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Good afternoon. I'm Beatrice Berman, chair of the forums committee for the Virginia Beach Human Rights Commission, and it is my pleasure to welcome you to our forum. The forum is community conversations, affordable health care. The Virginia Beach Human Rights Commission was established in 1992 with a mission to institute, conduct, and engage in educational and informational programs for the promotion of mutual understanding and respect among citizens and the fulfillment of human rights. To serve as a forum for discussion of human rights issues, to conduct studies, and to propose solutions for the improvement of human relations in our city. To provide assistance to persons who believe the rights have been violated by identifying the appropriate federal, state or local agency to address the complaint and referring the person to the agency that could help them. We present today's Health forum as an opportunity to talk about access to health care and affordability that affects all our lives. Health care is not just a service, it's a lifeline. When a community comes together to talk openly about health care, we create the conditions for dignity, access and wellness to reach every household. We hope that we all live here with a little more understanding and some guidance on how to navigate the challenges of the health care system. And before we get started, I have a few housekeeping matters to be mindful of during our forum. First and foremost, thank you all for helping us create a welcoming space by showing kindness and respect to our conversation, the moderator and the panelists as they share their experiences with us. We have also distributed cards and pens for you to write down questions that you may have for our panelists. Please raise your hand and give your completed cards to one of our commissioners. Here is one of our commissioners who will come in and get the car from you. But as you can see, we also have a microphone over there. So, you know, we invite you that if you want to come and use the microphone at the end, you're also welcome to do that. Um, during the portion of questions and answers. And also I see that there is no children, but I was going to recommend if we had children to have them supervise at all times. And lastly, the bathrooms are on the hallway to your left. And that is near the entrance. And one more thing I'm going to ask. Please silence your phones so that we are not interrupted. And I also want to inform you that we have the support of the Virginia Beach Media Department here. They are going to be taping our forum so that the citizens that were not able to come and be with us today. They also will partake in the information. Share with them. Thank you so very much. So after the panel discussion, there will be a community fair in the Folio Liberties Room across the hall, with resource tables from local organizations that you can speak with and learn more about the work that they do in our community. Also, we have the Lions Club mobile site and hearing. Then it is in the parking lot outside the auditorium site entrance. To provide their services. So you are hearing or I you know testing. There they are. Now let me introduce our panelists and I'm going to ask you to join me in welcoming them with a round of applause after I finish introducing them first, I'll start with Doctor Jenny Garrett. Doctor Jenny Garrett is a licensed professional counselor, certified Clinical Trauma Professional, and certified eMDR therapist with over 16 years of experience in mental health and human services. As the founder of Peace Clinical Solutions, LLC, she specializes in trauma informed care helping individuals and communities heal from the impacts of trauma, racism, and social injustice. Doctor Garrett is also an accomplished speaker and trainer who equips organizations and professionals with practical strategies to foster psychological safety, resilience, and well-being. She is passionate about making mental health accessible and empowering others to thrive personally, professionally, and within their communities. Doctor Caitlin Pedretti. She is the director of the Virginia Beach Department of Public Health and part time Eastern Region director. She earned her medical doctorate in Master of Public Health, with a focus on epidemiology from the George Washington University, and completed a pediatric residency with a certified certificate in global child Health at Children's National Hospital in Washington, D.C. she started her public health career with the centers for Disease Control and Prevention in the Epidemic Intelligence Service, joined the Nebraska Department of Health and Human Services as a medical epidemiologist, and then served as the medical director and state epidemiologist for the Iowa Department of Public Health prior to coming to Virginia. She has served as a contributing member of the Council of State and Territorial Epidemiologists and the American Academy of Pediatrics section on Epidemiology, Public Health, and Evidence. She is a fellow of the American Academy of Pediatrics and a member of the Goal humanistic Humanistic Humanism, Honor Society and Medicine, and the Delta Omega Honorary society and public health. She has a particular interest in the development of novel partnerships and innovative approaches to strengthen public health infrastructure and better support the public health workforce in their mission to protect and improve the health of our communities.

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Next is Doctor Cynthia C Romero. Doctor Cynthia C Romero is a physician, leader, educator, a nationally recognized advocate for health equity who has dedicated her career to improving the health and well-being of communities across Hampton Roads and the Commonwealth of Virginia. As director of the of the emphasis, Brock Institute for Community and Global Health and Professor of Family and Community Medicine at Macon and John Brock, Virginia Health Sciences at Old Dominion University. She has led innovative initiatives that improve access to care and address the needs of underserved populations. Today, as a panelist, Doctor Romero brings her experience as a physician, former Virginia health commissioner, and community leader to help us explore practical solutions for making healthcare more affordable and accessible to all. Next is Doctor Tammy Spears. Tammy is a doctoral prepared family nurse practitioner with more than 30 years of clinical and healthcare leadership experience. Dedicated to improving access to high quality care for underserved, uninsured, rural and vulnerable populations. As Chief Operating officer of ODU Community Care. Tammy led Virginia's largest nurse led student run free clinic, expanding access to comprehensive interprofessional care while creating transformative clinical learning experiences that prepare the next generation of healthcare professionals through innovative academy community clinical partnerships. Tammy has developed sustainable models of care that address health disparities, chronic disease, and the social determinants of health across southeastern Virginia. Outside her work, Tammy enjoys hiking, golfing, and spending quality time with her family, which keeps her grounded and inspires her continued commitment to serving others. Please, ladies and gentlemen, help me welcoming our panelists.

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We are very, very fortunate with their expertise. And thank you so very much for volunteering your experience, your time to the community. So we have a question to begin with, and I would like all of you to address them, starting with Doctor Garrett. Um, so we want to talk about what barriers prevent people from accessing affordable health care.

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Well, first I want to say thank you. Can you guys hear me okay. Okay. First I want to say thank you for having me. I'm excited to be here with such esteemed panelists for this discussion. And the first thing that comes to mind, I think just as a provider and throughout my career, I've always worked with the vulnerable population. So trauma has and people who have multiple layers of trauma for all types of reasons, has been my population since I started in my career, and one of the things that I've noticed that was always the same outside of who can afford to have the health care. Um, that I don't think a lot of people think about are the competing commitments. And so because of this, okay, maybe I go and I figure out someone sits with me and I sign the forms, I sign the paperwork. But no one really explains what your coverage really entails, what you're signing up for. So maybe I got the cheapest plan that I could think of, but no one explained to me, what's that going to mean to have this high deductible? So when I go to get services now I have to pay all of this money out of pocket. And so watching folks and now I have to make a decision between do I buy the things that I need for my household, or do I pay money into the things that we need for to take care of ourselves or. And so that has been a big struggle that I often see. And it comes up a lot in the therapy space as well, because when we are in the middle of treatment and let's say the year flips or, you know, all of these things happen. Watching clients have to make decisions about, do I do do I use my money to have stability in my home, or do I use my my money to take care of my health? And oftentimes people will choose to have food and to have the basic needs met. And then taking care of your health goes on the back burner. And so that's something that I find myself constantly processing. And one of the things that I advocate for when I meet folks and have with my clients, one of the things we talk about, well, let's talk about what your coverage really means, because so many people don't really understand that, and people don't usually take the time to really explain that. And before you know it, you've signed this up. You're stuck in it for the next year. But people don't think about all of the competing things when it comes to our health that create these barriers for utilizing your health care and even accessing all of the services that you're able to get.

