8th District candidates give thoughts on health care issues during ‘Pints & Politics’ events

The Southeast Missourian hosted two of Missouri’s 8th Congressional District candidates in “Pints and Politics” sessions, where editor Rick Fahr asked them about various political topics, and how they plan to address them.

The newspaper hosted Jason Smith, the Republican incumbent, in August and Randi McCallian, a Democratic challenger, in September. Among the topics discussed were health-related issues.

As the events were not in debate format and held separately, the candidates were not asked precisely the same questions. But both broached health care topics during the events.

Here is what both candidates said about health care policies during their visits with the Southeast Missourian. Both candidates mentioned that access to health care is a problem.

In responding to a question about gun violence and potential solutions, Smith brought up mental health.

Smith: The strongest laws on gun ownership happen to be Chicago; five people have died since the DNC convention started three days ago in Chicago, the city that has the strongest gun laws. So having stronger gun laws is not the answer. It's the mental health that is. That is a strong, significant issue that we have, but it's access to care. Because most of the people you see that are homeless, they're homeless because of mental health. It's mental health, and that's a big problem. OK, well, how do we fix that? It's going to require a lot of work, and it's going to require investment.

I had a health care roundtable in Nashville, and the CEO of a very large hospital organization said the truest statement I've ever heard anyone say, and he's like, “Congressman, just know that health care will follow the dollar.” He's exactly right. And when you look at reimbursement rates in rural America being much less than urban areas. Why is there more health care in the urban areas? It's because they get paid more. It's the same way with mental health. Let's have some parity so that we have a fighting chance in America when it comes to getting proper health care services. You think about a gentleman who contacted my office. They do heart monitoring, objects that check your heart in all different aspects. In our congressional district, the reimbursement rate they get is $36 a month. In San Francisco, California, it's nearly $90. So he's like, “Where am I going to spend my time in providing these instruments?” It's going to be where he's making $90 a month instead of $36 — that's the parity. The same way with mental health that we have; we’ve got to have the investment in rural America real, real quick.

McCallian spoke about health care access in broader terms.

McCallian: As everyone in this room knows, and everyone in the 8th knows, except for maybe Jefferson County, we have very little access to health care. I mean, there's even hospitals in our region that won't set a bone. Salem Hospital in Salem in Denton County, they won't set a bone. OK? Well, what happens quite often on a farm, you break a bone, right? Their hospital can't even set a bone. They don't deliver babies. So even if we have access to some health care or hospital care in our region, it's very limited, and so that's nothing new for all of us.

The Medical lobby and establishment has gained a lot of power, and they've created a lot of policy that makes it so that doctors are pretty much the only ones who can do certain things, diagnose, you know, and do a lot. You have to have a doctor present to do so many things, when, in reality, advanced nurse practitioners can do all of that. Midwives can take care of a huge swath of reproductive health care and, in this country, we still have a lot of limits on who's allowed to practice medicine and certain levels of medicine, and something that I've wanted to see for a long time is just increasing access to downstream health care providers. So a program that I worked on a number of years ago now was a grant-funded program to increase community health workers in underserved rural areas, and my program specifically worked with Florida, Michigan and Ohio and community health workers. The program that we had designed and that we use, we were training people to be lactation counselors and doulas to support people through child pregnancy and childbirth, and then to help them feeding their children after.

And what our program did is we go into the rural communities and we find people who want that job, and then we train them so you don't have to already have experience. And we know from lots of research that something as simple as someone who has some knowledge about lactation. So a breastfeeding counselor, for example, improves the rates of breastfeeding in their community, makes it easier for mothers and babies to feed, gives mothers more confidence. A lot of the time, we just need that peer-to-peer connection.

Same thing for mental health, same thing for, you know, when we have people recovering in drug or alcohol programs peer to peer, right? We know that those peer-to-peer connections work, but you can't have that peer to peer with a doctor necessarily, right? … But what we can do, especially in rural areas like ours, is increase the funding for programs that would literally create jobs in our communities, give people the training they need and then they serve their own community.

Another great, two great examples of this is diabetes management and asthma management. So across the country, we're using community health workers more to help people manage their diabetes and to manage asthma, because if you manage those, you're far less likely to end up in the emergency room, which saves a lot of money on the family and on the system itself.

And so hopefully you’re noticing everything I’m talking about this moment leads towards prevention versus the tertiary care when someone has landed themselves in an emergency room because of asthma, when if we could have gotten someone in there with some training into their home, that person could have removed some of those asthma triggers, and now that person wouldn’t be triggered as often and heading into the emergency room. Diabetes management diet, right? So helping someone and say, “See. here’s the amount of money you have. Let’s go shopping. How can we get more appropriate foods for you? What are some examples of meals that you would be willing to eat that keep your diabetes better managed?” And a doctor cannot spend that kind of time. They are the Band-Aid. They’re the final solution. When you’re having the asthma attack, right? We need to be putting the money in at the beginning to keep people from falling into the river. And so my background, public health prevention is key to that. And for the record, this country has only ever put about 1% of our funding into public health prevention, so when we’re all like, geez, everyone ends up in the hospital all the time, yeah, we should be putting more funding, money and time allocated into those prevention pieces.

