TWJ-S001-E007 - The State of our Health Care System with Mich Rep Laurie Pohutsky

12:25AM Jul 10, 2023

Speakers:

Jodi Graves

Announcer

Lori Pohutsky

Keywords:

doula

michigan

birth

postpartum

medicaid

laurie

families

livonia

medicaid reimbursement rates

insurance

issue

work

health

conversation

parents

jodi

maternal health

care

physicians

making

You're listening to Tea with Jodi. With your host, Jodi Graves. This is episode seven.

Okay. Awesome. Hello and welcome to our guests today. Our guest is Laurie Pohutski that represents Michigan's 17th district in the Michigan House of Representatives. Am I saying your last name correctly? Or did I just slaughter it for everybody to hear?

You got it. Pohutski is perfect.

Okay, perfect. So I'm so excited to have you on today I want to talk about some important topics. And I know that your time is valuable. So we'll get right to it a separately we're going to insert your bio into the podcast later, so people can understand a little bit more about you. But you do represent Michigan's 17th district in the House of Representatives, which is awesome. So let's just dive right in. Obviously, this show is all about all things birth and postpartum. So I want to kind of find out what legislation maybe you recently introduced or you're working on, that supports birth and early parenting for families.

Absolutely. So the last package that the progressive women's caucus was, which is a body within the Michigan legislature that focuses on the issues primarily impacting female and female identifying people in the state of Michigan. The last bill package that we introduced was specifically targeted at maternal and infant health. And it dealt with scholarships for doulas to, you know, enter the field and to be able to do that very crucial work. It dealt with creating an easier pathway pathway for birth centers to get licensed in the state of Michigan and to operate primarily in areas that have an acute need. But where it is very, very difficult for them to create a foothold. And to do that work. It dealt with extending postpartum care for a year out for Medicaid recipients and for everyone in the state of Michigan. So it really, really dealt with not any one particular issue, but just maternal and infant health writ large, and primarily making sure that the really crucial health care in those early days of motherhood and in life for babies, is being addressed equitably. So that was a package that we were really, really excited to introduce Chuck, but we are continuing to work on it. You know, it was at the end of the year, we knew it wasn't going to get a hearing. But it was important to get it out there so that people could see it and offer suggestions on what could be done differently or better, or perhaps even something that we missed. So we are continuing to work on that we actually had a meeting with some maternal health specialists last week. And we're continuing to work on it and to make sure that it addresses the needs and as comprehensive and equitable away as possible.

Awesome. Of course, I'm in the birth world and in the doula world specifically. So I've heard, you know, all the rumblings of things happening in the doula world and accepting insurance and all that great stuff. I know of at least one birth center that's going up in Detroit. So that's thrilling. And I'm certainly curious to hear how things are gonna go with the new bill that Governor Whitmer passed fairly recently that extends postpartum care through 12 months for people that are on state funded insurance. I'm certainly curious to hear what that does and how that evolves. And what what's being offered with that in time, because my hope is it'll impact commercial insurances as well and be a benefit for everybody across the board. So that's exciting to have some things in the hopper that you're working on. That's great. So what do you think that the government can do to better support parents to be a new parents as specifically, let's just look at Michigan, since this is your wheelhouse? What do you think?

For sure, I mean, one thing that we have discussed and worked on, although it was a little bit difficult to work on it, given just frankly, the the political lay of the land. But that changed significantly in the last couple of months here in Michigan, is the disparity in health outcomes for bipoc, particularly black mothers and their white counterparts. So there's been a lot of studying why this might be and making some recommendations. But I think we can really start digging into some of the underlying policies that we know to be an issue, you know, systemic racism that pervades every facet, but obviously, the birth experience, particularly access to prenatal and postnatal health, both for the pregnant person and for the baby. So I think that the availability of those resources and just the lack of equity and a lot of them is something that we can and need to address. We've been looking into it and I think that we have a lot of really great recommendations that came out of those task forces and committees and things like that. And it's it's beyond time that we act on them so

Wonderful. Yeah, that's you're absolutely right. It's beyond time for a lot of things. It feels like not much has changed. Even in the 24 years that I've been doing this work, we we've kind of stalled. So yeah, you're absolutely right. It's time for change. What do you think maybe is the most important issue facing parents and families? And specifically in your district. What are you seeing as the most important issue facing new families right now?

