006: Informed Authenticity
In this episode of The Social Leader, Fr. Justin Mathews talks with Brenda Sharpe, President and CEO of the Reach Healthcare Foundation. Brenda talks about the hard realities facing the uninsured and underinsured in our country and the importance of leaders to be informed about the issues and to be authentic and consistent—on and off the clock.
EPISODE 6 - TRANSCRIPT
Father Justin Mathews: Well, good afternoon, all of my friends out there. Welcome to The Social Leader. I'm your host, Father Justin Mathews. You are not going to want to miss today's conversation with Brenda Sharpe, the CEO of Reach Healthcare Foundation. We're going to talk about expanding Medicaid. We're going to talk about equity and healthcare. We're going to talk about her personal leadership tips for being more impactful and having a greater social impact in our leadership, no matter what we do. Stay tuned for this great conversation with Brenda Sharpe coming right up on The Social Leader.
Fr. Justin: Alright, as I said, today my guest is Brenda Sharpe. Brenda is the President and CEO of the Reach Healthcare Foundation. She serves as a board member for the Grantmakers in Health, which is a national organization dedicated to helping foundations and corporate giving programs to improve the health of all people in our country. She is a board member of the Greater Kansas City Chamber of Commerce. She is also the co-chair of the Healthy KC Commission. And lest I leave this off, the Business Journal named her as one of the area's Power 100 in 2015 to 2019 and Ingram's magazine the top 250 most powerful business leaders in Kansas City. That is an incredible resume. And I am very excited to welcome to the show, Brenda Sharpe. Good afternoon, Brenda, how are you?
Brenda: Good afternoon, Father Justin. It's great to be with you today.
Fr. Justin: It's incredible to have you here today as well. It's really an honor. I want to take a moment just to remind everybody that our conversation is being presented by Reconciliation Services and Thelma’s Kitchen is our show sponsor. Well Brenda, I want to dive in with you real quick and just make the most of the time that we have together because right now, all over the news, all over I know even Fox News, CNN, it doesn't matter, people are talking about health care, health care access, and health equity. And that is your bailiwick. That is what you and the Reach Healthcare Foundation focus on every day. Now, when we talk about quality health care, I really have to admit that's an elusive term, and I'd love to know, first of all, what's your definition for what quality health care would look like, for the poor and the underserved in our country, Brenda?
Brenda: Well, thank you, Father Justin, and thank you for all the work that you do to help people who are underserved and uninsured. The work you do is so consistent with our mission here at Reach. One of the things that I have always thought about when I think about the uninsured and quality and access and what that means is to think about how those of us who are fortunate enough to carry around a laminated card in our wallet, and what we expect to get and receive as a result of having that laminated card. What we want at Reach is for everyone to have that same sense of security, that same, right to access certain services, procedures, processes. The access to care and quality care for us is: do individuals who are uninsured, low income, underserved, under-insured, have that same expectation of access to preventative services, a mammogram, colonoscopy? Do they have those same rights and privileges? I would say currently in Kansas and Missouri as a result of long-standing underfunding of our state's Medicaid program, and eligibility rates, and a lack of access to Medicaid, we have a whole lot of people who have never enjoyed that peace of mind.
Fr. Justin: So if you were to just quickly give sort of a picture of what quality healthcare looks like, you're saying that there's more ubiquitous access for the poor. What would it look like for the individual? What are they missing out on that you want to see increased or have access to?
Brenda: Well, first of all, that peace of mind and not having to worry about choices between a prescription medication or paying the rent. I think that's a quandary that so many people find themselves in. Secondly, access to a primary care provider, whether that be a nurse practitioner, whether that be a physician, a physician assistant. Someone that when they do become ill or unwell, they have an opportunity to access that person in a relatively easy way in their neighborhood with someone who is culturally sensitive, appropriate, looks like them, understands their background. So that's kind of the healthcare access side. From an overarching standpoint and more along the social determinants of health, what it means is that people need to have access to places to exercise and a safe place to walk. Everybody right now is talking about during the COVID crisis, go outside, go and walk. There are many neighborhoods in our community where that is simply not an option for folks, it's not safe. And we really need to find ways to help folks enjoy all aspects of their health, access to nutritious foods, for instance, for people who are living in food deserts, access to high quality education.
Fr. Justin: You bring up a lot of interesting points there. Health care, when we think about it, is that needle on that vaccine or we think about access to well visits, but really what you're saying is that health care has so much more to do with other social determinants of health. So you're talking about exercise. I would throw in there probably breaking down social isolation and beginning to have access to healthy education about healthy food and healthy life practices. And so I really appreciate that you include those holistic aspects of healthcare when you're talking about what quality health care looks like. Reach Healthcare Foundation is really trying to advance health care coverage and access to this kind of quality care. What is the Reach Healthcare Foundation doing specifically in order to advance health care coverage and access?
