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

The Arkansas Times and Little Rock Public Radio.

Hello again, everyone, and thanks very much for being with us.

As the week drew to a close, so did the life of former Governor Jim Guy Tucker.

He was 81.

His was a colorful life, a life of accomplishment and controversy.

Our production schedule prevents more than a mention of Mr. Tucker's passing at this broadcast.

But in our next edition next week, we will have a fuller assessment.

February's half gone, but not this session of the Arkansas General Assembly.

And in this half hour, we'll cover as much of the action as we can.

Last week, we were joined by the Senate president pro tempore.

And later in the broadcast, we will speak with his Senate Senate counterpart, the minority leader.

But first, healthy moms, healthy babies.

It is how the Sanders administration styled its package of legislation to address Arkansas's woeful ranking in terms of maternal health.

The House and Senate have approved identical versions of the bills, which largely involve the Arkansas Medicaid program.

The package was unveiled last week by Governor Sanders and the Healthy Moms Healthy Babies Act, led by Senator Ervin and Representative Pilkington.

This legislation will make several massive improvements to Arkansas's maternal health landscape in addition to regulatory changes and incentives to bring more and better providers into maternal health care.

It invests more than $45 million annually in improving maternal health for the lowest income Arkansans, and this will be transformational for our state.

Thank you for your leadership for this.

With us now, Representative Aaron Pilkington of Knoxville, for whom maternal health has been a priority issue, I guess, for two consecutive sessions now, he is the principal, as we noted, principal sponsor of the House version of the legislation.

Are you satisfied?

Is this get the job done?

I'm very happy with the package in its totality.

Obviously, there's probably a few things here and there we'd like to include.

But, you know, as you come together, as both the House, Senate and the executive branch try to work on the big issues, what are the things that move the needle?

What are the things that are going to stop the bleeding and the closing down of labor and delivery units?

And so to me, this is a great package.

There are things that honestly I would say probably four years ago would never thought that we would be doing things like presumptive eligibility, community health workers dual as all those things I think that are in this package are great steps forward.

And the fact that we are now I think it's what, $45.3 million of funds now going towards maternal health in this package.

I'm excited about that.

And I think that's a great step for Arkansas.

And so I'm I'm very happy with what we're what we've accomplished so far.

And there's also some other legislation out there as well that I think we'll see.

I know Representative Lee Johnson has some language around more of a duals and community health workers that goes into this.

What we're doing and of course, represent a family has done a lot with certified nurse midwives, which are an important key player in improving maternal health.

So this is the big package.

There's also a few other little things floating around, but I'm really excited about so far this session.

I think maternal health has been in the forefront of a lot of legislators minds, and I'm glad that we are moving the ball down the field, she said.

Ms. Sanders says calls it transformational.

I believe that's direct quote.

You agree with that?

I do think it's transformational.

It's funny, there were some former lawmakers who laughed because they said, you know, community health workers was a dirty word back during an expansion in 2014.

Now where, you know, the Republicans are champion them as being an essential part of improving health care here in Arkansas, of course.

And then, of course, the presumptive eligibility is a huge part as well.

So making sure that women can get to the doctor, we're putting people before systems, and that's something I've said time and time again, but we can't focus so much that we're only focused on what is the system, say, let's get people seen and worry about the paperwork on the back end.

And so I think those are transformational moves.

And I'm really excited because it's getting women in the door.

And then, of course, once they're in the door using those community health workers have a warm transfer after delivery and getting enrolled in plans and getting with providers so that we can take care of their post postpartum health as well.

Come to that in just a second.

There it was certainly it was its adoption where this package adoption was was bipartisan, striking that the opposition seemed to come from within your party.

And we have some arguments that were brought up on the floor.

If you look at page four, the very last three lines there on on 26, 27 and 28, it says if an alleged medical injury occurred during childbirth, the miner or his or her representatives shall have until the minors fifth birthday to commence an action.

Currently, you have until the child turns 11.

We are now changing it to five.

And that's a really important milestone because you know what happens when you're five.

That's when you enter kindergarten and you're around teachers for the first time and you're around occupational therapist and physical therapist and speech therapist, who might be the first ones to say there's something wrong, We need to get some more testing done.

Why change 11 years?

One change of the drilling.

When you make a change like that, you've got to know to remote.

And I'm quite shocked because, like Representative Wooten said, this bill should be about promoting maternal health and all the wonderful things that it does.