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And I would also just want to say thank you all so much for having me and for hosting this conversation. I think it's it's such an important and timely conversation for us to have. And also, what a pleasure it is to be up here with such a wonderful group of talented professionals. Um, so I think I'll echo a little bit of what Doctor Garrett already shared, and I know that the colleagues to my left will have a lot to say about their experiences, too. So, um, maybe I'll just touch on two things that I would highlight. Um, first is to again, echo Doctor Garrett in sort of the complexity of it all. Um, and I think part of why I would mention that from my seat in governmental public health is that I have seen that sometimes it's hard for folks to know where to access care for particular problems. Right. Um, and in local public health in particular. Right. Is what I provide as their. Virginia Beach local health department director. Sometimes local public health will look different in different localities. And that makes stuff, like, even more complicated. Right. And so it's hard for folks to know, okay. What services, you know. Can I get through a primary care provider. What services can I get from an urgent care provider? What services should I really be seeing? My family provider, my primary care provider and my pediatrician. What services can I go to the health department for? Right. So there's a lot of complexity, even as a, you know, as a health professional myself, I am struck by how complex our system is, which I think can be a barrier to accessing care. Um, and to that end, I'll put a quick plug in. There are some flyers in the community fair that tell you a little bit about the services at our local health department, if you're curious. Um, and also available on our web page. But I'll highlight one in particular, which is sexually transmitted infection screening and treatment that we do provide at the health department. Now, not everybody will need to seek that care with us at the health department, but it is something that we provide. Um, and to that end, you know, the other barrier that I might highlight is the stigma, right? So sometimes there are folks who may not be comfortable going to one particular place to seek care for something like that. And so I think helping people know that there are options, there are services and ways that you can get care for things that you might be nervous about or not sure who to ask or who to turn to. Right. So just wanting to call out, you know, not just for that area. There are a lot of other places where people might carry, um, particular feelings or responsibility, even shame around health diagnoses. Right. And just wanting people to understand that there's a lot of supports available in the community. More than I think. Maybe we realize who can kind of help address feelings around where to access care for particular health problems.

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Okay, there we go. Good. Now you can hear me. Great. I also share my gratitude for the Human Rights Commission for having this timely panel, and also my gratitude for being a part of such an awesome, women led, um, engagement as well. Uh, I will simply build on the comments that have been mentioned already by my colleagues and add two additional dimensions. Number one is fragmentation and then number two is workforce. So I think when we're looking at barriers to access to care again, building on what's already been said, our health care system within the United States is incredibly complex but very fragmented. So it's very difficult to even see any type of continuity of care for prevention. And then certainly when something is acutely wrong and then certainly in emergencies. So with that, I think that is a significant barrier for any individual or someone who's helping care for an individual to know where to go, when, how. And certainly the fear and stigma that have already been mentioned, but also because access is very limited in terms of workforce. So when we are looking at trying to advocate for prevention and wellness, to try to make an appointment for a primary care visit is not just a day, a week, month. In many cases, it's even up to a year, right? If there's a cardiologist that's supposed to be seen. Someone in follow up. Oftentimes, the first appointment or the next appointment isn't really for a year, and certainly for a primary care professional. A new patient. New insurance, new patient. Again, that access is oftentimes limited because we don't have as many independent or easily accessible systems, particularly in those primary care. But when we also consider in Doctor Garrett's space, in particular mental health and all the other specialties, the limitation of not only the doctor level trainers or doctorate level providers, you know, even the grassroots counselors, you know, behavioral health technicians, community health workers. I mean, every step along the way, the limitation in the number of professionals that we have is limited for the population number that we have. And then certainly considering, you know, a larger population that we know is growing not only in age but in significant numbers are our older persons. So those who are even over the age of 80 and knowing that they have particular needs, the number of professionals who are officially trained and skilled in taking care of older persons who are very different than children, young adults, you know, everyone in between pregnant populations, etc. we are looking at, you know, how do we creatively look at new models of care to not only help promote wellness in all aging populations, but also to have access of services when they need it? So again, complexity, fragmentation and certainly limitations due to workforce, I believe are some significant barriers.

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And I would be remiss to not say thank you as well. And what a great panel. This is probably almost 100 years of experience in across a broad spectrum. So thank you for allowing me to be here. And they've hit on most of the key barriers but I'll add just a couple more. So Doctor Garrett, you spoke of um, basically access right. And health literacy and competing factors with social determinants of health, um, the complexity of the workforce. One of the major things that we see in our clinics is transportation. So simply if you have insurance, that's great. But if you can't get to the where you need to go, um, you're not going to make your appointment. So there's a high no show rate for folks who lack transportation. Um, we can give bus tickets all day, but then they have to navigate the trans transit system in the city of Virginia Beach or Norfolk. So transportation is a huge barrier that we see. Um, it's important to meet people where they are. So integrative health. So we talked about the complexity. So getting to a specialist, getting to your primary care, getting to your behavioral health, getting to the dentist your Lion's Eye clinic. Right. So all of those. Even for someone who can navigate health care, it's still a lot. And I have a binder and I keep track of everything and I'm like, oh, I'm going to miss an appointment. So for someone who doesn't have the health literacy to even know how to fill out the paperwork, um, those barriers just couple and completely tackle an individual without that knowledge. So I think it's very important that we look at how we integrate, how we become a one stop shop, how we put systems in place where they can go to one place and receive all the care. Maybe it's a half day visit, but they get everything that they need. Um, so again, the competing social determinants of health is huge. You can have insurance all day long, but if you can't afford the copay, if you can't afford the medication that they're going to prescribe, you're going to choose feeding your family all day long.

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Thank you. I'm going to ask you to speak a little bit louder so that everybody is able to hear you a little bit better. And, you know, the following question would be you are you work in the health care system? So how can you in us, the community, address the disparities in access and affordability? Because, you know, we don't want people to feel helpless. So what is the hope out there that either the provider or the recipient of those services can do to help the system.

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Where am I going first? Is this better? Okay, I can hear myself now.

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Yes, you can put it closer to you. And I think.

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I'm a big advocate for the healing power of community. And, um, similar to what has already been said, us working in our silos, not realizing that this this all works together. I can't treat mental health without the knowledge of what's happening with someone's physical health. I can the amount of things where I have a lot of clients, and they have a litany of medical appointments, and I'll ask questions like, well, has your provider ask you anything about your anxiety? And, and then I find, well, they're not finding any diagnosis because you're dealing with anxiety from all the trauma that's happening at home that hasn't been addressed. And so I think when we think about working together, like as a provider. That's one of the things that I feel is a big gap is we don't work enough together as a community. So speaking to that integrated approach, when we bring all of the services into a space that is accessible, we knock down so many of the barriers. But when we're connecting with each other and we're using the healing power of community and where where I lack, you know what? I have someone who who knows. And you don't have to go far. You don't have to wait another 6 to 8 plus weeks for that appointment. I'm going to take you here now and we can help address this. And I think the system in itself like, is if we're being honest, the system is just not designed to work the way that it is set up. It is just not feasible. Um, but there has to be enough people who are okay with saying the system is not working instead of submitting to it and just sitting in it. And we really have to be creative and look at how can community organizations come together in companies to really work together to make sure that we are all getting what we need. So as a provider, I cannot stand when I go to my doctor's office and I maybe I try to get first thing in the morning, but I'm here for hours and this is messed up my entire day because there's not enough staff to service. Um, and that's frustrating. And then I'll sit there and I'm like, oh, okay. And then when I get back there, we spend more time, they found out what I do and they're like, oh, do you have cards? Do you have? And I'm like, can we talk about my health care first? I'm here. I'm here for me. But that all that always happens and people are always looking for resources. So I don't think we work as well as we can as a community to help heal. And I think if we start doing that, that will start to break down some of those barriers.

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Yeah, I think once again, I would like to enthusiastically second everything. Um, Doctor Garrett has just shared, you know, I think at its core what she has said About the concept of community, right is so critical. So as I heard the question, you know, I was thinking about things like communication, education, um, hearing from our community, being responsive, um, meeting our community where they're at, as Doctor Speer has said. But I actually think you could maybe argue that all of that could almost be covered by the concept of community, um, and that, you know, coming together. Right. Um, and having those supports in your, in your provider networks as the, the system, so to speak, but, but within each other. Right, as, as neighbors, as friends, as people who live here together. Right. Um, and having the conversations, as Doctor Garrett has said, so that we recognize we're not navigating these things alone. Right. Um, you know, there's there's a lot of power in having somebody sit with you at a doctor's appointment. Right. And what is that, if not community? Right. Whether that's a family member or a friend. Just having another set of ears there. Right. And whether that's actually in your doctor's office, right in your visit, or whether it's reaching out to somebody to say, here's something tough I'm trying to navigate. Have you had to do it before? Um, and recognizing again, you know that within our community, we're stronger when we find those resources, those links, those people who have come before us, who can bring us along. I do think there's really a lot to be said for that. And again, more specifically, I think there are probably opportunities, for example, within public health, to look at ways that things like community health workers can help with navigating a complex. and, you know, overly burdensome system, right? There's some things that we can work on on our side. Um, but I think it probably truly does come back to that concept of we're stronger as a community.