Brenda: Well, we take a multi-factored approach. So we do a lot of grant making and I think that's what people expect from a foundation. That's one tool in our toolbox. And we grant to organizations like yours, that are providing direct and specific care to people who are low income, uninsured, disenfranchised from the system, marginalized populations and communities, for instance. And so that's a big part of that. We know we don't know everything, and you all do this every day. You know your clients. You know your population very well. So supporting those organizations that are highly aligned with our mission to reduce our uninsured rate and improve access to care is a large strategy. We fund about four and a half to five million dollars annually to those organizations in a six county region across the Kansas City metropolitan area. We also have other tools in our toolbox, one of those being advocacy support. And so again, we do provide support to organizations that are working statewide in both Kansas and Missouri to inform our policymakers and the administration in each state about the impact for instance of certain tax policies, the impact of eligibility rates, and ease of access to applying for and receiving public benefit programs such as Medicaid or TANF (Temporary Assistance for Needy Families) or WIC (Special Supplemental Nutrition Program for Women, Infants and Children). So that's a big piece of that work. And then we also advocate on our own. One of the conclusions we came to many years ago is that we can't just expect nonprofits who tend to be highly under-resourced to be out there carrying this water if we aren't willing to carry that as well. So my Board of Directors is amazing. They're a very diverse group of people across the region with lots of different types of expertise and they have been extremely supportive of us speaking out loud and clearly about the lack of certain things in our state, most specifically Medicaid expansion, which is something that our foundation, many others, and many other organizations have been advocating for in Kansas and Missouri, which remain amongst the last 13 to 14 states that have yet to expand their programs.
Fr. Justin: Before we dive into Medicaid expansion, which we're going to get to, and I really want to get your thoughts on that. One of the things that strikes me is that since you're a grant making foundation, and you're working with organizations like Reconciliation Services to advance access to care and improve the quality of care, for example, for us, it's healthy communities, it's access to healthy food, Thelma’s Kitchen, etc. You guys really have your ear to the rail and I love that you're able to translate what you hear from us and from the hundreds of other folks that you all fund and work with closely. You're able to translate that into policy development, which I think lacks a lot of time in the policy and advocacy that's done at the civic and public spheres. You don't always hear those who are difficult to hear. There are a lot of people missing from really critical conversations in our country. One of the things that I think has been a challenge, and I'd like to know if you agree, is just getting poor folks and folks who struggle to survive and succeed, enrolled in the existing marketplace. Politically, this has been a massive debacle for a couple of presidential terms and we don't have to get into the politics of it directly, but with that difficulty, with that barrier of getting enrolled, why is there that barrier? Why is it so hard for the poor to get access to the marketplace? And how has that lack of access impacted those poor and vulnerable neighbors during this pandemic?
Brenda: Well, I think what you're describing is, what we call at Reach, the coverage gap. And so most people who've never had to utilize a Medicaid program, for instance, or public assistance, assume that if you're poor, you lose your job, that that assistance is available and you just need to apply for it and you'll get it. What they don't understand, and going back well before the Affordable Care Act was passed, Father Justin, the eligibility rates for benefit programs, like Medicaid, for instance, in both Kansas and Missouri were already extraordinarily low. So for instance, in Kansas, you would have to be below 33% of the poverty level. In Missouri, it's even lower.
Fr. Justin: Can you define for our listeners just what you mean by the poverty level real quick?
Brenda: So The Federal Poverty Level is a benchmark that has been established by the federal government that says if you're at this particular level, you are poor. That benchmark hasn't been adjusted for decades and that's problem number one. Problem number two is some states, prior to the Affordable Care Act, said, “okay, if that's the federal government's definition of poor, that will be our state's definition of poor.” That did not happen in Kansas and Missouri. Missouri said 18%, for instance, of the federal poverty level is poor. In Kansas, about 30 to 33% of that amount. So if you make more than let's say, $9,000, a year in the state of Kansas, you are too rich for the state's Medicaid program.
Fr. Justin: Yeah, that just seems like a crime. I have to say that. You can't live on $9,000 and to say that that's a level or a standard of wealth is beyond me, so forgive me for the editorializing.