I hate to keep beating the same drum. But I really do think the availability of resources that, you know, so my district is interesting, I have a portion of Livonia, which is a primarily white, upper middle class suburb. And then I have Redford Township, which is a little bit more working class, and I have a portion of northwest Detroit. So there's kind of a a wide range of population demographics. So then, you know, correlated to that there's a wide range of income inequality and access to different resources. You know, I think that there's a lot of different ways to approach that a lot of people in parts of my district cannot afford to take time off for doctor's appointments, you know, they they work jobs, where they don't have the ability to, you know, take time off, if they take time off, they're not getting paid. And that's assuming that they even can take time off, they may not get it, you know, approved. And even just the the knowledge of what is out there, what resources are available. But you know, I mean, recently, particularly through that maternal and infant health package, we dug into a lot of double standards, things that are available through private insurance here in Michigan, but are not available through Medicaid or state funded insurance. So examining some of those things, even things as simple as screening for some things that we take for granted, those of us on private insurance, you know, prenatal screening, it's not covered by by Medicaid, and that can be really, really detrimental and really, really overwhelming for parents who may not know, just giving people the ability to prepare for whatever life they're going to bring into the world. And the fact that there is a double standard for private and public insurance is really, it's it's unconscionable, and I think that we need to work on that. And you know, that's, that's one example. But we know that there are a lot of examples for things that people who are on a state funded insurance cannot access. So making it easier and just making it more available for people to access just basic health care, basic prenatal and postnatal health care. And extending those benefits. You know, having them for you know, a month or two is not going to cut it when you have a new baby, making sure that we extend those at least two a year for sure. Is really, really important.

Yeah, I totally agree. And this is kind of my hot button issue. my soapbox, I'm sure my listeners are like, Oh, here she goes. But my biggest issue is the lack of postpartum support for families of all kinds, and all shapes and sizes. We have this kind of black hole of health care that occurs after we give birth, where we send people home, we don't see them, we don't talk to them. We don't anything for six weeks. And there's so many things that can happen in that six week time period, or any family any any post birth person, right, because there's no benefits for that there's no support. There's nobody stopping in to say hello, without doulas these families would be alone, you know. And so this is a big thing for me that I you know, one of the reasons why I wanted to talk to you is to put that bug in your ear, because that is a huge missing piece. For people I think.

Absolutely. And that six week gap, you're you're right. That's such an important time in such a beautiful and overwhelming and even scary time for a new parent, for sure. And another thing that we had talked about was, you know, we have wellness checks for baby. And that's great. That's important. But also use it as a touch point for the parents also to ask, how are you doing? You know what's going what, just making sure that that was a part of that wellness check, because as much as we want to make sure that you know, the newest Michiganders are doing well, at every single one of those checkpoints, making sure that their parents are mentally physically well and just have the resources they need. If they have a question, making sure that it's getting answered. Should be a part of that wellness. Those wellness visit should be comprehensive. And that includes making sure that parents are doing well, too.

Yeah, absolutely. I couldn't agree with that more. I know that some pediatricians do a one of the Edinburg, postnatal depression scale forms, you know, fill them out with the newly postpartum parent, but it's not universal. It's not every office because there isn't insurance reimbursement for that. So you know, a lot of pediatricians are like, I just I don't have time for it. I'm focusing on the baby and this is what I get paid for. So that is certainly a gap as well that we can fill somehow, with getting that to be universal. I think that would be really helpful, even if people are a little reticent to tell the truth on those, you know, on those forums. Yeah, it still is something right. It's still a touch point. Absolutely. At the professional some. Okay, awesome. So Sounds like we're definitely on the same page. So that excites me. Yeah. And then so how do you see the relationship between maternal health and early parenting? I know that over the last decade, postpartum mood and anxiety disorders have gotten a lot more attention than they used to have. So well, how do you see that relationship?