But this is the poison pill, as they call it.

They have all of these wonderful things, and then they take that one thing and make you swallow it if you don't vote for it, well, that should not be the case.

We should not have to do that.

This could be sent back to committee.

That portion could be taken out and we could pass this bill with 100% vote.

And that's what needs to happen.

All you pass it with close to 1% anyway, but you have to monitor factors that some of your colleagues were concerned about.

You had the malpractice.

Yes.

And the tort aspect of it and also the fiscal implications of the bill.

Yes.

Well, I'll address the I'll I'll just the fiscal impact.

One was this was already something that we initial talks about the budget in the governor's budget, where we're planning to spend this amount of money.

So it's not a new spending that came out of left field or something like that.

But I understand four areas have raised questions and his remarks because sometimes it's people want to know why are some things moving along the field and others are not.

And I, I hoped in my questioning when I answered him, I was clear that the reason why is because when we were when the governor was creating our budget, this was the amount she was waiting to spend.

And and so that's why it was able to go through faster than maybe some other things that are held back for fiscal impact, because we already knew what the fiscal impact was.

It was announced when we announced the bill.

Now, on the tort aspects, you know, I think what's really interesting is people sometimes forget how tort plays into health care and how it makes it expensive.

And so what we did is we realized from talking to health care administrators that running labor and delivery units, malpractice insurance was extremely high.

And so we looked at surrounding states.

You know, Louisiana, it's one year, Tennessee, it's one year.

I believe it's seven years in Mississippi.

We took an average of surrounding states.

And that's how we got to get the number for five if we're wanting to was interesting is especially in this conversation when we talked to ministers, they said they were paying for malpractice insurance for providers who had stopped delivering babies, but yet they were still having to cover them.

And so when they talk about closing their labor and delivery rooms, they said their malpractice insurance was a factor.

And so it's really interesting, too, that one of the represents who is speaking, you know, served by unity, how wish they would call their administrators and ask them about why they closed their new port labor and delivery unit that is also served by unity, because Newport's a unity hospital, they would tell them that that was definitely in fact, I believe they would tell them that was a factor in it.

So I think sometimes, you know, it's easy to think that health care is just payers and doctors, but there's a whole ecosystem in health economics that go into a part of this that I mentioned in my closing, that the Trial Lawyers Association was neutral on this bill.

They they understood why we did what we did and didn't feel that it was too arduous and wasn't anything that was destroying their industry or anything like that.

So and so and I do have a couple of members who said that was important to them, that they were neutral on that bill and it made them feel more comfortable with voting for it.

So I'd say I think sometimes the complexity of health care, things can get lost.

Obviously, this bill ran pretty fast and I could understand why people felt maybe they were caught off guard by it.

But I think it's what we need to do if we're going to try to stop the bleeding, which I mentioned before in my in my clothes as well.

When presenting the bill, we need to stop the bleeding and closing of labor and delivery units.

And this helps stabilize the ecosystem in Arkansas and and making sure that we can lower malpractice rates or the amount we're spending on malpractice insurance is helpful in that regard.

You mentioned postpartum.

So one of the things that you have tried and tried and tried to get through the General Assembly and through the administration is a one year extension of postpartum extension of Medicaid coverage.

Well, for postpartum mothers, yeah, you haven't been able to make the sale.

No.

And it's it's one of things I still support and I'll tell anyone that I still support it.

But, you know, in having these these conversations about the package and getting something that we could all agree on and move the ball down the field and like I said, stabilize the labor and delivery units.

There was something Representative Lee Johnson told me he said, So let me get this straight.

And you've got presumptive eligibility, you've got doulas, you've got community health workers, you've got he goes through the list of about the seven or eight things that all things I wanted you know, telemedicine, glucose monitoring, you know, Medicaid reimbursement for blood pressure cuffs.

And he said the house is going to follow your maternal health.

He's like, but don't let your ego be what's guiding your compass and not what's actually good.

And it can actually move the ball down the field in a real way.

And so I you know, I took that to heart.

I think a lot of my colleagues put trust in me on maternal health.

And so to me, this is a big win.

I think that we could all get behind or most of us can get behind.

And so, you know why I do this?

One aspect I support.

I still think it's good policy.

I think this is this is transformational.

I agree with the governor.

This is transformational.

This is big.

And to another point that someone once made is if we don't stop the shutdown of labor and deliveries by increasing reimbursement rates, it doesn't matter if they've got the postpartum coverage.