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Again, building upon my colleagues Doctor Garrett and Doctor Baghdadi. Yes, yes, yes, exclamation point. But also underscore the, the concept of it really takes a village to improve the health of each other and of our community. Uh, definitely the idea of going to where people are physically, but also where they are as far as understanding literacy and where they are as far as being able to know which way to go, who to turn to. Uh, I believe we as individuals, but also collectively as a, um, a set of interested parties really have the opportunity to not only share information that is credible, that's evidence based, that's science driven, but to also drive it through the most trusted messengers. I think where we are now, in this moment in time, is an environment where information is coming at every person through so many venues and so many means that it's hard if you're not a health care professional or you do not have someone who has that background to interpret for you, it's hard to know or understand if you're not being properly educated or oriented to your health and what you might need. So being able to identify trusted messengers within communities, wherever they may be, especially with those populations who are not tech savvy or those who are not reading the paper. Watching TV on the internet to go to where they are. Identify who their messengers are and equip and inform them on how various resources and navigating steps could be so that they could also help those individuals, families, and communities. I think individually, we all may have passions to want to connect with individuals, but oftentimes if we are coming from a a background or an understanding that is not relating to or connecting with specific populations, again, we just have to recognize that and know even with our levels of information and education, there is no way that a community will trust us as much as they will someone from their own who totally understands them. So I think we as individuals need to recognize and partner with those trusted messengers and also identify information, messages, resources and to have those available equitably as much as possible, you know, across all areas and across all systems.

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So I got to tell you, ladies, it's hard to be the last one.

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We'll begin the reverse next time.

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Thank you. But I will say as as a provider, I think the key, at least for for what our providers and our clinics is we take the responsibility for our patients. We get to know them. So if, if a patient says thanks for the prescription, but I'm not going to be able to get to Walmart, we have a community health worker that drives to Walmart and picks up the medication and we pay the $5 co-pay for them. So it's time in the health care that we pause. We take ownership. We go above and beyond for our patients, and that is going to look very different than the traditional health care model. But that is what we're going to need to do to scoop these underserved patients who are lacking all the things that we just talked about. It's time to pause. It's time to not have these patients a cog in the wheel and run them through every 15, 20 minutes to meet the Medicaid and the standards. And I know that's going against the grain, but that's what is needed to truly make impact in our in our health care system today. So take ownership. Pause. Go above and beyond and train our next workforce to do the same. And to not again look at that traditional health care model. Think differently.

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I'm going to begin now with you. Doctor Speer has to be fair. We go the other way around, too. And, you know, I want us to talk now about that other partner in health care, which is insurance. And so how can we make health insurance to be actually make coverage more affordable for consumers? And then let's talk about, um, Medicaid. And I think one of the concerns that we hear from the community is what may happen at the beginning of next year. And so what are the resources out there for people in need that need Medicaid in order for them to access health care? Yes. You go.

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Um, so this is a tough topic, and it's a hot topic right now. So I think for those of you that don't know, uh, beginning in 2027. Changes are coming. We're not going to prevent these changes. They're going to be catastrophic to Medicaid, to Snap benefits. It is going to be a cliff that hundreds of thousands of people fall off and become uninsured. And your conversation in question is timely. I sat in a conversation at TCC this week with Secretary Marvin Figueredo, who spoke about this, and basically they are saying it's coming. Harm is coming, and we as a community have to pull together and find a way to prevent the least amount of harm that's going to trickle down. There's hope. So what we can do is just like we talked about. So if there's health literacy, if people can't figure out how to fill out the forms, then we sit down with the navigator, we sit down with a community health worker and we fill them out for them. Line by line Snap benefits. Medicaid. So those are barriers that we can assist with making sure that they submit appropriately, making sure that they're aware of the recommendations that are coming afoot, that there's a work or a volunteer hour requirement in order to stay insured. Um, again, the paperwork is going to be, um, tremendous. And I'll pause because I know you all have other things to. I could speak a lot on that. Um, but there's there's hope, and we will help.

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It is different to go first or.

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But certainly building upon Doctor Spiros. Um, first of all, just addressing just overall health insurance. Uh, when we talk about silos, um, we also can consider them cylinders of excellence. And when we consider the health insurance and the payers in general, That is definitely a cylinder of excellence where they seemingly are doing things on their own. So how do we even begin to influence them when some of their priorities are increasing profits for their stakeholders and seemingly achieving quality of care metrics for the clients that are in? And that really seems like a competing environment. But I will say the biggest influence that we can have is to continue to press and advocate for more policy changes. That clarifies what health insurance payers cover. And again, I think that's a whole deep conversation and could be an, you know, a forum in and of itself. But I think influencing the payers to cover more of what we as kind of the community and what our community health needs and illnesses really require would really be advocating more for prevention, wellness, access to care and supports, etc. but when we're talking specifically about Medicaid, it really is better understanding what the changes are that are coming down the pipe and also setting up the systems now, which I know many coalitions and groups in the cities themselves are working on, how do we anticipate what the changes are going to impact? And I think we had heard so far of 133,000 have already begun to lose their benefits across the Commonwealth, and that number is going to continue to grow by hundreds of thousands of people who will not know that they need to renew their Medicaid services every six months, which how many of us can remember to renew something every six months. You know, how do we provide the support to remind them to do that? Then, when it comes to some work requirements, how do we think strategically about lining up the opportunities that are readily available and helping connect the dots and support them? So we need to be prepared to to understand what those changes are and how we can, um, proactively work together to prevent them. And then just lastly, I think one of the primary things we need to do is have more public community conversations like this that is very pragmatic, simple, straightforward, and to have the team, community health workers, health insurance enrollment specialists, I mean, anyone that might need to be available to support those who need them to be present to assure that they the community gets the supports that they need in the timely fashion that they need it.

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I would say definitely it's harder going last because I'm like, oh, that was good. I was going to. So to build, like Doctor Romero's been saying, I think the I'm sitting here and I'm listening, and the one thing that I'm thinking about are all of those folks who don't even know that this they need to be concerned about this now. And how do you reach those individuals? Because the reality is we're four months or so from from the new year that's going to fly by. Holidays are coming back to school this year, and so we're already in the shift. And so it's kind of like if in the next four months, if this becomes a thing that you're concerned about, you're already kind of behind the eight ball and trying to figure this out because most communities, most parents are probably back to school, shopping and prepping for the holidays. Here's where all this money is getting ready to come out. And there's this huge change that's happening. And I'm just I was just sitting here thinking, how do we create space to go to those individuals who, who, who have Medicaid and they're going to lose this, and this is going to be a huge impact, and some of them won't find out until it's happening. And I have these appointments. I have to be here. I have all of these things. So how to come together as a community to create more spaces, to just or even go into the community to sit and just have these conversations in forms or, you know, it's a little bit more scary nowadays to go and knock on people's doors, but to to go to the space to share. For those people who might think, this doesn't bother me, like I'm thinking about the children and all of these folks and all of these Services that people are going to lose and they just have no idea about it. So. So I love the answer of the advocacy because I feel like that's what we've. Been really talking about is every person. Like, just imagine what can happen if every last one of us took this and said, you know what, I'm going to go to the next level and share and get a group of people and we're going to go and advocate together, right? We're going to go to, to to the Capitol. We're going to go to these days, we're going to do letter writing campaigns. We're going to send the emails. We're going to make the phone calls to share the information and to also come together. Well, because it doesn't take a lot to put on community events and fairs. You find a location, you get a group of people together and invite the community out. Sometimes I think we make things a little bit more complex than it needs to be. So that's one thought. But my other thought was thinking about the providers. There are just not enough providers like Doctor Romero was saying in regards to the workforce. And when you're talking about insurance, I constantly hear in the in the mental health space the number of people who don't take certain insurance, and Medicaid is one of those because they don't pay enough. You have to jump through a lot of loops and hoops, and so you have a group of providers where most of the insurances that folks can have, they can get access to services that we're not taking because there's all of these things. And, um, Doctor Spears, as we were talking about the paperwork, I cringed because to sit with someone and have to fill out all of these forms, like, do we really need that? Do we really need all of this information to make sure that people have the health care coverage? Because that's the thing in itself and that will deter people. And working with I when I started my career, I worked with people experiencing homelessness. And so to go and sit with them to complete the applications, to go through all the paperwork, a lot of it was didn't get done because I don't understand what I'm reading and I don't have anyone to sit with me or this is just a lot like I'm trying to make sure I have my bills paid and to have a home, and now I have to sit and fill out this whole packet just to take care of myself. So I think there's so many levels in terms of what we just have to do it different and start to spread and grab as many people as we can who are willing to say, okay, the traditional way doesn't work anymore, and it's not going to work with this huge change that's coming that whether we realize it or not, it's going to impact all of us in some way, shape or form.

