June 3, 2020
In this episode we’re joined by Carol McDaid, the Principal at Capitol Decisions Inc. With over 25 years of experience in federal legislation, Carol joins us to talk about the work she’s done in Washington to fight for equal access and coverage for addiction treatment services. Following Carol, we’re joined by Kentucky Senate Minority Leader Morgan McGarvey. Senator McGarvey has served Kentucky since 2012, and will be joining us to talk about some of the current and upcoming legislation regarding addiction treatment in his state.
Zach: Hi. I’m Zach Crouch and you’re listening to Landmark Recovery Radio, your source for addiction and recovery news and knowledge. You can find us online wherever you get your podcasts and please subscribe to get the most up-to-date information from leading experts.
We have guest Carol McDaid joining us on the show today. Carol currently serves as the Principal at Capitol Decisions, Incorporated, a federal government affairs firm. She has over 25 years of federal legislative experience in Washington and has worked with leading drug and alcohol treatment systems, addiction physicians, prevention and consumer organizations as well as mental health provider organizations to refine public policy addressing addiction and mental health.
Carol, thank you for coming on the show today. We really appreciate this.
Carol: I’m delighted to be here and I’m delighted to be joined by one of our furry friends in the background.
Zach: I’m glad that you noticed that, too. That is the definition of podcasts that are unedited right there.
Carol: There you go. I like it. It’s hard to be upstaged by a canine, but it won’t be the first time.
Zach: You currently serve as the Principal at Capitol Decisions, Incorporated. Can you tell us a bit of background on the firm and how you got started there?
Carol: Sure, yes. We are a small government relations consulting firm sort of a boutique firm within a larger firm. We do specialize in addiction and mental health policy. I have a partner that works on municipal affairs as well. We have been in business since 2000. I also co-founded a peer recovery community organization in Richmond, Virginia with my husband John Shinholser called the McShin Foundation. Between those two things, it keeps me pretty busy.
Zach: Tell me. I was doing a little bit of background on the McShin Foundation. Tell us a little bit about that.
Carol: Yes. My husband and a team of other peer leaders run the McShin Foundation. I just helped my husband get it started. My policy work in Washington gets me pretty busy full time, but McShin was the first peer recovery community organization Virginia founded in 2004. We really started it because we were running out of sofas at the house to help people.
We live in a state where there was a at the time, thankfully that’s not the case now, but there was a 23-day waiting list for people who did not have insurance to get any type of help for addiction and Medicaid only covered addiction for pregnant women and women with children so there were a lot of people who needed help that weren’t getting it.
It started feeling really creepy to have a full house and also to be out representing all these treatment centers and working on legislation to increase treatment access and then ignoring people in my own backyard. Between the work that my husband was doing and I was with even trying to help people with substance use disorders for many years and I had as well we joined forces and came up with McShin.
My last name is McDaid and his is Shinholser so that’s where we came up with the name and we have that shared vision and hope that by helping other people we indeed keep our own recovery.
Zach: It truly is a Bill Rosen kind of story right there, people staying at your house like that. I love it.
Carol: Yes. It’s not because we’re so philanthropically-minded or whatever, but like others who have kind of cracked that code and not everybody needs to do this. For us, we’re the type of people that have the type of addiction where we know that if we don’t help other people we can end up being back with a problem again. John’s never relapsed but I have. I think that for us we know that the essence of maintaining our own recovery is helping other people.
We do it because not only to help others but because we know it helps sustain our own recovery and it’s an essential element to do that. I think that is really what’s at the heart of peer model that we have at McShin — individuals with lead experience in recovery helping others.
We do work with our medical clinicians of course. Many people who have been coming to us of late have opioid addiction and we work with our clinicians to make sure that people are detoxed properly and safely, but at our heart our model is peer-based with people with experience.
Zach: I think that there are quite a few people who listen to this program who are in recovery. They also share that same sentiment of being able to give back. I guess my question is did you sort of look at both yours and John’s skill sets and decide that this is what we’re going to do, this was the way that we want to make an impact.
Carol: I wish I could tell you we really sat down and analyzed it, thought about it, and rolled out a business plan.
Zach: You guys probably had a barking dog at the background during this time I’m sure.
Carol: Yes. I guess I’m probably one of those people who overthinks everything and my husband probably would own up to being a bit impulsive. We were at a 12-Step Recovery campout. We were sitting around the campfire with us and his brother and others. We began talking about how our daughter was growing up and the house was full. We just weren’t sure if we could keep doing what we were doing the way we were doing it.
There had to be a way to help more people. Hypothetic our statement was back then we’ve always had a shared bent for advocacy, too both my husband and I.
Zach: How long ago was it that you started it, Carol the McShin Foundation?
Carol: We started in 2004. We’re sitting around the campfire in July of 2004 and that Monday I’m at work and I’m busy. I’m in DC. John calls and says, “Oh, I filed for that non-profit.” I said, “What non-profit?” I was distracted and thinking of other things. He said, “The non-profit that we talked about at the campout.” I was like, “We were just discussing an idea.” He’s like, “Oh, it’s already filed. We’re doing it.”
Carol: I got a lawyer. I found a couple hundred feet of office space at the bottom of the treatment center. Daniel’s going to give me a phone and a coffee pot where there’s hot tea. I was like, “John, what are you doing?” You need a board. We need a plan. We need a budget. He’s like, “No, no. I’m starting tomorrow. I’ve already got a couple of customers.” That was how we started the McShin Foundation.
Within a week, I figured out that I can either stay on the board and monkey around under the hood of McShin or I could stay married to John because I’d do things the same way.
Zach: Yes, yes.