If we're not even able to deliver babies.

What's the hang up, though?

Is it fiscal?

I think there are fiscal concerns.

I think, too, is, as I've argued with DHS back and forth, is this idea of, well, a lot of women should already have different coverage, whether it's through traditional Medicaid or out are down.

So the yeah, the 138 to 200 is the is the group that we're talking about.

And while they do have access to subsidized plans, in my opinion and this is this is my opinion is you know I think there's more we can do for that population.

So while I would like to see that, I also understand is I am one member of 100, which is one half of the chamber, which is one third of the state government.

And so I'm excited for what we have done.

I think the conversation is ongoing, let me put it that way.

I'm still going to push for it.

I'm not I'm not giving up the fight that easy.

But I do think it's you know, I've told this time time again, there's no silver bullet.

There's multiple things we can do.

You know, I think I would describe this bill as a shotgun blast of bullets.

But it's but it is a it is an important factor, I think, as we move on.

And so as we can find a way to help bridge those gaps, let's do it.

Now, granted something else, you know, I think that some people have also factored in is we don't know what the federal government's going to do on Medicaid.

You know, RFK just got confirmed this week.

I'm really interested to see what our CMS is going to propose with regard to some of these expansion projects, not just maternal expansion, but even the AP models we have here in Arkansas through Arkansas work.

So are our homes.

I care what name we call it now, but so that's also, I think a little bit a factor as well will be should are we going to expand a program that might go away with a new iteration of how Medicaid's done through the feds?

Yeah, we have less than a minute remaining.

So.

Well, we've got we have new administration or a change in administration in Washington.

There is renewed talk of block granting Medicaid.

Now, health care is one of yours, your specialty.

So your thoughts on that?

You know, I'm not as afraid of block granting, I think, as some people are.

But granted, I've always leaned to the more innovative side of how we can potentially do things.

I think ultimately, I mean, I would want to see exactly how those how they want us to distribute those.

But, you know, change is scary in health care.

And we have to make sure that when we're doing it, the main focus is making sure that our providers are getting paid so they can take care of our patients.

Always.

Well, come here.

Come back soon.

Thanks a lot, Mr. Pilkington.

And we will be right back.

And we are back.

And now an overview from the Democratic minority.

We are joined by Senator Gregg letting a federal he is his party's leader in the upper chamber.

It's his turn, after all, since your Republican counterpart, the pro tem, Mr. Hester, was here in that chair.

Just just last week session seems to be moving along, but it can there's some big things still to be decided.

You can't get to a budget yet.

That's correct.

Things did start off kind of slowly this session, but things are definitely picking up pace.

We saw a lot of action this week, but the Joint Budget Committee hasn't really been able to do a whole lot yet, in part because we're waiting on some of the details for the employee pay plan.

And until we know more about what we're doing there, we're not committing to appropriations.

I think that's one reason also that the revenue and tax committees haven't done a whole lot.

Well, do you have the rough outlines?

I mean, we're talking about millions of dollars, right?

I know the governor's office has some of the rough outlines and some of my legislative colleagues haven't been working in that space too much.

But I am on the Joint Budget Committee and we're hoping we're going to get some real work and pick up the pace.

Otherwise, if we don't start getting worked on appropriations, that's going to delay our say.

That's going to delay the intersession.

Well, I mean, that's that would be unprecedented anyway, to get to to get to a budget out, you know, two, three or four weeks, even longer after the anticipated time.

Yeah.

And then on another front, yeah, things did kind of start off sort of slowly.

The session, the Senate Public Health Committee, which is generally one of the busiest committees for the first two weeks, I only heard one piece of legislation.

Things have picked up in there, especially this week.

But that's that is somewhat typical for things to start off slowly, but it just seemed to be extra calm at the start of this session.

Yeah, it would seem obvious that this session of the last several session, but this one in particular has taken a decidedly conservative term, a turn in terms of the ideological cast, anyway of the legislation that's passed.

That's absolutely true, in part just because of the numbers out of 35 senators, there are just six Democrats.

I will note that this year there are 18 sorry, 19 House Democrats, because for the first time in 20 years, Democrats actually added to their seats in the legislature.

I know it was just by one seat, but that's not nothing.

When you look at everything that's happened to the party over the years and that pickup came in Springdale up in northwest Arkansas with Representative Dr. Diana Gonzales were then.

