, well, what was the arc of this person's experience in the health system, where were the costs, where was the quality, and how do we reorder that, and what could that look like over time?

And this takes me back to why building these mega sets and having the data more holistically is our most powerful value add for AI.

- We have about a minute left, I just want to get this in, and this is not a small issue, but we had a CEO of a healthcare provider here, and I won't say his name because I don't think he liked the idea that he was fearful about inflation and he was very fearful about inflation in healthcare because of all the challenges.

In about 35 seconds sir, how do you model inflation in healthcare and what you do?

Is it important?

- Well, this is why we have a number of tools to try to control costs overall.

Healthcare is a complex market where people are getting something prescribed to them, and sometimes that is not what they need.

And those controls, and this is again where data and AI can be more powerful for us Over time.

We've gotta make sure those controls stay in place.

- Yeah, well said.

I know that's hard to do in about, oh by the way, you have 30 seconds can you wrap it up nicely?

- Yeah, well bring me back, we can do at least an hour.

- We will.

(panel indistinctly chattering) - [Antjuan] Yeah, I promise you said that last time.

- Please come back.

Good to see you again, sir.

Thank you.

Antjuan, thanks for flying in from DC and always glad to have.

Mary Ann Wolf come back.

- I would love to.

Thank you.

- Thank you.

Till next week, I'm Chris Williams.

Happy summer still, good night.

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