I mean, they're crucial, right? I mean, it sounds very cliche. But you know, if there's an emergency on a plane, you're told to put your oxygen mask on before you worry about anyone else's. If there's an issue with maternal health, then I don't know how we can expect someone to be doing everything that is required. And in the early life of a child, that's such a, that's such a huge responsibility, you know, under the best of circumstances, much less when there's either, you know, an emotional or mental or let alone physical issue going on with the parent. So I don't think that we can have a conversation about early childhood. If we're not also making sure that maternal health is part of that very same conversation.

Be sure to stick around to the end of this podcast to listen to Jodi's commentary, and for between the lines.

Absolutely. And could you say that louder for the people in the back? Okay, awesome. So it sounds like you are and your office are, you're making efforts to ensure that families have access to comprehensive and equitable postpartum care. So I love that I love hearing that. But let's kind of switch topics just a little bit. What measures do you think need to be taken to address the high infant mortality rate in the United States?

So, you know, obviously, we've talked about the availability of you know, prenatal postnatal care. But I think we also need to acknowledge what that care looks like for different communities, because what I think of as prenatal care may not be what an African American or black resident thinks of and in my district, you know, so when we talk about doula care, and birth centers, making sure that we understand that that is a crucial part of maternal health, and pregnancy health, for a lot of people in Michigan. And there's, you know, a number of reasons for that one people should feel comfortable with, however, they choose to have their child. And in a lot of cases, that does not include a hospital setting. You know, I have learned a lot and I want to say like I am a relative newcomer to this issue. You know, people like Senator Stephanie Chang and Senator Erica guys have been doing this work for a much longer time than me and they are so incredibly knowledgeable. And I'm so grateful that they are continuing to work and that they are passing that knowledge along to those of us who have since joined the legislature, but really getting a better understanding of why people choose to use doulas or midwives or birth centers. And the importance that that is like the the level of trust that is there, that therefore will bring better health outcomes, because when you trust your provider, it is going to be a better experience for everybody. So understanding what that looks like, and the importance of it and how it works, has been so eye opening for me. And I think that that is a really, really important part of maternal health and addressing and hopefully working to eliminate the negative health outcomes of pregnant people in this state. I don't think that we can ignore that part. It's not it's not always a hospital setting, and making sure that those that choose to utilize, you know, doula resources and other things in that similar vein, are able to do that, because that will also lead to better health outcomes for those people.

Yeah, for sure. And I think that you touched on an important point. Midwifery care is different than typical obstetric medical care. It's more woman or birthing person centered, right. It's there's more time taken. There's more of a trust in the process. There's more conversations, getting to know the birthing person. It's just a more it's a slower, more intimate, more trusting relationship than what you would get from an obstetrician. And certainly no, I'm not trying to bash obstetricians, but it's a different model of care. Right. And so I think that you're right, perhaps that is one of the keys of changing the high infant and maternal mortality rates that we see in this country. Absolutely. I know that across the globe, you know, other industrialized nations, the majority of their births happen in birth centers or at home in low risk situations, right with people that don't necessarily need the hospital. I wonder if maybe the future of birth looks a little bit more like that here as well. It certainly would be nice if it did.

It was an interesting conversation that started during COVID Because obviously, you know, people We're being told if it's not an emergency, don't go to a hospital, you know, like try to try to find other care for non emergency situations. And it was really interesting because my office got reached out to by someone who wanted to utilize a midwife for her birth. But her insurance denied her. And this was during COVID. Even so there was, it was just an interesting way to look at it. And then expand upon from, you know, this very dire situation where we have this global pandemic, but saying, Well, wait, what about people who, even under non pandemic circumstances are choosing to go the midwifery route or the doula route or the birth center route? Like, why is that being discouraged from a financial aspect? So no, it was a really interesting way to kind of have my my first introduction to this this type of care. It was it was really wonderful.