Carol: Yes. I opted to stay married to him and he and his team run McShin and I have a very dedicated team of women who help me run Capitol Decisions along with a partner J. R. Reskovac.
Zach: That was going to actually be a question I was going to ask you. It sounds that you guys kind of worked through that and figured it out.
Carol: We did, but it was bumpy. It was a little bumpy at first.
Zach: Yes. There are unique challenges to running a business when your business partner is your spouse.
Carol: Yes. It’s like if your business partner has been a paint contractor for 30 years and never had a board of directors, had his own business, didn’t have to answer to anyone, didn’t draft agendas before board meetings, calls up customers and says, “Hey listen, I’m driving around and remind me about that job,” just totally to me stuff that was totally unprofessional.
We had these wildly different…he was extremely successful because he was good at what he did, but it was not the way that Miss a-person-who-had-always-had-an-assistant and who’s super orchestrated and organized and I had to be living in two different places and helping raise a six-year-old part-time, just a busy person. I couldn’t afford to wing it.
He could remember stuff off of his head. We were completely the story of opposites attract, but that takes some doing to get used to when you have a joint venture.
Zach: I think you guys balance each other out too well.
Carol: Yes, yes. The thing that I think that makes it work is we both have this deep, deep, deep passion and love both for recovery and each other. John it doesn’t hurt that he saved my life when I was relapsing all over the place and about ready to take my own life. That helps as well.
Zach: I want to talk a little bit more about Capitol Decisions and sort of drawing out what you just said. Your day-to-day especially in a high-paced environment like Washington, does that compassion that you talked about with you and your husband and also drive I think it sounds that you’re a pretty driven person, does that come into play in your day-to-day at Capitol, just being in this sort of the gauntlet of Washington?
Carol: Yes. I think that’s the other beauty about having both legislative and advocacy practice in Washington which moves much slower than we’d oftentimes like things to do and then being able to come home in a more…we live sort of in the country and then be able to help people at McShin where you can see people literally blossom right before your eyes. It kind of takes off some of the frustration of how slow processes often move.
I think that one of the things that the piece of work that my team and I are best-known for is passage of a bill called the Mental Health Parity and Addiction Equity Act or people will call it the Parity Law. That was really formed out of my own frustration that I had great insurance. I was one of those working people with substance use disorders where even though I had a severe substance use disorder I still worked.
I went to work to get the money that I needed for drugs and unfortunately took it also where I could get it but also worked and kept the job because in the lobbying business back in those days partying and alcohol and all of that was a part of it.
Zach: Par for the course.
Carol: Oh yes and lots of it. It was actually considered a plus the more that you did. This is like a dream come true job for me in the late 1980’s and the early 1990’s until it wasn’t. I had this great insurance and ended up overdoing it on the partying side. Like with a lot of people, if you keep using and you start early like I did at 12 eventually substances turn on you as mine did on me. I needed help and I needed residential treatment.
It said in my little summary plan booklet that my insurer gave me that we had up to 30 days of in-patient care. That was the hole that I found out and here I am working in healthcare benefits at the time that in fact just because it says you have something in your booklet does not mean that those benefits are actually available when you need them even though you, your family, and your employer are paying premiums for those benefits.
That experience, not once but twice really got an ember and a spark burning inside of me that if I had not been from a family of means that could pay out-of-pocket and employers that were willing to go the extra mile to let me go and let me have a month or so off and come back and have a plan of care, of continuing care after I got back and 12-Step me and do all the things that we know are part of good care, I’d be under the jail cell right now.
It really burned that social justice flame inside of me that you had to be well-to-do to get help in this country at that time. For 12 years, we fought for the passage of this legislation and finally in 2008 it passed. It became fully in effect in 2014. You might be scratching your head going, “If this great bill passed…”
Zach: Six years, right?
Carol: Yes, six years for the regulation, 12 years to pass the bill and I’m not bragging about the amount of time that it took by the way, but when you have an opponent…
Zach: That’s your point that how slow the stuff gets…
Carol: Yes. When you have an opponent that outguns and outmans you they had a different lobbying firm sometimes on key healthcare committees for every single member of that settlement committee. They knew what color tie the member was going to wear before he or she showed up for committee. We are talking…the health insurance industry is wired for sound in Washington and has been for years and decades and decades.
Going up against them with a disorganized kind of a hodgepodge of very small groups that were not well-organized yet was difficult and we had the addiction and mental health communities fighting one another. Until we stopped doing that, came together and became an organized constituency of consequence that we are today thank goodness we were not able to get big mass of bills passed.
Once we became organized we got Parity passed in 2008 and then in 2010 the Affordable Care Act passed which made addiction mental health mandatory benefits in the health insurance until under state Obama Care Plan.
Zach: I would like to just if you can just briefly if you can explain to our audience what are Parity Laws.
Carol: There are state Parity Laws and there’s federal Parity Law. I am referring to the federal one. The reason why the federal one might be more important than your state one is because with a few exceptions and I congratulate Illinois and New Jersey and a couple of states that have passed ones that are just as strong.
The federal law what it does is it says that a health plan or an employer plan may not impose barriers or restrictions on their addiction mental health benefits that they don’t impose on their other medical and surgical benefits in their health plan. Before your eyes start rolling in the back of your head, let me give an example to help this makes sense to you.
If you want to go to see your primary care doc and you have a $20 or $25 co-pay, in the old days if you wanted to go see an outpatient counselor either for addiction or mental health like a psychologist or a licensed clinical social worker or something you might have been charged 50 percent of the cost of the visit which is a totally different and higher amount than if you were going to get a medical service outpatient. Under the Parity Law, that is no longer permitted.