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Yeah. Doctor Romero.

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Yeah. Thank you. Doctor Garrett, one thing that you made me think about during your comments is that oftentimes when we hear those who are covered by Medicaid, those who currently have Medicaid, we immediately think of, okay, those are the poor or low income populations, but Medicaid also covers older persons who are in nursing homes, covers pregnant persons as well as those with mental and physical limitations. So in reality, I think your final statement of this impacts everyone. What employers should be thinking about this as well. Because if they lose some of their employees who get sick because they're not getting care and they have to stay home, that's lack of productivity for their businesses. So I just wanted to just kind of make that point to say, you know, yes, it's impacting everyone, but businesses should and employers should be thinking about this as well.

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Thank you so very much for the conversation. And, you know, when we talk about the community challenges, this conversation can go on and on because we have to take into account transportation, paperwork, language access or coverage gaps. Right. And so how can we address all of that. And of course, we want to involve the community. And I think I want everybody here to prepare because it's going to be very soon. Your opportunity to ask questions or to add to our conversation. Um, the other question that I have for us to discuss is that in the media, we have heard a lot of controversy regarding vaccinations and other things, you know, that actually do not provide the correct information for our community. So, um, what screenings, vaccines or preventative services are most important, um, for families in our community right now? Can anybody address that? Yes. And everybody is looking at Doctor Bodily.

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You know.

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Especially.

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00:46:27,079 --> 00:46:29,480
Um, you know from my, my family practitioner.

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Colleagues.

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Right. I'm a pediatrician. I'm a public health professional. And I'm an epidemiologist. And I can tell you I have had to say to parents. You know, in my career, and it's been a long time, thankfully. And I've had to look at parents and say, look, we've done everything we could for your child. I'm so sorry they've died. And that is horrible. And I would do anything to not have to say that ever again. And that's what vaccines are. So vaccines are this incredible, life changing. Absolutely. Um, exceptional tool that we have that can make it so that our kids never have to experience these horrible diseases that can take their lives. Um, and it is such a gift right now. All that being said, I also completely understand that people have questions, right? Um, there's, like, nothing better than an adorable, chunky six month old. And when you bring them to me as the pediatrician and I'm like, okay, we're going to give them a bunch of vaccines, and then I give them back to you and they're upset. I get it. That's not a good day for you. However, it is just such an incredible opportunity for for you, for, um, for your child, for us as a community to do everything we can to set our kids up for success, for health, and to make it so that, you know, they live long, happy, healthy lives. So people should have questions. You absolutely should have questions about your health, about vaccines, about why we do the things we do. And those questions should go to your trusted as doctor said, your trusted providers, your health care providers, your public health providers, folks who do this for a living, who want to see you and your family succeed because that's really what we want. We want to keep, you know, you and your kids and your families healthy and safe and happy. And that is why, again, I just can't say enough how incredible vaccinations truly are and what a scientific achievement that we have to make it so that now, rather than children dying of things like polio. Right? We live long enough that we've now started to talk about chronic diseases, which are so much more complicated and so much harder. And I wish we had vaccines for them, but we don't yet. Maybe someday we will. Right. But we have achieved this wonderful thing where we have taken away some of these really scary things. And that's that's what prevention is, right? That's how you prevent a bad outcome. So again, all of that is just to say I completely understand when it is hard to find out what the right information is for you and your family. I totally get that, especially these days. But I would just encourage everybody to take those questions, take them to your health care providers, take them to your public health professionals, take them to your trusted community members. Right. And have those conversations because these are really, really incredible tools that we have to offer. But vaccines aren't the only screening and prevention tool. We have a lot of things we recommend that help keep people healthy.

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Yes, and just want to underscore the importance of vaccinations and understanding what the fears or the barriers challenges are for the individuals and families and the communities that are choosing not to go along with the recommendations. Again, I think that goes back to trusted information. And again, a TikTok video or, you know, a very quick, you know, snippet isn't going to address what the family members or the individuals concerns are so in a non-urgent place or space like this is time to allow people to come up to professionals and listen and understand what their fears are, and then also give the incredible history of the number one public health strategy that has saved millions of lives through the decades, through the years, is really vaccinations. And as you know, organisms grow, evolve and become, you know, survival of their, you know, their, um, their species. We're seeing new and newer organisms that are just resistant to, you know, treatments, whether there are viruses or bacteria. So the idea of science investigating and really just at least implementing the proven vaccinations that we know have saved lives through the years. Again, that's a long conversation to have with individuals who, again, have fear or concerns or who are getting information from, you know, not the the most trusted, science based, evidence based sources. So again, just want to continue to underscore that. But the other messaging as far as additional screenings and way to be healthy, I think we need to be doing a better job as the health care community to advocate for staying healthy and well today with where you are, you know, how do we help you? Whether you're a child, a teenager, a pregnant person, you know, a person who's taking care of children and their aging parents. Whether you're older, you know, how do you, in that moment in time, know what is going to keep you as healthy and well as possible? And that's physical activity, sleep, healthy diet, you know, and certainly screening for any chronic illnesses that already run in your family, whether it is mental illnesses, whether it is diabetes, cardiovascular disease, whether it is cancer, right. There are so many aspects of medicine where we can predict by simply looking at an individual's family history, but also their current lifestyle and their current habits. And so getting information to the general public, to the community about the various risk factors, you know, what they may be more prone to potentially get because of their family history and current lifestyle, but also just by simply getting older, right? Our bodies simply get older and develop certain conditions like the cardiovascular disease, etc. but it's sometimes it's not a matter of if an individual will develop a certain disease like diabetes, cardiovascular disease, or cancer, it may be a matter of when. And so how do we delay that onset as much as possible. So getting information out. Allowing as many people to understand, you know, kind of the ways to stay as healthy and well as possible and then to screen for them or detect them early. So there are definitely blood tests that can be done to look for sugar levels. There are different ways, whenever you go to a clinical setting, to be able to check your blood pressure and check it, even at home, monitor those. And then certainly around cancer, the mammograms, the colonoscopies, blood tests, and knowing, especially in family history of various cancers, you know, what are those tests that could be done early so we can detect them early, understand what the options are, and then pursue treatment, access to care and continue the treatment to improve quality of life. So just a lot of great opportunity there. And then certainly the whole idea of, you know, how do we screen for is someone able to access their supports and services because of the social determinants of health or the social drivers of health? Do they have transportation? Do they have social supports? Do they have language barriers that need to be overcome to be able to access the health care system? I think there are just a lot of opportunities to help keep people healthy and well as possible. Thank you. You can tell I'm passionate about that.

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Yes. No. And that is wonderful. And, you know, at this moment I'm going to ask everybody that has a question. Raise your hand if you want to give a question or you card to one of our commissioners and they can raise their hand. They are around here so that they can, uh, pass it over. And, uh, what we are going to do is pass it behind the the table over here so that.