Well, let it not be said, though, that there's no room for bipartisanship in this process in terms of public health legislation on and certainly on the maternal front and the child nutrition front, too.

Yeah, a lot of what Governor Sanders announced in her State of the State address at the start of the session was stuff that got applause from both Democrats and Republicans, including maternal health, the free breakfast program for public school students, regardless of their economic status.

I think most everybody's a co-sponsor on that piece of legislation and in public health.

Just yesterday, when the Senate Public Health Committee took up a possible repeal of our statewide fluoride program, there was bipartisan opposition that kept the bill bottled up in committee.

Yeah, well, in terms of maternal health.

So we still can't go the 49 or the yeah, the full year on postpartum care.

Right.

And which 49 other states.

Yeah.

49 other states still not quite sure what Governor Sanders is so dug in on that particular front given we are literally the only state who hasn't done that and I think that would be very meaningful for maternal health, though.

Is it the fiscal outlay?

Do you what what's the thinking there?

I don't have her insight, but she obviously is taking steps.

And so are Republicans, Democrats on other fronts.

Again, this week, we saw the Healthy moms, Healthy Babies acts in both chambers advance.

There's a lot of good in there that's going to do a lot to hopefully improve maternal health outcomes.

I know there was some bipartisan concern about the very last section having to do with the window of time that a family could pursue litigation if their child were injured during childbirth.

Yes, but there was the good far outweighed my concerns there.

And so I supported it, as did most everybody.

I believe the only no votes in the House came from Republican lawmakers.

Well, there was, though, concern, too, about the fiscal aspect of the bill.

Right.

You know, Governor Sanders announced earlier this session that we're going to invest 45 million about $45 million in improving maternal health.

Only about 13 of that is going to come from the state.

The rest is supposed to come from the federal government.

Hopefully, that's still going to be the case, but that is a considerable investment.

Right.

Still in your in your conference, your caucus is their concern.

And beyond that, there is some concern privately expressed quietly expressed anyway to me by by some Republican members that revenue obviously is declining because of the tax cuts of previous sessions.

Are you concerned about the possibility of a real downturn?

Am I mean, not to be pessimistic, but we never know what the future holds.

A lot of Arkansas managed to weather the pandemic rather well, in part because of all the federal dollars that were flowing through the state.

A lot of that's kind of worked its way out of the system.

We have been pretty aggressive about cutting income taxes over several years.

And there's concern not just in the Democratic caucuses, but among some of my Republican colleagues that maybe we've gone too far and we definitely need to slow down a little bit.

So that's why you don't hear as much talk this session about another income tax cut.

Not in this.

Yeah, not in this session.

I'm sure down the road, once the economic picture becomes a little clearer, grocery tax here, that is the hope.

I believe that was the only tax cut Governor Sanders referenced in her State of the State address.

Again, you know, we did quite a lot of work on that.

I believe that was Governor Beebe that started cutting the grocery tax.

But he, I think wisely didn't go all the way out of concerns of the state's financial picture.

There were supposed to be some metrics that we had to hit before we did away with it completely.

Never quite got there.

But I am hopeful that we can do something to further reduce the grocery tax.

Back on the health front, if I may, there is a lot of serious talk in in Washington now about major adjustments to the Medicaid program and indeed going from the present the existing system to a block grant program that could have obviously enormous implications for for all the states, particularly Arkansas were so Medicaid dependent.

Yeah that's a definite concern among me, our caucus and some Republicans.

This administration is obviously bringing in a lot of big, huge changes, some of which we know are coming, some of which, you know, you never know quite what to expect.

I have deep reservations about shifting to a block grant.

We are incredibly dependent on Medicaid.

Just when you're talking about childbirth alone, I believe it's something that about almost half of childbirth in Arkansas are covered by Medicaid.

So definitely some deep concerns about what's happening there.

I guess one potential bright side is that our governor does obviously have a close relationship to this White House, and so maybe that will be beneficial to any kind of conversation.

Yeah, well, another thing, let me try to stay as much as I can strip the partizanship out of this.

We're talking about an enormous amount of tariff declarations from from the incumbent presidential administration.

This could have a serious effect on commerce of every corn crop.

Absolutely.

Particularly agriculture.

That's our state's top industry.

We've grown almost half of the rice and that all centers and I believe that we export a lot of that rice overseas.

And I am definitely worried about what retaliatory tariffs could do to our exports here in Arkansas and what it would mean for consumers of the things that we import.