The other thing that the Parity Law does and this is what has been so difficult to enforce it says that health plans cannot impose medical management criteria that is more stringent than they impose on the majority of their medical benefits. What do I mean by medical management criteria? There are all these ways that health plans can keep you from accessing the coverage that you’re paying for that are not written down in your health plan booklet.
These can be things like medical necessity criteria. It’s not medically necessary for you to go to addiction treatment or you haven’t gotten prior authorization for a particular medicine before you started taking it or you have to fail at outpatient before you’re eligible for in-patient.
These kinds of techniques and I’m calling them as an umbrella term, medical management criteria they can’t apply them more stringently across the board to behavioral when they do their medical benefits. What was happening in plans all over America is that they were applying it 85 percent of the time to behavioral health benefits and ten percent of the time or zero percent to their medical benefits.
If you have a health plan and they have what we call fail-first criteria that you have to fail at outpatient before you’re eligible for in-patient, that plan is illegal and you should report it to whatever depending on whatever type of plan you have to your insurance department or if you work for a big company that sells insurance you report it to the Department of Labor.
You can go to parityispersonal.org to get the numbers on exactly the websites and the phone numbers and all of that on how to complain. If you hit on the consumer tool kit, we’ve got a lot of information in there about how to appeal denied claims. The most important thing I could say about this is…
Zach: Carol, is that specifically that piece that you mentioned is that on your website?
Carol: It is. That website again is parity, P-A-R-I-T-Y is, I-S personal, P-E-R-S-O-N-A-L.org.
Zach: Thank you. I’m curious as well as you’re talking I had a question that just kind of came up for me. You mentioned the fail-first piece. Obviously I’m in the treatment industry and I work as a counselor. We’re the outreach side of things.
Nonetheless, there are a couple of things that our patients benefit from. One of those is especially if they are opioid dependent or alcohol dependent there’s a medication. There’s an oral form of this medication and then there is an injectable form. Obviously you can take a guess and decide which one is more expensive.
Zach: There have been times where and this is I don’t know how long ago it was where the insurance company would decide that they needed to try the oral form first even if they aren’t successful on that then they would decide that they would go ahead and pay for the injectable form. Is that qualified to what we’re talking about?
Carol: It does. It does. The thing is though in that case oftentimes the plan will have fail-first criteria for other medical drugs, for other injectables. Let’s say rheumatoid arthritis or breast cancer and so you have to ask the patient…first of all, you have to help your patient because if providers do not help people with their appeals there’s no way that most of the patients, many of our patients who are impaired or the family…
Zach: They can’t do it.
Carol: It’s way too complicated. They’re impaired. Sometimes they don’t want to take that medication because it blocks your ability to feel alcohol or opioid so they’re not…
Zach: According to my friends, “You’re damned right.”
Carol: Yes. They prefer to take their oral and be able to skip a dose and play games. If you know darn well that they would benefit from having that injectable which gives you a steady stream for 30 or 60 or whatever length of time it is and that usually is the case then the clinician A, needs to say that to the health plan, but B, needs to look at that patient’s summary plan document and the best way to do that is to ask for that before they ever arrive.
Compare how many…do they have fail-first on other medical drugs because normally it will be in the exclusion section of that summary plan document. Unless you see two or three or four others on medical drugs then make the challenge that this is a fail-first, an illegal fail-first requirement under the Mental Health Parity Addiction Equity Act. In the denial letter, enforce the plan to come back and tell you no it’s not and show you the analysis of how they’ve applied that equally on the medical side.
Zach: Got it.
Carol: If in doubt, do the appeal based on that fail-first because we’ve got regulations that come flat-out and say they cannot apply fail-first criteria more stringently. We’d love it if there was an exact formula for what more stringently is but all they’ve done is give an example and any example they use percentages. You can’t apply to 70 percent of behavioral and 20 percent of medical. The analysis is important but just to make it easy just appeal every single fail-first you see.
Zach: That’s an interesting…go ahead
Carol: What I’ve been seeing with my clients is they win these appeals when they do them. It’s just a lot of people don’t want to bother.
Zach: Yes. As you were talking I was thinking more about the examples. Obviously here in the United States we have a justice system and judges will cite different cases as examples for whatever. If it’s a new case they just go back and say, “Hey, it’s back to this case.” When you’re talking about examples like you’re citing here, who makes those decisions on if it’s overturned or if it’s approved or it’s not approved?
Carol: It’s not straightforward. It depends on what type of health plan you have. If you have a commercial insurer meaning if you have Blue Cross, Blue Shield of Florida or if you have Anthem or if you have that kind of thing they have their own third-party outfits that they contract to do with their appeals. If you have Medicaid the federal government has its own entity that does its appeal. It depends on the type of health plan you have.
If you have self-insured employer plan, we go through that in that tool kit. I will say that we do have about 60-plus I was just on a call on Friday, Parity lawsuits are going on right now and we have…pretty soon you’ll be able to cite some of these lawsuits in your appeal letters when you are doing them.
I would say you can go ahead already and cite the Wit case which is W-I-T which is a case against United that the judge has decided but he has not decided the remedy yet meaning what penalty the insurance company is going to get. United was making up its own medical necessity criteria.
The judge in a really long opinion basically said, “Hey, you can’t do that. You got to use some type of medically consensus-based medical criteria. You can’t just go behind closed doors and make it up based on whatever saves you more money.” The Wit case has been very helpful. If you see a plan sort of making up their own medical necessity criteria that’s another good automatic appeal if you’re a provider. Automatically appeal that claim, that denied claim.
Zach: Can these Parity Laws be reversed ever?
Carol: They could, just like any law can be reversed by Congress.