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Can I add just something. Something different.

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So yeah, let's keep it going.

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Vaccines is not my area of health care. So I bow out of that. But as you all were talking, I started to think about just the overall stigma that just exists and how the reality is we live in a country. We live in a world where division is what's accepted, right? Like chained. True change doesn't happen when we're divided. So we live in a space where whether you believe in vaccines or you don't. Okay, well, we don't agree. So we need to feud. We don't work together. We can't possibly still be in community and do things and help each other because we're on two different ends of the spectrum and what we believe. But but all of this is rooted in fear, right? Those who get vaccinated, there's fearful of what will happen. Those who choose not to are fearful of of what happens. And so I started as you guys are talking, I'm thinking like, where does this originate, this thing, these things originate in our homes Because in our homes where we first learn about the world. And I know for me and a lot of the I work with mostly minority populations and a lot of the clients I work with and folks that I serve. You're not talking about health care and taking care of yourself with your children. Like my my parents don't. They didn't start talking about it until it became an issue. Their parents didn't talk about it until it became an issue. So by the time the conversation is something that is fruitful and we're trying to change lifestyle, some people have already been affected by it. So as you were talking to them, thinking like, how do we really change and reduce the stigma and really respect each other, whatever in your on to its it has to start in the home when we're young and we have to give the information because so many people just do what they're told to do. There are probably some people who get vaccinated. They have no idea why they're what the vaccine is for. It was just went to the doctor and they said, your child is however much older you need to get the vaccine, Okay. And so instead of, I think and living in a world where there's so much division in the differences, it's causing us to get further and further from this collective healing, and it's making us sicker and sicker because we're so divided in our beliefs that I can't. Well, you believe in vaccines, so I can't possibly learn anything from you, and you don't, so you don't have anything to add. Instead of looking at this as a holistic thing, like, how do we all come together and just make sure that folks are informed so they can make informed decision? I respect whatever decision you choose to make, but let me give you the information so that you can be informed and let me guide you to the place so you're not making decisions off of misinformation. And I believe a lot of that stuff starts in the home. Because if you don't have that information like we've been talking about like that health literacy, if you don't have the true information, to have a conversation, to sit with your children and to talk about the importance of being active and having a balanced meal and these kinds of things, or you don't even. You were never taught that. How did you pay that forward? Most times it happens where now we're older and we're sick, and now we have to make these drastic lifestyle changes for things that we could start a lot earlier on. So I just wanted to add that that piece to thank you.

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It also I'll remind you that there is a microphone right there in front. If you want to step forward, please feel free to, uh, share your question. But meanwhile, let me give you one. It says, what can a person do who is on Medicaid but unable to meet the new work requirements?

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Yeah. So what we heard this week, um, they are looking at that. They're looking at the work requirements are also if you are in training. Right. So if you are doing volunteer hours. So they are recognizing that that is going to be a barrier. Obviously, if you are disabled, you're not able to work. They'll be those qualifications that allow you to you'll be exempt from the work requirement, but I do. I did appreciate that they are looking at other avenues like training. So in putting training programs together for people who do meet the work requirement but may not be able to work but can work towards that, so there are other options.

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Yeah, yeah. One thing and again, we we went to the same session with Secretary Figueroa. And in addition, some of the people that I was sitting with were talking how they were able to attend an MRC, which is the Medical Reserve Corps training, where again, you can be a volunteer for Virginia Beach, Norfolk, Chesapeake, any of the cities that have a health department also have a medical reserve corps, and you can volunteer and sign up for that. And the MRC are being trained to be educators and informants about the work requirements. And just by being trained as that type of trainer and spreading that word and holding sessions with the community will go towards the hours for work force or for that work requirement. So I think there's going to be more guidance that we heard from the Secretary that the state is trying to make things as easy as possible, not only for those who might need to achieve those work requirements, but actually how partners like MRC and other organizations that may have volunteer and training opportunities to have those more readily available to community members. So I there's definitely going to be a lot of information in the coming months to make it easy, especially for the Medicaid patient. So thank you for that question.

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Excellent. Um, the next question is almost like the opposite of that.

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Yes.

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What is the work required?

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And what is required of those who are on Medicaid as of January? We're we're talking about what do you do if you can't make it, but what exactly is required or going to be defined?

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I think and and we will want you'll want to double check this with Virginia Beach. So if you're talking about Virginia Beach, it's Virginia Beach's Department of Human Services, right. Who administers our program locally? I'm fairly positive it's 20, 40, 60, 80 hours per month. Um, is what's being asked of either work or volunteer or education, I think. Um, so I think for folks who might not be able to meet those 80 hours, it's my understanding so far that there may still be an exemption process. I don't know that it's quite clear from the federal, state and local level exactly what that looks like. And so that's where it becomes really important to stay tuned with whoever your local administrator of your Medicaid is, right. So again, you know, our human services in Virginia Beach or whichever localities somebody is in. Um, you know, because I think as, as we do start to hear a little bit more about the exact details around what will be required, some of those pieces will become a little more clear. And for example, I think some of what Doctor Romero and Doctor Hess are saying is I think there's efforts at the state level to try to think about, um, different ways that that requirement can still be satisfied, even for folks who may be experiencing some other kinds of challenges. So all of that is just to say that's my current understanding. But I do think there's, you know, it's important. This is a place where it's super important to stay tuned, because I do think there's going to be more to come on the exact specifics. I don't know if anybody has more.

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Excellent question. And thank you so very much. Okay. I'll follow up with the opposite of the first question. And it says here my PCP has basically a concierge Medicare plan or medicine plan. We are lucky to afford this. But can you speak to the impact to those who can't afford this increasing, increasing trend?

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I, I can start. So again, I was in private practice for 20 years, and I had the benefit of having my mom as my partner and my dad as our office administrator and so truly family medicine practice. Uh, but I had the the incredible pride and opportunity to appreciate the value of a, a longitudinal patient physician relationship and that access, getting to know patients very well and having the patients get to know me very well. I mean, it just was truly a gratifying professional experience. And I truly felt that I was taking the best care of patients. The concierge model certainly allows individuals who can afford to pay a certain amount every month to have unlimited access to their primary care, whether it's by telephone, by a virtual visit, or scheduled in-person visit. That's great for those who can afford it. from all of our standpoints, all of us here on the panel and those of us who are really concerned about the health, especially of those not only who cannot afford that, but those who are likely not getting care at all because they feel fine, they don't have symptoms. I feel that that is creating yet another tier of access to care, another barrier, and widening the gap to more health disparities, where I believe that that's going to show that those who do not have access to care today, those who are challenged by the social drivers of health, no transportation, no appropriate paying jobs, no stable housing environments, no access to healthy foods, no safe environments for them to walk or to exercise. All those who are already facing barriers and challenges to access to care. I believe that that concierge model is simply making it wider for those who need. Health care professionals need information and guidance to keep them as healthy and well as possible. Are just going to continue to have more and more barriers. So again, I appreciate that it helps the providers who are involved in that scenario. Setting up those practices have a little bit more life work balance. I, you know, valuing that relationship with their patients and having the patients value their relationship with that provider, that clinician. But again, I my heart goes out to those who cannot afford it and who are simply not getting care today. And I think that's going to continue to cause barriers. With that said, I think going back to what Doctor Spiros was talking about related to, It's interesting how it's being seen as innovative care now, which is integrative and person. Patient centered care is a model that pediatricians, family physicians, general internal physicians have known for decades. Right. So the fact that it's, oh, it's new and innovative to have person centered integrative care, duh. You know, but but to to truly advocate for that where we have to be, you know, creating this image and this model, that truly person centered integrative care is not just physicians. It's not just nurses, it's just not psychologists. It's really almost every discipline and health profession that is out there trying to advocate for health and wellness, pharmacists, chiropractors, you know, you know, anyone in the community, nonprofits that are, you know, helping, you know, how do we have that message that put the patient, that person that you're trying to care for and keep as healthy and well as possible. What do they need? Who are they getting care from? And how do all of us who are involved in that team manage each other up, you know, and not be competitive because there's so much business, right? Everyone should be able to have this wonderful team of interdisciplinary and multidisciplinary supporters, and to just help provide as much information to that individual, to that family member or caregiver who's trying to care for that individual and their family and their community. And again, I just think we need to again, promote that cohesiveness and put divisiveness aside and really focus on health and wellness of the individual families and communities.

