Report from Santa Fe; Rebecca Dow and Debbie Armstrong

The National Education Association of New Mexico, an organization of professionals who believe that investing in public education is an investment in our state's economic future. And by a grant from the Healey Foundation, Taos, New Mexico. Hello, I'm Lorraine Mills and welcome to report from Santa Fe. We have two esteemed members of the New Mexico House of Representatives with us. Representative Rebecca Dow. Thank you for joining us and Representative W. Armstrong. Thank you for joining us. Thanks for having us. Well, we're filming kind of a midpoint of the session and we have a lot to talk about. First, I'd like to talk a little about your background, your Republican from District 38, Grant Hidalgo and Sierra Counties, and who's seat, who's seat are you taking? Oh, well, it's a very, very big shoes to fill.

I've taken the place of Representative Diane Hamilton and before her, Marie Ryan. That is a fine tradition. It's a great honor for you to be serving in the, in the footprints in the trails of Diane and Marie, some of the finest we've known. And what an honor to be mentored by them both in preparation of coming to the house. Yes, indeed. Yes, indeed. And Debbie, you are a Democrat from District 17. You've been here since 2015. This is your second term. This is my second term. And I also am filling some really big shoes. It was Ed Sande of All-Saint, who served for 34 years. And was head of tax and ran, yeah, really. It's giants. Well, you know what, women? It's good. I'm glad that you're here. So you're the chair of the House Health and Human Services Committee, right? Vice Chair of Rules, and you serve on the health, and this is your first. Yes, I'm a freshman. Yeah, yeah, yeah. And you serve on the Health and Human Services Committee. So we have a lot to get to.

I'm going to ask each of you to just introduce yourself, tell our audience your background a little bit since your newest will let you go first. Well, thank you very much. Like you mentioned, my home is Truth or Consequences in Mexico. I move there with my husband and two small children in 99 to open up a faith-based nonprofit focused on early childhood. And over the years, we've grown to expand and fill other gaps in the community. So we do home visiting, early childhood, after-school programming, New Mexico pre-K for three and four-year-olds. After-school programming, we have a small private school team programming. Just pretty much everything to help a family, a supportive family, in reaching their hopes and dreams. I do love the name of the Apple Tree Education Center. Yeah. And it's from one of my favorite scriptures in Psalms 1, 3 that says they'll be planted by the river. They'll be like a tree planted by the river that brings forth fruit in their season, their leaves will not wither, and whatever they do will prosper. And that's what I hope and dream for my district. Yeah, and for the children. Yes, for the children, too. And now, Debbie, your background is quite extensive. Yeah.

Well, I want you to give me the highlights, because I know you so well. And I would get hung up on being the cabinet secretary for the Department of Aging in Washington Care Services and being a consultant with Delta and going in. Well, I've been in health care or related for more than 40 years as a physical therapist. And then I went to law school, because I wanted to do health policy. And I ended up at the state agency on Aging, which when it became a department, I was the secretary of Aging and Long Term Services in the last administration. And since then, I manage the executive director for a state-created, non-profit New Mexico Medical Insurance Pool, which offers health insurance for people with pre-existing conditions. That used to be co-abahair. It's a high-risk family journey. Patty Jennings started that, yeah. And then what made you decide to become a lawmaker? Well, I've worked on so many other people's campaigns.

And when Representative Sandeval decided to retire, I got a call from a few people. It said, why don't you run? Okay. I'll do it. Well, you two have a lot of, you've worked together on a lot of the same issues. And that's why I'm loving to have both perspectives from you. Quickly, if you can just mention the nurse's licensure comeback that we sh- right through the house and send it and was signed by the governor. That was our number one priority. It was really, really critical that that passed and passed then. We had two days to get it done because that we were part of a compact already among multiple states, about 26 states. And that compact was going away because everyone had signed up with a newer enhanced compact. And if we weren't signed up in part of it on the day it went into effect, we would have had nurses all over the state who were here practicing in hospitals, nursing homes, schools