Carol: In election year it passed by an overwhelmingly bipartisan majority in Congress, 395 to 17 and 99 to 1 in the Senate. It was signed by George Bush. I don’t think…it will be highly unpopular I think for someone to try to repeal the Parity Law, but they don’t need to because what many of the plans have been doing is ignoring it, getting fined and just taking the fines as the cost of doing business to keep on going.
This is why I’m saying it’s so important for people, for consumers to complain and for providers to appeal denied claims and not to just put up with it because if you keep putting up with it they’re going to keep doing it.
Zach: I was asked this question. It seems like we’re going to have a guest on who work in governmental affairs, so to speak. Is that the biggest sort of tool that we can use to really have some leverage here as consumers is our ability to complain? Is it also maybe…go ahead.
Carol: I think the press is also and a really important outlet when I say the press I mean social media, I mean writing op-ed letters to your newspaper. I saw a survey the other day which really shocked me that a member of Congress will start following an issue. It doesn’t mean that they’ll vote your way, but they will at least start tracking and following an issue if they hear from 30 constituents, that’s not very many on that member’s Facebook page.
If they hear from 30 distinct constituents meaning people who live in the zip code of this congressional district that they represent and if you don’t know how to figure out who your member of Congress is you can go to congress.gov and put in your zip code and it will tell you who your member is. You might have to put a little more because like your whole full address because sometimes districts cross over.
If you send 30 distinct Facebook posts to survey over 300 chiefs of staff and other members of Congress and other people at work in their offices I would have made this. Out there we need 30 to start tracking an issue. If you get more than that of course the more you can pile on the more you move them from tracking to moving in your direction. I thought that was pretty fascinating that that’s all that it takes for them to start watching it.
Zach: Pretty small amount.
Carol: Yes. Back in my day before Facebook in order for me to get a vote scheduled on that Parity Law, we had to get 10,000 calls played. Yes. Just think of the difference now between social media and the battle days when we used to have to do things the old-fashioned way. That’s what it took to actually get a vote scheduled on the law. Of course back then we had the insurance industry fighting us, too the whole way on the stronger version of the bill.
It’s really exciting now. I think the trick is don’t just do nothing and think you can’t make a difference. That’s the biggest thing because that’s what people are counting on is that our community and I mean providers, consumers, and families that we will give up. We will not fight. We will not go to our HR person and complain that our benefit package has done a really lousy job on addiction mental health benefits because we’re too ashamed or they’ll think we’re a bad parent or something.
They count on that and then they take advantage of that and have really limited networks of providers. They don’t cover people like Landmark or other people in their networks. They can get away with it because no one complains. Complain, complain, complain whatever way that that works for you.
Zach: Right. You need to be heard.
Carol: Yes. If you’re not a social media person…
Zach: Write letters.
Carol: Figure out who’s your congressman or write a letter, yes.
Zach: Make a phone call.
Carol: There’s a role in this movement for everyone. If you don’t like the addiction system that we have in this country we’ve got the system that we fought for.
Carol: If you don’t fight unfortunately you get what you get, what you’re willing to fight for. There are many, many other people out fighting for other interests and we have to keep organized and not…I see sometimes that we turn the guns inward and start shooting at each other instead of at the right target.
Zach: Right. As we’re starting to sort of run out of time I wanted to touch base with you also about some of the current projects you’re working on right now. What are they? Are there any specific pieces of legislation that you’re working on now to get passed?
Carol: We are. I want people to be aware of this. Some of the data that we’ve looked at from the 2007 to 2009 recession shows us that for every five point increase that there is in the unemployment rate and this study was done by the Meadows Mental Health Institute out of Texas depending on the state they took a look at Texas and a few other states, but there are 400, 500 more deaths from overdose and suicides.
We’re already at 17, probably going to 20 percent unemployment. We are going to have a post-COVID suicide and addiction epidemic that’s going to follow COVID. One of the things we’re working on is to make sure that in the next COVID package which I think will be the last major one which is probably about right. We’re trying to make sure that there are dollars that are earmarked for these addiction and mental health services.
I think people need to understand that unlike the last epidemic we’re going to have a lot more people who are going to have turned from alcohol misuse to full-blown alcohol use disorders just because they’ve been home drinking. I think we’re going to need more residential beds and we need for people with opioid who could be treated with just MAT in an outpatient setting. The detox for severe alcoholic is much more dangerous and needs observation by medical professionals on a 24-hour basis.
I think we need to be thinking a little bit differently about that and make sure the dollars are set up in a way that we are ready to make that shift because all you need to do is go to your grocery store and take a look around at what people are filling their carts with or whether you’re going and ordering it or picking up or whatever. Take a look at what’s being ordered and alcohol sales are way up and it’s kind of crazy that alcohol, ABC stores are essential service during this time and we’re going to pay the price for it.
Zach: Do you think part of that is…why are they essentials? Is it because of the fear that people who’ve had their alcohol that they’re going to go into withdrawal?
Carol: I think that could be and I think it’s a state revenue need and they need that. I think they need the tax.
Carol: The tax revenue that’s being generated because they’re not getting the revenue in other places that they normally would have because businesses are just collapsing all over the place. I think it’s a combination of both.
Zach: People ought to know that right now. People they’re tired of being at home. They’re tired of all that.
Carol: Yes, absolutely. Myself included, yes.
Zach: Sure. Me, too.
Carol: Yes. I just can’t drink.
Zach: I can’t either.
Carol: I’m sure if I could, I would.
Zach: Yes, yes.
Carol: This isn’t a judgement thing. It’s a fact thing. It’s a public health comment that we need to have a system ready because that next wave is coming. That’s one project we’re working on. We’re also working on making sure there’s opioid dollars that have been going out, making sure that they can be used for any kind of addiction, not just for opioids. It’s called the State-Targeted Response. You’ll hear it called the Opioid Response Dollars.