Brenda: I couldn’t agree more. No one can live on that amount. And the choices that you have to make then are do I apply for Medicaid and I’m not able then to work because it's going to make too much that you're going to disqualify yourself for that health insurance that you desperately need. So the Affordable Care Act came along and attempted to close that coverage gap. And for a year or so we thought everything was going to be great and we were going to close that coverage gap. But then lawsuits were filed and the Supreme Court ruled that states can decide whether or not to expand that gap up to 133% of the poverty level. So back to my example, in Kansas, not only if you make more than $9,000 in the state of Kansas, you're too rich for Medicaid, you are too poor. You don't make enough to qualify for subsidies on healthcare.gov, so you're in this horrible gap. One of the things we fund are navigators and assisters who help people make those applications. And I can't tell you how heartbreaking it is for those workers to have to tell someone you're too poor for this program and too rich for this program and therefore you are cut out of access to health insurance coverage. And that is what has gone on for the last seven years in the state of Kansas and Missouri because they have opted not to close that coverage gap so that we could have more people covered. And in Kansas that's about 150,000 people. In Missouri it's about 230,000 people. So now let's think about what's happened with COVID. The number of people who are now unemployed is absolutely staggering. And what we know about our American health care system is your health insurance follows your employment essentially. So if you had employer based health coverage and have lost your job, you might be able to use the COBRA program, but I'm talking to folks whose COBRA premium is $1,200 dollars a month for them.
Fr. Justin: That's very expensive. I've had people in my life try to get on that and they couldn't afford it. You’ve just lost your job.
Brenda: You've lost your job, you've lost your insurance, you found out you're too rich for our state's Medicaid program, and too poor for healthcare.gov. So it's a real quandary. And our legislative leaders have absolutely got to to address this this session as soon as they get back. We're going to be in a world of hurt. We already are. But we're going to be in an even more strange system here in a few months.
Fr. Justin: I want to pause for a second and let everybody know that if you have questions for Brenda Sharpe, who is the CEO of the Reach Healthcare Foundation or if you've had an experience with this exact kind of gap that they are trying to close, feel free to comment on one of the social media platforms (Facebook, Twitter, Instagram, YouTube) and we'd like to continue the conversation. I love when folks are interactive on the program. Well, Brenda, we're going to come right back, I want to take a minute to talk about our sponsor Thelma’s Kitchen. But when we get back, I want to pivot a little bit and talk about what the world would have looked like if we had done what you're suggesting. So hang tight with me for just one second.
Reconciliation Services is the presenting sponsor for this program, The Social Leader, but Thelma’s Kitchen is a donate-what-you-can cafe located right here in Kansas City. Thelma’s Kitchen was the first donate-what-you-can cafe. Of course, the restaurant is closed now. We're on the corner of 31st and Troost, but right now we're literally giving away food to over 325-350 people every single day during this COVID crisis. And I'll tell you, the type of people that are coming is really changing. It's not just folks who are homeless, or folks who are on fixed incomes. I met a guy the other day, who was a painter who was out of work. I met somebody who was a maintenance tech at a large law firm. She's out of work. So right now there's a note of urgency. And so that's why Thelma’s Kitchen, which is the sponsor of this show, really needs your help. You can go to ThelmasKitchen.org and you can find out more about the work of Thelma’s Kitchen and the work of Reconciliation Services, and you can sponsor a meal for those who are in the community.
Well, I'd like to jump back now and talk with my guest, Brenda Sharpe, who is the CEO of the Reach Healthcare Foundation. And Brenda, you are just getting ready to talk a little bit more about Medicaid expansion. And I'll be honest, for somebody who doesn't understand the details of the law, the way that I know you do, and the insurance system, the way that you and your colleagues do at the Reach Healthcare Foundation, I'd like to know from you kind of in layman's terms, which I'm saying layman even though I'm clergy but we'll let that stand, what would the world look like for the poor, for those who are in that gap? What would the world look like right now during COVID had we gone ahead and expanded Medicaid for those in Kansas and Missouri?