Yeah, it's unfortunate that we have to have a pandemic to start thinking that way. Right. Right. It's I think, some good positive things have stemmed from the pandemic, as horrible as that sounds, you know.

No, I mean, there was a lot of things that happened out of necessity, then that I think, have you realized, oh, wait, this might just be a better way to do this. So I I get exactly what you mean.

Exactly, which I love. And I guess if that's what it takes to get us to learn different ways, and I'm all for it. Right. So what is your vision for ensuring the safety and the well being of mothers and children? Are there some things in the works, some additional things that we haven't talked about maybe or some other things that you envision during your time in office?

I mean, there are things that the Department of Health and Human Services here in Michigan are working on completely independently of the legislature. That's not to say that, you know, there's not communication happening. But they can do things by administrative rule, you know, through the department, so things like including doulas in, you know, Medicaid reimbursement, something that they did all on their own. Now, that's not to say that we aren't working on also codifying that via statute, because as administration's change over time, those administrative rules can, you know, go into place, they can go back out of place. So, I think, you know, trying to provide some consistency there is important, but it's also really important to note that our Medicaid reimbursement rates are not great in the state of Michigan. Yes, yeah. That I mean, that extends to you know, maternal and infant health, mental health, you know, the entire health conversation, this, this impacts it, because the reimbursement rates are low enough that there are some providers that just will not accept Medicaid patients, which then makes it worse. And then, you know, for the Medicaid system writ large, but then it also makes it worse for those people that are trying to access all these various types of care. So that's something that I think we have need to have a very, very serious conversation about. We talk about the maternal and infant health crisis, we talk about the mental health crisis, we are not having a serious conversation about any of those things, if we are not talking about Medicaid reimbursement rates. So that being said, there,

If we were in the same room together right now I'd be high fiving. You going? Oh my gosh, yes.

But you know, I am, That being said, I am very, very grateful for the initiative that DHHS has taken on a lot of these things. So I would like to codify a lot of the really great, forward thinking policies that they have put into place internally, again, to provide that level of consistency.

I appreciate you bringing that up. Because I I have a background actually in medical billing before I was a doula. And so I have been a loud critic of accepting Medicaid, insurance for payment. Certainly, I am a huge proponent of providing doula support to anybody and everybody. But I'm not a huge proponent of making $1.50 an hour to do it. You know what I'm saying? Right? Exactly. It's, it's been a, I'm probably one of the only people that is out there sort of Pooh poohing it to everybody on social media and in groups, because I know exactly how this works. I know, there's a reason why physicians don't want to participate with Medicaid because they don't, it's pennies on the dollar in some cases. So it's not, it's not sustainable. So I really appreciate that you're having that conversation and and pushing others to hear it, right, because that's important. It's all tied together, right? Good quality care, comes from good quality care providers. And that's how you attract and maintain those good quality care providers is compensating compensating them appropriately. Right. So it's, as much as I love being able to provide services for free to support the community. We just can't we do that, but we certainly can't do it every day all day long. So Right? Well, that's fantastic. I love a lot of the things that we've talked about here. And I appreciate your time with all of this. I can't wait to see what you all come up with. I love that Michigan has kind of been trailblazers on quite a few. These things are starting to become trailblazers. So I am excited to see what the future holds. I have a feeling that we may see each other again or hear from each other again, because this is my passion and changing the laws and changing how we do this is very important. So I certainly appreciate your time and all that you do and I wish you all the best.

Thank you. Thank you for the work you're doing and thank you for taking the time.

Yes, of course. Thank you so much.