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Do you mind bringing the microphone to Doctor Berman there? Thank you.

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Thank you for.

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What's that? Yeah.

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It's on.

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01:08:52,560 --> 01:08:53,760
Yeah.

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Thank you for all that's been discussed. And I wanted to ask the panelists the question and wrote it down. But I'm going to suggest an answer, too. Wouldn't it be a solution to many of the many issues and barriers and problems that were discussed today to have universal health care as a basic human right? We're the human Rights Commission. I was in practice, family practice for 30 years. So I've seen all the problems. I was paid $8 a visit for Medicare Medicaid patients. I was the only one on First Colonial Road and even wider that took Medicare and Medicaid patients because it paid only $8, which barely covered the paperwork itself. Well, anyway, I came all prepared to talk about a part of healthcare that isn't involved in modern medicine today, and that is oral health care. And I had a whole spiel here, but I'm going to tell you something that happened long before most of you were born. Even I was a hospital orderly in about the 1969 or 70. And I was called to come and restrain a patient that was acting completely abnormally violent.

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You can imagine. So I had to restrain this patient, and I found out that he was in for some kind of a psychological problem, and. during the course of restraining him and finding out, and I had to take care of him after that.

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The head nurse came down to talk to this person and he bit her hand. He bit one of her fingers off the head nurse. She had to have her finger reattached. In those days, they used to hospitalize people much more liberally than they do now. You didn't have to meet all kinds of restrictions and out of humaneness. They sent this person to the operating room because they noticed that all of his teeth were just nubs, but he was able to bite off the finger. They removed his teeth and he became the most tranquil. patient. He was humiliated in his own mind that he caused such a problem. He had a complete psychological turnaround, and when he left, everyone smiled. I witnessed this. Anyway, I won't go through the speech that I had, but within the world of medicine, there are even topics that don't get covered at all, which is most not basic, but oral health care that intercedes with medical care when it causes infections to go higher. So I completely changed my mind, having been in a, you know, a health care position where we had to collect money and follow the rules to stay alive. But wouldn't it be a good solution or what? What's your idea about finally leveling many of these restrictions and having the thing that I thought I would never say universal health care for everyone? Certainly you've heard that there are problems to that, but we're having it sounds to me many other problems that would be solved by this. Health care is a human right. Not according to me, but according to every other developed country in the world except for us. And that's us. Thank you.

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Yes, please.

54
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So thank you for your thoughts and your question. And thank you for being one of those unicorns that opened your doors to the uninsured on insured or less insured. Um, I'll tell you. Odoo community care, our safety net clinics. We follow your model. We are a holistic approach. Our doors are open to everyone. We don't accept insurance. We're free because we do think it is a human right to have health care. Now that's not fixing the big problem, but know that there are programs in your area, in your city that are tackling that concern. We also have a mobile dentist who presents to both of our clinics in Virginia Beach and assist with dental care to those that can't afford it. He does take Medicaid. He's one of the only dentists in the area that takes Medicaid. So I appreciate your thoughts, your heart, but and know that I'm not going to solve the bigger issue of universal health care. That's for more smarter people than me. But know that there are teams out there that the doors are open to everyone.

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Thank you.

56
01:14:40,199 --> 01:18:06,619
Yeah. Yeah. And again, thank you for your years of service to our community. Taking care of patients, but for sharing your story. Um, what I would say is, I agree with you wholeheartedly that universal care should be a right, a human right. Agree 1,000%. The trouble is, politically, it has become more of a hot potato because it oftentimes gets confused with or kind of combined with a conversation related to universal payer and assuming that the government will pay for everyone's health care. And when we look at how well the government has done in terms of implementing Medicare and implementing Medicaid, there are critics about that and saying, well, maybe we don't want the government to be the single payer to cover the health care. So I think unfortunately, a lot of the conversation gets confused beyond the human rights piece that you're describing. I think we need to continue to advocate for that and educate our policymakers and everyone involved that access to health care should be a right. The other piece is that it's very complex, because even having that statement that universal care is a right, it does not guarantee at this point today universal access, because, as we've discovered, again, the nursing shortage, the physician shortage, the councillor short, I mean, all you name, even the oral care, the dentist, even dental hygiene when we look at all the health professions that make up the health care delivery system, especially the primary care, the workforce is very limited. So even though we can say yes, universal access to care should be a right and yes, universal payment for that should be, you know, a, you know, an assumption. It does not guarantee access. So again, that's what makes it a little more complex is to say, how do we assure that everyone has access to the quality of care, like what the community CARES is offering today? How do we assure that everyone has access, not just knowing that they can go to the health department to get their immunizations, but the awareness and the understanding that at this age they're due for this. You know, as a teenager getting ready to go to high school? They're, uh, they're in in the timing to get an HPV vaccination. A senior is eligible to get pneumonia, vaccination, etc.. It's like, how do we assure that access to those services is part of that? Statement of universal access to care is a human right. So it's a very complex. But I would agree with you that it should be a right locally, statewide and certainly nationally in the in the United States.

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I would just add thank you for.

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The.

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Question and for sharing what you did and for your years of taking care of folks. I don't think there's anything I could say better than what we've already heard. So, um, agree and and would just take the chance to to add if folks aren't familiar in a small way. again. You know, there are some resources, as Doctor Spear has said. So at the health department, for example, we do offer pediatric dental services for families and kids who may have trouble accessing it otherwise. But you're so right that oral care, particularly as a preventive health care, is just so under emphasized, and absolutely not just for, you know, not just for the teeth themselves or the infections, but we know it has implications for gut health, for immunity, for all of these other things that go into overall health and wellness. So thank you for bringing up oral care. You're absolutely right. That is a critical piece of preventive care. And and the overall access that folks should have.

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Thank you. Any other question from our audience, please? Yes. Oh, doctor Garrett, please.

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I would just add one. Thank you for your your passion For, for this and again that that particular part is not my area of expertise in as you guys are talking, I'm just sitting here thinking, wouldn't there be some nice to live in a world where we just saw people as people and address the needs as they need to be addressed? So not this one size fits all. You have to meet all of these things, because there's always going to be somebody who doesn't check. I check all 99% of the boxes, but there's the 1%. Oh well, you can't get it this way to really have this really real, individualized approach to where there's not just one way that health care treatment looks, but okay, well, if we have folks who might have these needs and have these needs kind of similar to what you were saying, and I'm going to treat you based off of what your needs are not, you can only get this because if you qualify for these, but oh, you don't need this. So you can't get this full access of services and to speak to what you were saying and um, Like

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I'm trying to be nice. The nice way to say it. I don't think it's. I know it's complex, but I don't think it's as complex as our our, our leaders and our governments make it. Because if there are other countries, there are other places who are doing it. Yes, we all have these different things, but it's amazing what can happen when you just sit people down in a room and the main thing is the main thing, and we sit and we really come up with and we're solution focused rather than the continued competing agendas over and over that. And then the real topic gets lost, because now I'm frustrated at what you said and we're not even talking about the issue. So we have to keep coming back to the table and we never get to to a solution. It almost feels like that is intentional. Let's stay here in this cycle, talking about all the things that have nothing to do with what we're talking about. Meanwhile, people are dying every moment that we're sitting here feuding with each other. And so I like my prayer is always that we we live in a country where the community and the unity of it all is more important than the dollar, or the status or the power and the privilege, because those things get in the way of us really being able to move forward. But if I always look at like, okay, if this country is doing this and everybody, every country has their thing, but if other places are doing it, it's possible to do. And sometimes I think we make things more complicated than they really need to be to get to the solution. And not thinking about the the thousands of people who are dying while we're sitting and waiting for the right answer.