States have been getting a certain amount of money for the last couple of years for the opioid epidemic. Last session we got it moved open for stimulants and I think we’re going to try to make sure that that’s open for any type of addiction now.
Because of this COVID recession I think we want to make sure that there’s still far more alcohol deaths than anything else that it can be used for alcohol as well; as well as the other drugs and not sort of have this drug du jour policy that we’ve had in the US where we go one drug at a time and focus on that then it balloons out another area. That’s what’s happened with stimulants.
Zach: We’re sure we’ve seen a lot more of that here in the state of Kentucky. There’s no question about that.
Carol: Yes. I think that people need to understand there is no protective effect of mixing a stimulant with your opioid to protect you from a fentanyl overdose. I think there’s been a lot of misunderstanding on the street about that which is not true. I think that has increased the stimulant numbers because there’s some folklore out there that if you mix methane with your…
Zach: You’re going to stay up. You’re not going to nod off and die.
Carol: Yes that somehow that will keep you alive. It’s a total misnomer.
Zach: That’s a lot to cover, Carol.
Carol: It was a lot of territory. I know and I talk fast.
Zach: This is great. This is good. Fantastic. Thank you so much.
Carol: It was a pleasure. Yes, it was a pleasure. I’m as delighted as I could be to be included and look forward to using your podcast, your listeners. Anybody who has a question they can write me at [email protected] about anything that I mentioned on today’s call and we’ll check the e-mails and get back to you.
Zach: Thank you.
Listen, if you know someone struggling with an addiction and are searching for answers, visit us at landmarkrecovery.com to learn more about substance abuse programs that are both saving lives and empowering families.
Until next week, I’m Zach Crouch with Landmark Recovery Radio.
Zach: Hi. I’m Zach Crouch and you’re listening to Landmark Recovery Radio, your source for addiction and recovery news and knowledge. You can find us online wherever you get your podcasts and don’t forget to subscribe to get the most up-to-date information from leading experts.
We have Senator Morgan McGarvey joining us on the show today. Senator McGarvey has served as a member of the Kentucky Senate since 2012 and in 2018 was elected to be the Senate Minority Leader. He is also one of only two members in the nation to serve in Senate leadership under the age of 40. Senator McGarvey is also an active member of his community being involved in the Domestic Violence Advocates Program as well as coaching baseball, soccer, and basketball in his spare time.
Senator McGarvey, it’s great to have you on.
Sen. McGarvey: It’s great to be here. Thanks for having me.
Zach: You previously worked as an attorney. Was it trajectory for you always to kind of run for public office?
Sen. McGarvey: No. It’s funny you asked that question. I’ve always been interested in government. I’ve always been interested in how it worked and how people get elected and people that run for office. I worked on the Hill before going to law school and worked for a congressman there Congressman Chandler from Kentucky and even after law school worked briefly in the Attorney General’s office as an Assistant Attorney General, but didn’t think I would be the person to run.
I’ve always been interested and just got presented with kind of one of those unique opportunities where in 2012 the person who was my senator had been there for 24 years and they did redistricting. They redistricted the district. They took him out of his own district. They took me out of the district, too. The plan was so bad in fact that the Kentucky Supreme Court held that the redistricting plan was unconstitutional. They said, “We’re going to give everybody three days to decide whether they want to run under the old district.”
The person who’s been my senator said, “You know what? I’d already come to peace with the fact that I was no longer going to be serving. I think I’m going to retire.” I had three days to decide whether I was going to run. I tell people all the time if I’ve had a fourth day I don’t know if I would have said yes. It’s was just one of those opportunities where like you’re there. You’ve been interested and it was time to decide whether I was going to go down that path myself.
For three days I said, “You know what? I talked about the mission. I talked about the things that I would do if I happen to get elected. I’m going to throw my hat in the ring and see what happens.”
Zach: Got it. Tell me more about the redistricting of these different counties. Is that similar across other states that you’ve talked to? How does Kentucky differ or similar to other states?
Sen. McGarvey: Kentucky follows the way most states do. There are two ways to do it and I’ll talk about how we do it. The two ways are you have some type of non-partisan commission that draws the district lines. That’s not as common. That’s what a lot of people are pushing for.
There’s the way Kentucky does it which is the way most states do which is to have what we call a partisan redistricting. That means the party that is in power draws the district lines for the states representative. They also draw them for the congressional delegation. When you think about it everybody serving in office has a district that’s drawn for them unless they’re elected to a statewide position.
They’ll accept for your governor, your attorney general, the United States senators, everybody has a district. These are drawn by the state legislatures. The party in power draws those district lines. The party in power whichever party it happens to be, Democrats are guilty of this. Republicans are guilty of this. They often draw district lines with advantage to their party and we see that in Kentucky.
In 2012, we had a Democratic State House and a Republican State Senate. The Democratic House drew lines that benefited the Democrats in the house. Republicans drew lines that benefited the Republicans in the Senate. Both plans, the House plans and the Senate plans were ruled unconstitutional because they went too far. I’d like to see us move to non-partisan redistricting.
I’d like to see all states do that so that you have more continuous communities represented. We’ve got some really weird-looking districts under the way we do it and most states do it as they try to keep one party in power.
I think it will also moderate your legislature and because you know what happens when you have partisan redistricting you draw a seat that basically no Democrat could win or no Republican could win in a general election then you’re getting people who aren’t worried about what the other side of the political aisle thinks. You should be worried about what your community thinks and feels, not as much what the party does.
Zach: You bring up an interesting point, too about this non-partisan redistricting. What would need to happen for that to take place in our state?