who are actually licensed in another state who wouldn't have been able to go to work that day. And so it would have been a health care crisis in New Mexico. It was a wonderful piece of bipartisan legislation that so many people signed on to. And especially for my district, which is a border, a border's Arizona, it was critically important to make sure that those nurses coming over and were able to continue providing services in New Mexico. So we worked on it in the interim and identified it as really critical and that due date was really important. So it was bipartisan House Senate with the governor's office was all, it was all wired when we got here to get that done. Well, it's pleasing to see such efficiency in the, in the House of Representatives and the Senate and the governor line, everyone together was really good. So we'll kind of leap forward back and forth. One of the things that you have that there are a lot of resonances on, on a federal level, your House Memorial line to study an innovative Medicaid buy-in option.

So tell me how many, what percentage of New Mexicans are already on Medicaid or Medicare and what this buy-in would do. So we have about 40% of the state is on Medicaid now and I'm not sure about Medicare, maybe another 20% on Medicare, which is for older adults or persons with long-term disabilities. This would, but we still have 250,000 or so uninsured and we have many people who have bought insurance but can't afford to pay the, the cost sharing. And so they still end up going without or going tapping into the indigent phone or whatever. And this is an idea that's creeping up nationally and it's been Ray Luhon, but this state public auction, option act, it's bipartisan by camera both the House and the Senate and they want to expand Medicaid, Medicaid eligibility to anybody who doesn't have insurance.

Yeah, and it's similar to the whole national effort by Bernie Sanders and others about Medicare buy-in. So it takes an existing system that's working well and allows those who can't afford insurance or who are uninsured to buy-in too. So we have, it may not be, look exactly the same as our Medicaid benefits, that's what we have to explore and how much it would cost, et cetera. But it would essentially create kind of a public option in a system that we know works well here. And I think some of that, well, I think what we want to do is have health care accessible to all. And the question that I ask as a Republican is, is it insurance for all? What does the deductible cost? What is the premium? What is covered? And how do we keep it affordable, accessible and sustainable? And so those are the questions that I have as we look at this and I hear from constituents

who are on Medicaid and that's one of the best options. And those who are on Medicare and even by additional packages are struggling to keep health care insurance affordable. And so when you talk to small businesses or you talk to folks who are not getting their insurance through a large employer, either paying $8,200 a month with a very high deductible and does this help or, does this lend itself as a solution? Does it solve the problem? Does it create an unintended consequence? And so we don't know yet. So this is a let's study it, let's look at it, let's see what it would take and see if maybe it's a solution for New Mexico. Another big problem, you both have addressed, one of your first pills was an opioid overdose education act and you just got back from a national opioid conference. So you know, people don't like to talk about it, but it's a terrible problem nationally and a terrible problem in New Mexico.

So why was just one of your first priorities when you became a mom maker? Well, it ended up being the bill that was signed and I think there's a bigger issue of how do we prevent people from becoming addicted in the first place. So what are we doing about pain management? What are we doing about proper prescription? What are we doing about behavioral health services? You know, because people arrive at this situation in a, in a myriad of ways, how are we supporting our veterans and, and those who are exposed to trauma? And so this is the bill that stuck, this is the bill that was signed. It, it prevents those that are being released from prison or from detox centers or, or, and law enforcement officers to carrying a locks and, and to make it available to those who are dealing with abuse because the most 18 to 21 days after release or after they've completed a program is when they're most vulnerable to, to go back to abusing again. And so this provides a way to preserve their life, to save their life, but it doesn't address the root cause and prevent it from occurring. It's part, it's part of what we need to do to address the epidemic that we're already,

we've been dealt with. And we've been in a, um, an opioid crisis or an addiction crisis for a long time, long term heroin use here, prescription drug, um, abuse and an addiction is on the rise across the country here too. And so many states have instituted lots of policies to try and control the, um, miss, use of, and, and over prescribing of opioids, but that's not the only issue, uh, and we do have to get a, at prevention, um, and so I think that's, that's really, we can't just make it a crime because you've been abusing drugs. And it feeds into the behavioral health, it feeds into all the people and corrections and it doesn't get at the root cause, and it causes trauma to families and children because that's, that's one of the, the indicators of a long term issue with children and ending up in foster care and, and other kinds of issues.