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Thank you, Doctor Garrett. And we have a question here. And then after that question and the answer from our panelists, do you mind bringing the microphone? There's another person there, their needs actually our chairperson. Uh, go ahead please.

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Thank you so much, everyone, for this dialogue, and there's so many what ifs and what can we change? And what is this going to do to the emergency room and what does it mean for preventative health? But I grab the microphone just to have doctor talk a little bit more about ways we can access things, such as front door, if you don't mind just closing what front door is so that those that are listening or have the ability to listen to this can hear about how they can reach out to resources that are there right now and currently. Thank you.

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Thank you.

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Yeah. Thank you. So Morgan is the director of the Housing Resource Center clinic that we run. So thank you, Morgan. So this hasn't been a tough conversation today, right? It's heavy. It feels a little bit heavy and rightly so. What I want to say is there's hope. People care. The community cares. Organizations care, students care. Um, and because of that there is a lot of work like Doctor Romero said, and everyone is a part of. I think everyone here is a part of the there's a health health care safety net program that's occurring throughout Hampton Roads area, and there is a new program called Front Door. And at our resource table, if you swing by, we'll share that resource for you. It is a new resource. We think it's um, some again, innovative thinking out of the box. We're trying to be preventative, not reactive to what's coming down the pike with health care. And we're providing resources. So it is a QR code that will take you to a website that provides you. You put your zip code in, you put what your needs are. Is it mental health, is it medicine? Is it vaccines? Is it oral care? Um there's buckets, main buckets, and it'll tell you who can. If you don't have insurance, it'll tell you where you can go. Um, in Chesapeake. In Norfolk. In Virginia Beach. In Suffolk, the whole area. So it'll give you all of those resources. It'll give you the telephone number, the website and what to expect in next steps. It also gives you a virtual care option, so you click off a couple. It's very easy to use. You click up off a couple checkboxes and it'll say you're a great candidate for a virtual visit. Would you like to talk to someone right now? Um, again, free free free free. So there are services. We just need to be synergistic, work together, um, and get the word out to those that may be in need. So thanks, Morgan, for the opportunity to share that.

67
01:24:58,789 --> 01:25:01,710
Thank you.

68
01:25:01,710 --> 01:25:29,560
Yes. I just wanted one quick question. I believe you talked about, um, I would say due to recent legislation, there have been cuts to Medicaid and Medicare populations in the state of Virginia. Can you describe a little bit about how that looks like, what do those cuts affect and who exactly will be affected and how would they be losing access to care?

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01:25:29,560 --> 01:27:14,210
A lot of pressure with that one. So I'll be honest, I don't know. I'm not the Medicaid expert. And if someone at the table jump in. But what we have learned and what we know is the current administration, and I don't want to get political, is going to try to right the ship, if you will, to avoid abuse of the product and how they're doing. That is now the barriers and restrictions that they're putting in place are going to trickle down to individuals like you and I and our parents and our friends and those living in the woods. Um, the restrictions like work restriction, having to show that you work or you volunteer and if you don't, they're going to enroll you. The fact that you have to re-enroll every six months is unrealistic. People are going to fall off the cliff, and they're not even going to know that they don't have insurance until they present somewhere to get their medicine refilled or to get their mammogram or whatever it is. So these services are going to affect again. Like Doctor Romero said already this year, just because of the pre implementation, over 130 people have lost insurance and are currently uninsured. Additional on top of what we already had. So starting January of this year, um, when all of these restrictions come into play, hundreds and thousands of people are going to fall out of being insured to uninsured with. And then there's little access to care when you are uninsured. I hope that answers a little bit and feel free to add any other details.

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01:27:14,210 --> 01:30:16,510
Yes, yes, and I'll thank you for that question. And it is really confusing. But it a lot of these changes are a result of the HR one, which is also known as the Big beautiful bill that follows just in the health care realm follows a lot of the benefits that were put in place with Obamacare. And again, following on the heels of eliminating a lot of the subsidies that actually, you know, kind of working families, working adults who are able to get funding from the government to be able to access health care. All those subsidies have already been eliminated. So to have that be eliminated, to have some of the cuts and the the barriers that are going to reduce those who are enrolled in Medicaid, you know, it's achieving the overall goal of reducing expenditures on the federal government because in addition to not having as many individuals in the Medicaid program, which in Virginia, we've we've actually had a pretty, um, tight, uh, criteria for having those who really qualify for Medicaid. We really have people who need Medicaid enrolled in Medicaid. But we certainly expanded when the Medicaid expansion occurred a few years ago. But to follow that, we're also seeing that the the ideas of reducing even the Snap benefits, which had access to information about nutrition as well as access to food supplies, is also being eliminated. Again, the idea of reducing expenses from the federal government was really the overall intention. Uh, and lastly, uh, each state, the way that the system of Medicaid works, we oftentimes would get some matching dollars for various programs from the federal government as well. And with a lot of these changes, including the reduction of those enrolled in Medicaid, were also reducing the number of dollars that are coming that are also helping support other supports and services for the rest of the Commonwealth. And certainly, you know, trickling down to our localities as well. So it really is like pulling a thread of a sweater that once you pull that thread, it will start to unwind a lot of other connected support and services that many of us don't think about until we see that the challenges are there. So it really has a lot of other implications.

71
01:30:16,510 --> 01:30:23,229
Yes. Another question over there. Thank you.

72
01:30:23,229 --> 01:30:23,789
Hi.

73
01:30:23,789 --> 01:30:51,390
I'm wondering what is being done to communicate this information out into the community so that we can make sure that people are aware of the changes that are coming and educate them on what needs to be done so that they don't show up at the Ed to find out. Oh, I'm no longer covered. Even though Eddie is a bad a bad choice because but can I?

74
01:30:51,390 --> 01:31:07,000
Can I add one more thing in terms of the requirement for the volunteers and all that the work, who is actually saying what they provide is valid? How do they how are they validating that?

75
01:31:07,000 --> 01:33:56,930
Okay. I'll start with the first. Um, so what's being done? So what we've heard because we asked the same thing, this great talk, great information. Now what are we going to do about it? Um, and what he shared is over the month of September, there's almost multiple per week meetings across human health services, D.D.S., DD. I mean, so all of the the big services, social services in the communities are going to meet on a regular basis so that this information from the state can trickle down to the city level so that that the city folks can then disseminate information. Um, so a lot of information, we're being told is coming specifically in the month of September and moving forward. So lots of information. Um, we'll see if that happens. We have to remain hopeful. Um, and then they did talk about so, you know, talk about paperwork, Right. We're all like, so that was the other piece. And not to get in the weeds with money, but they talked about the which I wasn't even aware the federal government actually penalizes the state of Virginia when the paperwork isn't filled out correctly. So when we fill out the Medicaid form, the Snap form, and we hit submit and it's not accurate, and then there's all of this administrative work that has to be done to fix it. Um, we're penalized. And they they estimated that will be about a 9% inaccurate submission rate. And that will cost the state of Virginia $180 million, $180 million just for not having forms completed correctly. So big dollars happening in Doctor Garrett. You said it feels intentional. It is intentional. Don't don't be fooled. This is all very methodical. Intentional. Um, so again, I digress, but it's big dollars. It's big money. The state is being very proactive with all of this, and we, boots on the ground, are hopeful that we will see the information. They're supposed to train people up, navigators who will be sent out to our programs, who can sit at the health department, who can train our community health workers, who can show us how to fill these forms, how to help, or even, you know, Sentara has already discussed with us putting a navigator. If I can get you a navigator in your clinic, will you take one? Absolutely, yes. Bring anybody on because the by the end of the day, we just want to help the people that need the help. That's all we want to do. So information a lot of information coming that we're being told. And as soon as we get it, we'll be sure to pass it along to all of our partners and community members and just disseminate broadly.