Sen. McGarvey: We would have to change the law. We’d have to put a law into effect that said this is how we’re going to do this. We would appoint some type of redistricting commission. Still there’s going to be politics played no matter who’s in charge just because. I say politics like my life works in corporate America. I don’t know if there’s any more political place than corporate America. In some ways it’s more political than what we do in Frankfurt.
Sen. McGarvey: It’d be nice to have people really looking at populations, population movement, communities, where they think people are, where they’re going to be as opposed to how many registered Democrats and how many registered Republicans are there in a certain area.
Zach: Got it. Is the redistricting is that something that happens each new governorship? How often does that happen?
Sen. McGarvey: Great question. It happens every ten years. I’ll put in my plug right here. It’s the year 2020 and years that end in zero. Last time we did it was 2010 and 2020 we had it again. It’s the census time. Everybody, anybody who’s listening please fill out your census. That’s how we determine how many people live in a state, how much federal money comes here, how the school districts are organized. Everything we do just depends on that accurate count.
We get that census count in years that end in zero. The legislature typically comes back in in a year that ends in two after we’ve had a chance to review that data, seeing the population changes in our state and then in years that end in two we redraw the district lines. We do that because everybody elected to an office like a state legislator or congressman it’s not defined by geography. It’s defined by population.
You represent a certain number of people. For instance in the State Senate, a State Senator represents about 120,000 people. In Louisville that means you don’t represent the whole county, but in many places in Kentucky that means you represent most of the counties. We get those population numbers and then we draw the district lines.
Zach: Got it. I’m kind of switching gears here. I want to talk a little bit about our state. It’s well-known at this point we have been in the middle of an opiate crisis, epidemic, so to speak; not only just opiates anymore, it’s all kinds of substances that we’re seeing. What do you see right now as the most urgent issue regarding addiction in the state? What is it?
Sen. McGarvey: Yes. The first thing I’ll say when you and I talked about doing this podcast for the first time nobody was really talking about the coronavirus. For anybody listening who’s struggling right now, please know you’re not alone. We know this is a tough time. I hope everybody continues to get the help they need while people are staying safe at home. I’ll just throw that out there first.
Zach: I appreciate that.
Sen. McGarvey: We’re kind of in a different world right now than when you and I talked about doing this initially. Opioids in particular are still after the coronavirus the epidemic that impacts the state the most. I think we’ve done a decent job as a state in the last five years in passing some legislation and providing for more treatment options. I still think the most urgent thing that we can do is continuing to help people see that paradigm shift where addiction is a disease.
It’s a disease that needs treatment that we cannot incarcerate our way out of this problem, that we need treatment and that we need to be understanding of relapse. I think one of the urgent things we can do is help that shift particularly with our courts. An issue that we’re working on in Frankfurt right now is to continue funding and to continue the expansion of family drug court, to continue the expansion and funding of veterans court.
We know there are lots of veterans out there who are struggling with substance abuse and again they need help. It’s a disease and we recognize it’s a disease and we want to help treat it. Getting people to view it that way I still think is a challenge. You know we set up so many good framework in our laws.
Now we have to get people to help us makes those laws effective. You can’t just put something on paper and have it work. You got to have people out there who are spreading that message and saying again this is a disease and we’ve got to have treatment for the people who are sick from it.
Zach: Yes. There’s certainly somebody I guess in my vernacular there’s got to be somebody among not just the professionals like myself and other people in the healthcare industry but grassroots or lay level with families, people who don’t really do things like with treatment and addiction on a daily basis and educating themselves how the brain gets affected by substance use over time. I think that erasing stigma around this is a huge thing. It’s a huge thing.
Sen. McGarvey: I’m glad to hear you say that. Yes, you guys are on the front lines and again there shouldn’t be that stigma. There’s no shame. People get sick and they need help. That’s what we all need to be out there doing.
Zach: You kind of serve on the Senate’s Health and Welfare Committee. What is that committee currently working on to help the addiction rates, the state of Kentucky seem like now help with that?
Sen. McGarvey: We just talked about with that family drug court. That’s a big deal to me personally. We’ve got a pilot program going in Jefferson County and of course part of what that does is it really helps keep families together during the trying time of addiction by taking a caregiver out of the home that we’re providing along the way for people to get treatment, to not be in jail and to keep families together. I think that’s a big deal.
It can have generational impacts like kids with their family. That’s a big deal. We still see funding as a problem. I know people don’t want to hear that, but there’s some truth to it. Kentucky doesn’t have enough money to operate the basic needs of state government as it currently exists. We’re going to see revenues plummet even more now with the coronavirus.
Treatment is the most effective strategy and it’s the best investment we can make, but there’s an upfront cost to it. We’ve got to make sure that we have the funds to make that investment because again it’s going to pay off. If we’re investing in treatment then we are helping people out. We’re helping their families out. We’re changing life trajectory. There’s that emotional side of it which is really compelling. Let me tell you.
You can also put it in cold fiscal terms as well. When you keep someone out of prison and you are able to help them battle this disease then they’re going to get a job and they’re going to pay taxes. They’re going to be productive members of their community. Their family is going to be better impacted. We know that their kids will be better off and have a better chance of finishing high school and going on and having careers and that sort of thing.
There really is a fiscal component to it as well which will benefit us. It just doesn’t benefit in those first couple of years necessarily in an immediate way. I still think funding and putting that emphasis on treatment. I can be on here. You can get any lawmaker on here. We can talk about the value of treatment all they want, but until we actually put our money behind it those words aren’t actionable promises.
Zach: I think that what you’re speaking to and I agree here is a longer-term approach versus a very short-term solution which is locking people up to keep them off the streets, keep them from stealing, whatever.