If there's been, um, in, within the home, not only drug overdoses or drug abuse, but in and out of prison, um, and other issues and it's, so it's all wrapped up, uh, together and how we increase the health and well-being of children and families, then we, that's an issue we have to get at and we have to get at the root cause. See, I, I, I, I wonder if providing a misdemeanor or, you know, some sort of crime for use of, of, of, or possession or substance abuse would allow people to be mandated into a program that are often voluntary right now, then I would support something like that or, you know, that may be in the case of where it's how we get them into services that they need. And, but also, um, I agree with you, it's not, you know, just to criminalize it is not, this is, is not the right answer. I mean, these are vets that have come back from service center to their nation and they fight or they, they have a, an accident or they have trauma and they have an injury or they have, uh, depression or they're, they're dealing with PTSD and, and they were prescribed these, you know, these are the, the medications that they were given and we're also talking

about expanding, um, the use of medical marijuana to include, uh, opioid treatment and, and alternatives. Right. Right. And we have to get at, with the whole prescription drug issue, we have to get at appropriate pain management, which, um, is not only appropriate prescribing of opioids, but what are the alternatives as a physical therapist that is a, that's a big alternative, um, physical therapy, uh, acupuncture, chiropractic, yoga, I mean, all kinds of things that we can, uh, behave your management issues, peer supports like, like AA, um, but for, um, uh, for drug use, but we can, uh, you know, we, we have to look at it as not just a crime, yes, but it has a, uh, a chronic health condition. And we're speaking today with representative Rebecca Dow and representative Debbie Armstrong. And you're both members of the interim behavioral health committee.

And so I hear in this undercurrent, there is a level of behavioral health, uh, that will address the issue of addiction and the addicted personality and pain management. But we had, um, talked to me, either one of you about the history of behavioral health management, especially in the last five years or so, there was a very disturbing thing that happened. We lost a lot of our providers and, um, so would, do we, do you want to give it a little summary of that? Sure. Um, we had, I think, a fragile behavioral health system that was underfunded and, and pretty fragile to start, to start with. And we had been working for, um, back when I was in the Richardson administration, trying to redesign behavioral health to try and strengthen the whole system. And in 2013, there were apparently billing issues or something in, in providers and, uh, the department, um, this administration decided that there was a, uh, potentially fraud that

was occurring. But unfortunately, what happened is that the, she canceled the contracts for 90% of the whole system on day one, I mean, in a 24 hours, pull them all in the room, cancel their contract, brought in providers from out of state that that was not a smooth transition. And I think we lost a lot of people in the, um, through the cracks in trying to, um, make that transition. I don't think it was well planned out. And those companies that came in from out of state have mostly all left by now. And so we've been redesigning our behavioral health system again. It's just really been, um, really been hard. And in the end, there was no fraud, um, uh, it took years and millions of dollars and audit to figure that out. And there wasn't any. And I, I think we could have done that differently.

Um, do you thought that because I do, this hit the most vulnerable population, these are teenagers. They said drug addicts, these are crazy people. These are, you know, people who really need support and once you finally have a therapist, sometimes it takes years for them to identify with a therapist and they have that rug pull that from under them and they're in free fall. There's no one else to help them and no one that they trust. I, I was just appalling. Yeah. You know, it's, I don't know that we have recovered our capacity on that, but I think it's given us an opportunity really rally together to raise awareness to, um, elevate the issues and, and what it looks like, uh, to try to receive services and to, to get help in the state of New Mexico and, um, we see bills as a reflection of that right now. There's a bill to add the, um, rural tax credit to be extended to those that are doing social work and counseling services. And, and I think it's sort of all hands on deck as far as the House and the Senate's concerned. And I, I would hope to say that that's the same, you know, with the fourth floor that we're looking to find the solutions and, uh, it really made me say, as I step into this