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01:33:56,930 --> 01:36:04,590
And I think this is the therapist in me that always gives people a challenge, right? Um, I really want to challenge every person in this room to take the information and make sure every time you learn something new, you share it with a person and challenge them to share it with the person, because it's the ripple effect. So we've been talking a lot about the accessibility and the where these forms and these things are great for those folks who are tuned in to that and who are going to show up. But there's a whole community of people who don't even think that this is something they need to be worried about, who are not going to show up to these forms, who are not going to go to the webinars. And the word of mouth is one of the most powerful things that we have. So, um, don't underestimate the power of sharing. And if even if you don't have all the details that we'll get direction, we have direction of what site, where do they go to get the information but using your network. So if we all informed each person, like if we sat and wrote along, took five minutes and just wrote down the people in your network. You know what? I'm going to go down this whole list to make sure that everyone is informed and know where they can go. This is coming and challenge them. You share that with someone else. Here's where the resources are. Here's where you get the information. The onus doesn't lie on just certain organizations. Going back to that community model like this is going to impact every last one of us at some at some way, shape or form. And so it almost is. It's also our collective responsibility to make sure that we are doing our jobs outside of our what we get paid to do, to make sure that the people that I talk to every day. Are you informed about this? Have you heard about this? Let me give you the language, because when you give people the information, they can use it. And so sometimes we can reduce information giving to certain settings. But when we go out to dinner with those family members and those friends, these are the conversations we should be having when we run across people randomly in the grocery stores or in the small talk like, have you heard about this? I just want to let you know. So don't underestimate that power and our collective responsibility to help our communities stay healthy as well.

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01:36:04,590 --> 01:37:13,880
Thank you, Doctor Garrett. And that is a perfect moment. To start with our closing remarks. I'll start with Doctor Purdy to your side, and then we'll end up again with you. But at this moment, I would like to remind our audience and also the public that is viewing us tonight, that that is the reason why the Virginia Beach Human Rights Commission has this public forum on affordable health care. Make sure to watch it. This is going to be by the media department, and you can check this forum on YouTube and make sure to share with other people. This is great information that needs to be distributed, and all of us can contribute to the knowledge and strengthening of our community. So we'll begin with Doctor Pedantic in closing remarks, and to remind you that this is also an opportunity to invite the community to partnership with all of us in the effort of reaching out to our elected leaders and others that have a role in making decisions. So thank you, doctor.

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01:37:13,880 --> 01:38:34,970
Yeah. Thank you. I think I would just say thank you again so much for having this event. Right. Creating this space. I think, you know, that's one of the ways we start to share this information to Doctor Garrett's point. Thank you all for being here. And to everybody who chooses to participate and listen and watch. Um, it's that concept of community again that matters, right? It's it's our community. It's it's our neighborhood. It's up to us to kind of come together and talk about the things that are important to us. So, um, really appreciate you all. Um, I appreciate the folks I get to sit next to and do this work. And just a reminder that we know there is more work to do. So there are more opportunities for us to share this information, you know? Please don't ever hesitate to reach out to your local health department. We want to hear from you. We are here for you. That is the whole point. Um, you know, and I hope that you'll think of us when you have questions or feedback, things you need from us. You know, things you'd like to see us do more of. Um, just remember that we're more a part of our community and want to make sure that we're doing everything we can to support you and keep you healthy and safe. So thank you.

79
01:38:34,970 --> 01:39:51,579
Great. Likewise. Want to thank the Human Rights Commission for Virginia Beach for hosting this panel. And again, to my esteemed colleagues again. It's been a pleasure to participate in this. And can we meet again in a week? Because this is really fun now and certainly to the audience. Thank you for taking time to come out and to listen to this not sexy topic, but very critically important to each of you, to our families and communities that we truly have the privilege to serve and simply say, just keep your ears, eyes, your heart open to as much information that's going to be coming down the pipe over the coming months and probably years, and know that each of us have truly that opportunity to be part of that village that helps improve the health and wellness of everyone around us. And again, we're all in this together. And truly, it is a great privilege to be part of this conversation and know that this is only the beginning of understanding where we need to go and think of who is missing from this conversation that needs this information, and that needs all of us to consider them. So just thank you all for your time.

80
01:39:51,579 --> 01:39:59,260
Thank you, Doctor Romero. Doctor. Daddy did. Now you. Miss Speer, please.

81
01:39:59,260 --> 01:40:00,300
Thank you.

82
01:40:00,300 --> 01:41:20,229
Um, so I hope you're sitting here not feeling great because I would implore and encourage you to take those. Maybe you're a little angry. Maybe you're a little disappointed. Um, and any of those emotions. This is not rainbows and butterflies. Um, but like I said, even though it might, um, people are going to get hurt. We can be proactive. And there is hope. There are community members that care and it is going to take a village. So I implore you to reflect, look inward, look at your community, your neighbors, your what organizations are you a part of and how can you make impact? Because each and every one of us, if we took that stance and said, I can do a little bit here, I can do a little bit here. And as a whole a little bit puts it all together. So we're going to be fine. We will look after our city, we will look after our people, we will look after those people that are living in the woods. We will look after the 80 year old man that I just pulled out of the woods two months ago and is now housed and now has disability and now has food, and we will continue to do that. But I implore you to look inward and see what is your piece, because everyone's got a part of this. So thank you all for allowing me to be a partner.

83
01:41:20,229 --> 01:41:21,069
Yes, doctor.

84
01:41:21,069 --> 01:41:22,430
Garrett, please.

85
01:41:22,430 --> 01:43:49,649
Yes. And just echo what they said. So thank you all for for hosting this conversation. Thank you all for being here. And doctor actually took exactly what I was going to say is again, that challenge for that individual piece lean into the discomfort we no longer live in really probably never should have been living in this, in this space where we are just so comfortable that we don't do anything to help advance this country forward for those that we love and that we care about and for ourselves. Like, I always walk around and it really always humbles me, no matter how much privilege I have, no matter how much success I have. We're all one decision away, potentially, from needing a level of support that we think we may never need. Like I think about those individuals, we talked a lot about Medicaid, but those individuals who who have that as their insurance and the stigma that comes with it, but it takes a lot to sit and sign up for, for these services to go and to the, you know, Virginia Beach social service or human services and to apply and to sit in these spaces. And I'm sure most all of them, that wasn't their dream, that wasn't what they thought they were going to have to do. And so I always think about on my worst day and my worst moment, what would I need? And that is support and someone to extend some grace and to share. So don't keep the information. I learned some new information I'm excited to go and share on my social media platforms with people that I talk to, and I've been sitting here thinking outside, how do I get outside of the box of my normal conversations to share? You know, we make sure we've all seen people walk around with pamphlets of information and they just hand it out. Like, maybe that's the thing. Maybe you don't want to talk to someone directly, but can I share some information with you? It costs us nothing. So thinking about those ways that we can really start to disseminate all of this stuff and not gatekeeping the services, the person that we walk by that we might not pay any attention to, might be the one who needs the information. And so leaning into the humanity and meeting someone, person to person is how we transform communities. It's how we transform lives. And I think we overlook that because we're so tunnel vision sometimes in our lanes. But this is going to require something more than all of us can do. But if we can do a little bit at a time and take some responsibility differently than we have, I think it will lean and it will allow us to see the change that we really want to see, or will build the change that we might not ever get to see, but generations to come. We'll get to experience.

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So thank you. Please join me in giving a round of applause to our panelists. Thank you so very much to all of you and friends. Thank you for joining the Virginia Beach Human Rights Commission on this important conversation, a community conversation on health care. Today's forum reminds us of something powerful. Even when our communities face real barriers, we are not defined by those challenges. We are defined by our courage, our compassion, and our commitment to one another. Every story shared. Every question asked. Every truth spoken. Here is a step toward a healthier, more just future. Hope grows when people show up for each other and you showed up. We now carry that hope forward. We care for our neighbors. We lift up the voices too often unheard, and we advocate with purpose and persistence. Because when a community stands together, change is not only possible, it becomes unstoppable. Thank you for being part of this work. And let's leave ready here to support one another, ready to speak up and ready to build the kind of health care system that every family in our community deserves. Now, I invite you to go to the next room to take part of our beautiful two rooms full of information that you can go out and share with our community. Thank you everyone. Have a wonderful day.