Sen. McGarvey: Yes. It doesn’t work that way. We’ve tried that. It’s interesting. When we look at addiction and drug policy you see a lot of bipartisan agreement. I think the reason you see that is we all start from the same place. We want to see people get help and we want our communities to be safe happy places to live. What we’ve seen based on drug policies we have decades of research that shows that what you just described — find somebody, lock them up, throw away the key it doesn’t work.
It costs a lot of money. You keep in mind it’s not free to have people in jail and you’re not getting at the underlying problem.
Zach: Morgan, just briefly what are we talking about the cost to keep someone in jail or even prison for about a year?
Sen. McGarvey: To give you an exact dollar figure I’d have to go back and check my notes. I don’t want to say the wrong dollar figure. It’s tens of thousands of dollars. It’s not a cheap cost to keep somebody in jail. Our jails are overcrowded right now. It gets into another aspect of bail reform which we don’t have to get into right now.
There are real monetary savings if you want to look at it again and serve it in a cold fiscal way. There’s the hidden cost as well which is helping people get better dealing with the underlying symptoms and making that fix more permanent.
Zach: Yes. I’m curious to hear from you, too because you’re obviously in the political arena, so to speak. There are quite a few politicians that have many and currently are making their names know on the platform of being tough on crime which often also equates with if you’re not on that sort of platform then you’re soft on crime. You’re weak on crime. That often equates to locking up people who are there for maybe non-crime-related drug offenses.
It’s a crime act but still drug offenses that are not putting a lot of people at risk, so to speak in terms of life, violence. Is there anything that needs to sort of happen with that sort of mentality of being either tough on crime or soft on crime?
Sen. McGarvey: Yes. I think we need to change the words entirely. I think we need to be smart on crime. Again, people think about politics I think they think about it as some far-off thing or that you’ve got representatives and senators who maybe live in some alternative reality.
You and I have talked, Zach. I live in Louisville, Kentucky and we send our kids to St. Matthew’s Elementary. We live in a community. We work in a community. My wife works full-time. I have another job besides being in the State Legislature. I want our community to be safe. I don’t want us to live in an unsafe place.
We should approach criminal justice and crime as we approach a lot of other subjects. Let’s look at the data. Let’s look at the research. Let’s look at what shows to actually work. With drug policy again we’ve sort of learned you can’t incarcerate your way out of the problem. That’s not the source of the problem. If you commit murder you’re going to jail for a long time. That’s a punishment and you’re going to be punished for that and you’re going to be in jail for a long time if not for the rest of your life.
When we talk about drugs a lot of times what we’re seeing with drug offenses in particular if you have addiction it’s a disease. That disease is compelling you to find ways to get drugs and there are often possession charges or petty theft type charges. They’re not violent offenses.
With treatment and with drug court, veterans court, things we’ve talked about you can get better and again become a productive member of the community instead of just saying, “Okay, we busted you. You had a little bit of drugs on you and you’re going to jail for a long time.”
Zach: You bring up an interesting topic of data which the organization that I work for are big on data, collecting it, improving services, those kinds of things. From a state policy standpoint you brought up fiscal data being one thing we can look at to make the case for treatment versus locking people up, but what other forms of data do you say politicians or people in government look at as it relates back to creating drug policies and things like that to informed decisions?
Sen. McGarvey: There have been a couple of really good organizations across the country that put together that information. We have an Office of Drug Policy here in Kentucky that we look to for data and information. We look to of course just the actual police reports and the court reports — who are getting arrested for what, how much of this is happening in the system. We work with local health departments to get data on things.
Now we have policies in place like the needle exchange; how many people are using it, what’s the effective rate on getting people treatment. We have used that. We’re constantly mining that data to try and say, “Is this working? What can we be doing better? Where are the choke points?” We’re not just passing legislation especially when it comes to things like drug policy and addiction. I think the majority of people up here that are passing legislation as an effort to make things better. We want to know whether it’s working.
Yes, trying to analyze what we’ve done and not being afraid occasionally to try things. If it doesn’t work we’ll come back and revisit them.
Zach: Do you find it difficult though because politicians in the United States face the law all the time, too and that you find instead of saying, “You know what? We tried this. It didn’t work. Let’s move on and try something else. Let’s maybe get some bipartisanship together. Let’s reach across the House.” Do you find that gets in the way a lot of the time?
Sen. McGarvey: Sometimes. I say sometimes because again the people want to view what we do as so different from a normal office place. Zach, maybe even like you work on a project with somebody at work. They get an idea and they’re running with it and they’re going with it. They don’t want to let go of their project. They don’t want to let go of their idea that it doesn’t work. I think that’s just sort of some human nature.
I run into a little bit of up here. “Hey, this is my idea. I really wanted it to work.” You could get some of that just like you would in any office place. I also think that when it comes to again drug policy and addiction we’ve seen some really major steps taken on that in the last five to ten years. We’ve seen members of the Republican party, members of the Democratic party unlikely allies coming together.
You’re seeing more of an open dialogue. In drug policy in particular, people are willing to have honest conversations of is this working, is this not working, here’s an idea. You’re not getting shot down as quickly.
Zach: That’s great.
Sen. McGarvey: Yes. Criminal justice reform and addiction treatment, I think you’re seeing a lot of really good conversations happening on both the state and federal level.
Zach: Morgan, how long does it take or can take for that matter for a bill to pass the Senate floor before we see it enacted and actually affecting the community?
Sen. McGarvey: Yes. Years. I tell people not to get discouraged. I think back to a bill we passed. That was awesome. The Conference Committee helped pass the bill and negotiate the final version of the bill, but it was the 2015 session when we passed landmark drug reforms in Kentucky. That year was the at least fourth session that a bill addressing in particular opioids had been in front of legislature.