position, what are the unintended consequences? Even if it's something that I believe in strongly, what could be the unintended consequences here and to carefully consider, you know, our actions because they do affect the families of New Mexico. And, and I would, I would add to that that it, it has given us, um, an opportunity to relook at the system and I think that there is, while we can quick jump to say this was a partisan thing, the governor did this, but by partisan, House and Senate, by partisan, all recognize the issues of behavioral health and the need for appropriate services. And so I do think we've all rallied, um, together to try and, and address and rebuild the system. But it was such a grievous blow to the health of our, of New Mexicans, that when this recent thing about the elder, elder care services, one of you, when the same looked at it was going to happen again with our due process, without following procedures, fortunately, that

was stopped. But let's, uh, well, you're more old, you know, you know, you, you're, you've got a background with health care. Yeah. So I, I had a really big, uh, issue with the, uh, cancellation of the contract for the area agency on aging, which impacts the whole system of care. And again, the problem was that there, it wasn't thoroughly investigated where the issues were or any attempt to try and correct those issues before trying to cancel the contract. And that's, that's the problem. And, and I tried to tell people, I'm not necessarily defending the AAA and that they did everything right, but you have to, the state needs to do their job and take the time to do a correct ive action plan, put in a monitor, get some, uh, consultation, use the other tools and their tool back to try and short up and make it a better, uh, functioning entity, rather than completely destroy it and throw the whole system in turmoil and particularly with

aging, um, unlike with behavioral health, with aging, there's a whole system of required due process steps that are in federal law and in state law. And so I think those were ignored, um, but fortunately, they've seen the light, they've backed off of the cancellation of that contract and I hope we'll work together, um, the state with the AAA to make, um, address whatever issues there are, make whatever corrections and, uh, that need to be done and, and make it a better agency and, and improve the, the system and services that we provide to seniors across the state. Well, we have to quickly get up to this session and what's going on. So we did a really cool thing, um, in the 30-day session, the issues are limited to what's on the governor's call and you actually got the governor to message down your early childhood care accountability act and didn't every woman in the house sign that, tell me about the

bill. Oh, yeah, it's the early childhood care accountability act and it will allow the state to receive data and, and know the child outcomes, the impact that, uh, early childhood has across the state, particularly in the little over 700 licensed child care centers that work through CYFD and the reason that I wanted the bill is because, uh, there's so much attention on early childhood, urban land grant fund, you know, all, where's the money going to do, go, who's going to provide the services and often when they talk about home visiting, there's an annual legislative report on home visiting and they talk about the huge impact that home visiting has on building parent child relationship, which is true. They talk about New Mexico pre-K and how it, uh, assures that children are school ready and that's true. And then they start talking about child care and they say that's babysitting and, um, it's not true. But what, what is true is that although, uh, there are many, many standards in place, many standards, many regulations, rules, curriculum, we are measuring child outcomes, taking authentic observations, referring children for services, making sure they're engaged in services, working with community partners and the goals, school readiness,

uh, there's no data that's, uh, in statute reported to the legislators. So I feel like as this moves forward and we focus on early childhood and particularly because of the $25 million asked from CYFD that, uh, you know, child care providers want the state of New Mexico and the legislators to know the important work that they do, not only for the child and school readiness, but also this report will gather why are families accessing the care? Is it work? Is it because they're going to school? Is it because the families are in foster care, the children are at risk of abuse or neglect? And so now the legislators will see the two generational impact that, uh, child care has in school readiness and helping families work and go to school. And so it wasn't every single one, I believe, uh, chairwoman, uh, Chasey and chairwoman Lentstrom were out. They were working on committee. Yeah. And every other, every other woman in the house, I'm sure they would have signed. I just didn't get the chance to ask them and I didn't want to wait one more day. Yeah. Well, it was great. And I was honored to sign on. It's, um, because we do talk a lot about should we tap into the permanent fund to do early childhood and then, you know, the,