Speaker Pro Tempore Laurie Pohutsky is serving her third term representing the 17th House District which encompasses parts of northwest Detroit, North Redford, charter Township, and northeast Livonia. She is a longtime activist and volunteer and has spent time as a crisis hotline volunteer and a caregiver at Angela hospice bogucki He graduated from Michigan State University with a degree in microbiology. While a student at MSU she took part in community outreach activities and protests at the Capitol. These experiences instilled a deep interest in politics and demonstrated the importance of ensuring everyone has a voice in government. After college, Laurie worked in the fields of food safety, toxicology and health care, she brings this knowledge along with her experience and water quality testing with her to the Michigan House of Representatives. She has a deep commitment to bringing a scientific perspective to government and advocating for environmental causes. Laurie Palacky is a member of the Livonia Democratic Club and is active in Michigan united. She lives in Livonia with her rescue pets.

You've heard the rest of the podcast now stay tuned for a deeper dive in my between the lines segment.

Okay, so just a few thoughts here about the conversation I had with Laurie Pohutsky. Today. Obviously, I've been vocal about my views on doulas accepting Medicaid, and, you know, allowing Medicaid to reimburse us for our care. I have a background in medical billing. So I know exactly how horrible the reimbursement rates are. I know early on in the program, they have promised doulas a rate that I don't believe is going to be sustainable, because physicians are also making around that same amount for the state of Michigan and it's about $700 That doulas are being paid. Physicians also make around the same amount of money in the hospital when they catch babies. So once the physicians figure out that doulas who are not in school for 12 years are making the same amount they are, how do we think that's going to go because I don't think it's going to last. So what we're doing is kind of setting a false expectation that this is going to be the case long term, Medicaid reimbursement rates suck period, there is no two ways about it. And so this is hard to think that people will get good doula care or good doula support from a doula that's non biased and non judgmental and isn't part of the hospital system, which by the way, is a conflict of interest when you work for the hospital, and then you pretend like you work for the family. That's not how that works. That math doesn't add up. It's difficult to then say, oh, yeah, this is fantastic. doulas being paid by Medicaid is amazing, etc, etc. I don't think so. And the bottom is going to fall out of it at some point sooner rather than later. Certainly, when the other political party takes back control of the legislature in Michigan, it's coming. And because this is what we do we cycle. And so it's important that people understand that even if you're getting reimbursed right now, right this second in the beginning of the program, $700 per birth, it's not going to be like that forever. So it lends to like everything else, like what Laurie said, a lack of care. There's a reason why physicians and therapists and other clinical professionals don't want anything to do with Medicaid. It's not because it's too hard, although that's certainly a factor. It is because the rates of reimbursement stink. And so what does this do for families? How does this help families? I mean, really, truly, how does this help families when you have a doula that stays with you for 36 hours or more, and they're being paid far less than minimum wage to do so during that time, and they can't support their own families? I guess it just perpetuates a mindset or it perpetuates poverty is what it does. And doulas certainly deserve better than that. families deserve better than that. So while this might be a temporary Band Aid, this new Medicaid paying for doula services, this is not a long term fix for sure. So I am curious, I'm interested. I'm excited to hear what else the Michigan legislature comes up with. I hope to God at something, something is better than nothing.

That's it for today's episode. Thank you for taking time out of your day to listen to our podcast. We will like to thank our guests for taking the time to appear on our show, and contribute to these important modern birth and postpartum issues. If you liked the show, we asked you take the time to subscribe and consider leaving us a review. Also, please share this podcast with your friends. Also find us and like us on Facebook and Instagram at Tea with Jodi and at Michigan Family Doulas. See the show notes for a transcript of this episode. And thank you so much for listening.

I've learned over the breadth of my career, my experiences were far from the exception. In fact, quite the opposite. Because of this, I've created the group, "...tell me a story, about your birth". If you have a birth or postpartum story that you would like to share, please join us in this movement by sharing on our Facebook page, tell me a story about your birth, where we're gathering stories, both good and bad about your specific birth and postpartum experiences. Or send me an email to post anonymously for you, Jodi@Jodigraves.com. This is your host, Jodi graves of Tea with Jodi. Thank you so much for listening.