Smith on the future of Medicare and Social Security:

Smith: What I'm worried about is the solvency of Medicare and Social Security. It is reported by the year 2032, 2033, both of those programs will be insolvent, and if Congress does not address that issue, you'll see immediate cuts for all seniors. And this is something that drastically would affect the people in the 8th Congressional District. It would drastically affect my mom, and I would definitely hear about it, but I am 100% aligned with the former president, President Trump, when he says that we have to protect and preserve Social Security and Medicare, we can absolutely do that without cutting benefits to seniors. There's a lot of areas that we can help the program not be insolvent. But it has to be bipartisan. It absolutely has to be bipartisan. Social Security and Medicare are two very important programs that mean a lot to the majority of Americans and if both parties aren't coming together with that, we're in trouble. I've been holding roundtables with all the members of our committee and bringing in different people to study and analyze all the issues that we are facing with Social Security and Medicare insolvency, and the discussion has been going very well, both with Republicans and Democrats, which is what has to happen to be able to do it.”

McCallian was asked about her thoughts on reproductive rights. She said she saw abortion as a health care issue.

McCallian: So abortion is health care, and my you're gonna, you're gonna get a personal Randi here for a minute. Because I really, really thought when I was working with families when I was younger and when I was also hopeful about the leadership of the states and the nation, and a little naive that we would have things like paid family leave before I had children. Well, I'm done having children, and my youngest is 6, and we do not have paid family leave.

In fact, we've gone backward. So the United States is the least safe place to be pregnant and to give birth and to be an infant. Out of all the industrialized nations in the world, we are last. Missouri is somewhere in the 40s for maternal and infant health. So Missouri is also one of the worst, worst in the world of developed nations, and now they've banned reproductive health care in Missouri, so we will have more mothers and infants dying. It's very frustrating for someone like me who wanted to see progress. It's not helpful at all when we insert the government into health care and remove choices when there was never an expansion of safe health care to begin with.

What I mean by that is, again, it's very dangerous to be pregnant, to give birth and to be an infant in the state of Missouri, and when abortion was banned, when reproductive health care in pregnancy was banned, they didn't expand insurance coverage after childbirth. The Democrats made that happen here. So let me, let me reiterate that we did get it expanded finally, and it was the Democrats who made sure that people who give birth can have insurance coverage up to 12 months now, where it was six weeks. Well, most of the maternal mortality happens after six weeks, and 70 to 80% of those deaths are completely preventable. But people didn't have insurance, so they wouldn't go back when something wasn't right or didn't feel right, or to go to get a checkup, and so then they die at home, all completely preventable.

So one other example I can give is in the 8th Congressional District, there are two hospitals in the 8th Congressional District that have a neonatal intensive care unit. When you live in extreme poverty, like our district is the most impoverished congressional district in the state, you're more likely to have a premature birth when you have less access to healthy food, like we do in the 8th Congressional District; we are the most food insecure district in the state. Poverty, low access to food, high stress, all those things contribute to more premature birth. Premature birth often lands a baby in the NICU, the neonatal intensive care unit. There are two hospitals in the 8th Congressional District with the NICU, and both of them are in Cape. Both. So all the rest of those 28 counties, if a parent has a child who needs to go to the NICU now, they're going to have to travel to either Springfield to visit them, St Louis, if they're closer up there, or Cape. So for our counties right there in the middle: Ripley, Bollinger, even Douglas County, so many more of them, Shannon, like there are so many premature births, there's going to be even more babies born now that we have an abortion ban, and yet there is no more care for those premature babies. They have not expanded care. We have, in fact, lost hospitals in the 8th, so there isn't an effort to make it safer to give birth. There is no effort to make it safer to be an infant. And yet, the government is inserting itself in your reproductive health care and, to me, that's vile and shouldn't be happening.

Smith was asked about the budgetary shortfall in the Pact Act, which provides care for veterans, including those exposed to burn pits during their service.

Smith: It's very disturbing. Um, it's a $15 billion shortfall. It's the largest shortfall the VA has ever had under any administration, and I blame the President Biden and Harris administration. It's poor management, poor planning and poor execution and, unfortunately, it is harming our veterans because of this administration's lack of attention, lack of detail. The Pact Act, as I tried to let everyone know, this was going to cost $600 billion, and it was unpaid for. How are we going to pay for it? Well, now it's affecting every veteran, not just veterans that had the issue that they needed to be rightfully taken care of for what happened, but now it's affecting everyone because it's not properly funded. And that is what I raised when it was passing. At that time, I was the ranking member of the Budget Committee. I voted against it. That was not a popular thing to do. I was in the minority, but it wasn't paid for. $600 billion. And so many people say, let's cut our spending, or let's actually get our national debt in order. But when it requires you to actually do it, they're out for a walk, but they love to just give little pieces of candy to everyone. That little piece of candy turned into a very big one that is affecting all veterans.