the senate finance and house appropriations say, but we don't have any data. How do we know? It's really going to, it's really, um, uh, cost effective and it's getting us what we want. And how are we going to decide that? So I think it was a critical piece that was missing to be able to prove the effectiveness of early childhood. And this morning it passed its first committee. So it passed state governments. And so it's headed on to health and human services on our committee. I think, well, I think we'll get it out of there. We just got to hurry. Another bill that you're sponsored with, uh, Representative Dines, one of my very favorites, that to fund the cancer survivor programs because they make it through. They're okay for now. And then there's no support. Yeah. So thank you for that. Yeah. Um, and it's, it's, they are programs that have been historically funded by Department of Health. And when we had our, uh, you know, economic tight, you know, tightening our belts over the last few years and all the budget cuts, um, you know, that for the department, their priority was prevention.

And so some of these other programs and they're small, it's not a lot of money, um, were let go. And now that we're a little bit better, uh, financially, I think we need to not lose side of the important services and supports that, uh, some of these programs, uh, get, give. So trying to get, um, the department to focus on not bringing some of those programs back. Can you each in a minute talk about some of your other bills and what people should look for? Uh, another bill that I'm excited about caring is with the New Mexico Association of Commerce and Industry, uh, we see a lot of bills on, you know, uh, pregnancy accommodation at, pregnant worker accommodation at parent leave, sick leave, you know, and, and they come with penalties for non-compliance, other mandates they're, they have legat, they, they open up liability for the employer. I want to see New Mexico economy grow and thrive. And so I introduced the family, been friendly business tax credit. It's sort of a carrot instead of a stick that will provide a

tax credit to employers who choose to have family friendly practices and allow for leave and allow flexibility. Maybe they have childcare, maybe they do some, uh, health insurance. And so I, I hope that that's able to bring a discussion on how we grow families because after all these small businesses are also parents, they're also families and they're, they're trying to, uh, make a living for themselves as well. They get sick, uh, they leave. And so how do we lift us about a poverty and strengthen families? Great. Well, I have, I have several memorials that are also like the Medicaid buy-in just looking next year at, um, how we can change our, and strengthen our system. But a bill that I've, uh, introduced is one that would, um, uh, make an exception to schedule one drugs for an FDA approved drug that has a marijuana derivative in it. So there's one, um, under investigation and being considered by FDA now. And since anything with any derivative of marijuana or cannabis is a schedule one and, and you can't do anything, we've, we've exempted

everything under medical marijuana. And so, uh, this bill would exempt should FDA approve this drug. And the drug is being developed for children with very, very severe epilepsy. And so it's a very specific, um, uh, drug that, that for these kids is really important. So if it gets approved, I want to make sure that, then, um, doctors in New Mexico can prescribe it. And I want our audience to know that we can watch anyone with a computer can watch the webcast sing of all the committee meetings and the floor sessions. And the other thing, you all, as lawmakers are so accessible to the citizens of New Mexico, they can send you an email, they can come to schedule an appointment, don't just drop in and expect to see. Well, actually, I tell they, they can drop by and they can pull us off the floor, they can stop by in the office. It may be hard to find us unless they pull us off the floor, but, but it's really important that people who care about some of the issues that you're working so hard on know that they can talk to

you and that you as your, as lawmakers are really receptive to the input of New Mexico. Absolutely. Let us know what you think. Absolutely. I thank you for all you do. Um, and the session will be over of February 15th. Mm-hmm. And so if you care about these things, you know, I want you to contact our guests who are Rebecca Dow. Thank you so much for joining us and Representative Debbie Armstrong. Thank you so much for joining us. Thanks for having us. I'll be watching you during the rest of the session. Good luck. Thank you. And I'm Lorraine Mills. I'd like to thank you our audience for joining us today on report from Santa Fe. We'll see you next week. Past archival programs of report from Santa Fe are available at the website reportfromsatife.com. If you have questions or comments, please email info at reportfromsatife.com. Report from Santa Fe is made possible in part by grants from the members of the National Education Association of New Mexico, an organization of professionals who believe that investing in public

education is an investment in our state's economic future. And by a grant from the Healey Foundation, Taos, New Mexico.