Well, are you conveying that to the administration?

Both Washington answers and a little we do raise those concerns.

I also always encourage Arkansans don't just reach out to your state lawmakers do make sure you're calling the Capitol switchboard in D.C. and talk to our two senators and our four members of Congress.

Again, on the conservative cast of this General Assembly.

You're going to do well.

A tort reform bill went through for the first time.

And I think, yeah, maybe during my time there, there's certainly been many attempts.

That is an issue that isn't clearly partizan.

There has been bipartisan opposition to that.

There was again, this time it's one of the rare examples of a debate on the Senate floor where there was good, meaningful, constructive debate from both sides.

The outcome wasn't predetermined and it ended up coming down I think was 1817 with the 18th vote in favor coming in at the very last second on on a similar topic.

And that's the the prison situation.

Now, there seems to be a widespread feeling that it would cost the states getting ready to incur an expense that's significantly larger than was initially projected.

You're concerned about that?

I have a lot of concerns.

Yeah.

The first figure we heard last year, it's moving 70 million.

Yeah, and we're over three times that.

I still think the odds are this project does move forward.

Certainly the administration seems dug in, but the folks in Franklin County that are pushing back are incredibly well organized.

They're doing a great job with their messaging.

They have an ally in me.

There is bipartisan again, opposition Senator Gary Stubblefield from Franklin County, Senator Brian King has been probably the most vocal and is doing the most.

He's got some legislation he introduced this week trying to slow this down.

So we'll see what happens.

They seem to be outgunned.

And you I mean, the opponents.

Absolutely.

I do think there's there's wider concern about the potential cost of building a new prison and building it here.

There are other communities that would be open to this.

Even the folks in Franklin County that are fighting this prison have said they don't necessarily object to a new prison in Franklin County, just not in the exact spot that the administration picked.

Well, on the longer, larger question and longer term question seems to be Arkansas's incarceration policies compared to the other states.

It's just it's just through the roof.

Right.

Is there any serious move to reassess how we employ jail and prison space, the number of the number of individuals that we send out?

We certainly need to have those conversations and I think they are happening.

But unfortunately, I think we're in a place right now where there's still we are still more inclined to put people in prison than we are to let them out of prison.

And you want to make sure that you are addressing those people who do pose a true threat to public safety.

But we do need to be smart.

We don't want to waste resources.

We don't want to lock up everybody.

We want to make sure that the people that are truly dangerous are the ones that are in prison and not the ones that we're just mad at.

Yeah, well, I mean, prisons are designed particularly even even the advocates for a reassessment of the situation are quick to insist nonviolent or violent offenders need to be locked up for a long term.

Right.

But is there any serious movement in that direction?

I mean, alternatives to incarceration?

Certainly we are having those conversations.

I don't know that we're going to see a lot of successful legislation this session along those lines, but we do need to make sure that we are again, having those conversation and that we are smart about the policies and that for the people who are in prison, we are providing them the kind of resources and programs they need so that someday when they are released, they are far less likely to wind back up in prison.

At the end of the session.

Will the minority Democrats and both House and Senate be able to claim some significant wins?

I think so.

You know, despite the fact that I am just one of six personally, I've been able to pass bipartisan legislation every session I've been down there.

As is true, I think of just about every single Democrat.

There are instances where our votes do matter.

We came very close again to stopping that tort reform bill just a couple of weeks ago, and we are sometimes able to influence outcomes where a piece of legislation might pass that we don't like and maybe don't support.

But because of conversations we had as that bill was crafted, we were able to at least sand off some of the rougher edges.

And I want to squeeze one final question, and that is public ballot access.

In terms two of initiatives and proposed amendments, it's getting tougher, it would appear.

It's getting very tougher.

Some would say it was already too tough.

And I have seen some people say online that Republicans are passing these initiatives because they're afraid of the people.

But it's actually the opposite.

They're passing these ballot initiative, these anti ballot initiative measures because they don't expect the people to make them pay a price for it.

It is unfortunate you don't want it to be super easy to get something on the ballot, but you want to make sure that the people have the ability to do so because especially when the legislature is so unbalance and how to check, the people need to be able to be a check on the legislature.

I have to end it there because we're out of time.

Senator Gregg letting, thanks very much for coming aboard.

Come back soon.

You and that does it for us for this week.

As always, thanks for joining us.

See you next week.

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