Zach: Was that [Inaudible][01:04:36]
Sen. McGarvey: Yes. That was the version that actually passed. Yes. That was one of them. This has been years in the making. The House had different opinions on this. In the Senate there were different opinions within the Senate. We really had to get together and hammer it out, but ultimately we passed that bill. It had compromise from all sides.
We saw treatment become a priority. That’s when we passed the needle exchange which at that time particularly for a Southern state it was a really new idea. It took a long time. It took a lot of people getting together, but it ended up working out.
Some laws can take days or weeks to pass but usually those are simpler. You get an idea from somebody in your community who told you something has happened, something has gone wrong. If it’s a quick fix with intended consequences you can pass that pretty quickly through a state legislature, but the big-ticket items we’re talking addiction, criminal justice reform, education, healthcare those can take years to get through a state legislature.
Zach: Got it. For those listening, for the voters in the state what would you say is one of the most important things that they can do to help their local governments bring about effective change and aid during the opiate epidemic?
Sen. McGarvey: The number one thing, the absolute number one thing I tell people this all the time is contact your state representative and state senator.
Sen. McGarvey: Let them know what you’re seeing. Again we pass policy up here with the best intention, but if you see a problem don’t assume that we know it’s a problem. Every year I have passed bills. It feels like a lot of years I passed bills that’s just been brought to me by a member of the community.
This year I passed a bill through the legislature. It was brought to me by a teacher who said, “Hey, this is the current law right now regarding teacher certification and it makes no sense.” You’re right. It makes no sense. We passed it. If you’re seeing something that’s part of the law, that’s part of what your experience is whether it’s in the court system, whether it’s in getting help for addiction, finding beds, finding policy, reimbursement from Medicaid, don’t assume we know about that problem.
Please reach out. Contact us. If you want to do it somewhat anonymously there are ways to do that, too. Be specific about the problem you see. If you want to work with a State Senator or State Representative, there are people up here that their job is they want to help you so don’t be afraid to call.
I think we’re talking about state legislature. I guess I should say this. Zach, you know this because we’ve known each other for a little while. People think that state legislature is maybe like Washington. We don’t have a big staff. The first time you e-mail us you get us. You call us on the phone. You get us.
It’s a pretty direct way for anybody listening. If they have an idea to take it to your local Councilperson, your State Representative, State Senator and it’s a good interaction to have. Make that contact and then help them see what you’re seeing and try to bring about change.
Zach: To be frank, that’s what you guys are getting paid for to represent the constituency of the state of Kentucky.
Sen. McGarvey: Absolutely. It’s our job. That’s why we’re here. We don’t have a big staff. If you’re calling and I won’t say a name I want this to be a part of something, but if you’re calling your United States Senator very rare you’re going to get through to him or her directly. You end up with a staff person, but that staff person has been hired by their senator. They do the committee work. They do get that message up the chain. US Senators represent an entire state.
You call your State Senator. For the most part they have one staff member that they share with two other Senators. It’s not a person that they hire or fire. It’s a non-partisan staff person provided up here on through what we call the Legislative Research Commission. You call us. You’re going to work with us directly. It’s a great way for you to bring about the change that you want to see.
Zach: Would they just go on find your website and be able to access those kinds of contact information?
Sen. McGarvey: Yes, absolutely. Again for the legislature it’s the legislative website. You can go on there. You can even enter in your address. It will find your State Representative for you. It’s legislature.ky.gov, so legislature.ky.gov — talks about all the legislature, all the bills, all the committees. It’s a great resource and pretty easy to navigate, too.
Zach: Got it. I’m curious as we kind of close down here. What would you say is the thing that you’d appreciated most about how our governor has sort of walked us all through this COVID-19 crisis?
Sen. McGarvey: Yes. I think Governor Beshear has done a tremendous job. I like the way that he is calmly presenting facts. I like the fact that he acted smartly and decisively initially. I think it has really helped flatten the curve here. I also think that he’s done a good job in getting information out in pieces, but I think people should know he is working on this problem.
His staff is working on this problem every day of the week including Sundays. I’ve been on calls with the governor’s staff many times over the weekends. They are looking to the next phase, too. He says it all the time. We need to flatten the curve and stop the spread. I think what he doesn’t say intentionally is after that so we can get back to some kind of normal.
I think that normal is going to be different. I think it’s going to be a newer normal, but I think he’s shown leadership and he hadn’t done things that are popular. He’s done things that a leader would do and I’m appreciative of that leadership on this issue.
Zach: Got it. I can tell you right now you’ve motivated me to this has been sitting on my desk now for probably about three weeks now this census paper so I’m going to fill it out tonight.
Sen. McGarvey: Yes, definitely Zach, fill out the census form. I’m telling everybody it is so, so, so important. Kentucky for whatever reason is often undercounted in the census. It determines how many federal representatives we have. It determines the federal money that comes. It determines how apportion state money. That is how we determine how many people live in our state and where and what kind of help these people get because of it.
Zach: Go ahead and fill that out, folks. Don’t let it…
Sen. McGarvey: Fill it out. Fill it out.
Zach: Don’t let it gain you.
Sen. McGarvey: Yes. That’s right.
Zach: Listen, I really appreciate you coming on the show today.
Sen. McGarvey: Thank you for having me. I hope you guys are staying safe and sane and healthy. We will talk soon I’m sure.
Zach: Listen. If you know someone struggling with an addiction and are searching for answers, visit us at landmarkrecovery.com to learn more about substance abuse programs that are both saving lives and empowering families.
Until next week, I’m Zach Crouch with Landmark Recovery Radio.
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