Brenda: Well, let me share with you, to be on Medicaid in either Kansas or Missouri, it's essentially a “poor and...” You have to be poor and pregnant, poor and disabled, poor and elderly. So what it would look like if we had expanded Medicaid is we would be able to pick up those hard working folks that you just referenced the painter, the maintenance worker, who are working generally one or more jobs, sometimes two, sometimes three jobs but none of those employers may offer healthcare coverage or affordable health care coverage to that employee. So they are going without and that is the group that is really falling into the coverage gap. It's the working poor. You'll hear a lot of rhetoric from folks who say, “well, those folks are able-bodied, they can get a job and they can get insurance, they can afford insurance.” And again, I think people assume that there is this very benevolent level of public assistance out there. And that's just not the case in Kansas and Missouri. So we started so low with our eligibility rates, whereas other states started at about 100% of the federal poverty level. And when the Affordable Care Act offered the opportunity for all those states to expand, they closed their coverage gap very quickly, because it wasn't as big of a gap. We have a huge gap. So we were starting at a real deficit before COVID. We now, I suspect, what's going to happen is that much like after 2008, when the recession hit and many people became unemployed, they assumed that there was some place for them to go, they assumed that there was a community based health clinic or center. And there are. We have wonderful centers in our community, but they are already at capacity, they are already under-resourced. And those hard working people who through absolutely no fault of their own have found themselves now without employment, and aren’t able to get employment, even when this comes back I think we'll still be seeing unemployment rates very, very high for quite some time, those folks would have at least been able to have their health insurance covered. Because if you're uninsured, you're forced to make terrible choices. If you are sick or a little sick or not sure if you're sick, you are not going to go see a doctor or go to a physician or an emergency room because you know there's going to be a large bill behind that coming to you and you won't be able to pay it. Medical debt is the number one cause of bankruptcy across the country and in our two states especially. So you're going to make that choice. So what's going to happen is you're likely to wait until you're much, much more ill and those treatment costs then to treat you are going to go up and that's the quandary. We could have helped ameliorate this to some extent for years in both Kansas and Missouri and it's about to get worse, I'm afraid.
Fr. Justin: Yeah, I wonder how the tens of millions of people who are now unemployed, including gig workers and side hustlers, and folks who didn't have ever access to that kind of big company style group health insurance, I wonder what's going to become of them and especially their kids. We know people right here at Reconciliation Services who come in and they need to go to the hospital. I remember one time one of my dear friends was having a panic attack, but she didn't know if it was a panic attack or a heart attack because sometimes they can feel very similar and she absolutely needed medical attention. She would not allow us to call the EMT’s, would not allow us to call the ambulance. Because once you do that if they determine that you need to go to the hospital, it's very difficult to kind of refuse that. And she could not afford the bill that would inevitably come from the hospital visit and the ambulance ride. And so to watch somebody who desperately needs care, not get the care because in the middle of their crisis, they're actually thinking about the bill from the ambulance. That's not how health care ought to work. And I'll be honest, it's not only impacting healthcare, I think you would agree with this. But that kind of lack of access is not just about that moment when you're sick. But isn't it about the kind of rippling secondary trauma that happens or the rippling health effects within the family system? How does that moment impact that whole family system, Brenda?
Brenda: Well, we know the kind of anxiety that comes with a diagnosis of any chronic condition. So if you are diagnosed with a chronic condition, let's say, asthma, diabetes, and you're also uninsured, that's a multiplier effect. And that's going to spill over into every aspect of your family work. Everyone in the family is going to be in a heightened state of anxiety, leading to higher levels of stress and depression. Sometimes family violence as a result of that additional stress and anxiety. So it has a ripple effect. I do want to go back to one thing that you mentioned, you mentioned children, Father Justin. One fortunate thing about the United States and our Children's Health Insurance Program at the federal level is that it is much more generous than coverage for adults. So I encourage anyone who finds themselves newly unemployed and without insurance or family insurance that covers their children, at least get your children enrolled. You can do that online in both Kansas and Missouri. But that's called the Children's Health Insurance Program and the eligibility rates percentages are much, much higher. So it's much easier to apply for. You will have to have some documentation, you may have to have some other paperwork and assistance, but there are people that can assist with that, but get your kids covered for sure.
Fr. Justin: Yeah, and I think education is a big part of it, so I just want to encourage everybody to go to ReachHealth.org to find out more about the work that Brenda Sharpe and Reach Healthcare Foundation are doing and get educated about the kind of things that she's been sharing with us today so that you can have a greater social impact as a leader no matter what your job is or what you're leading. Well, with that, I want to pivot a little bit now to talk about your leadership because the work that you're doing is really hard, and it can be easy to be overwhelmed by a problem as immense as the American healthcare system and it can be overwhelming to hear the stories day after day of those who are struggling to survive and succeed and who go uncovered or don't have quality health care. As a leader yourself, you're somebody who's known, and I know you personally, to be somebody who wants to have a significant social impact in your leadership and in your work. And I think you would do that whether you were at a tech company or at a foundation. I think that's the kind of leader that you are. What are your personal strategies for how you keep focused on that true north? And what do you do to ensure that as a leader you're having not only a corporate impact, but a social impact as a leader?
Brenda: Well, I thank you for those very kind words, and I would say I don't know any different. It's in my DNA, I think. I grew up very poor. I grew up in a family that had multiple challenges. And I grew up without a lot of things that I now am incredibly privileged to have and I don't forget that. And I think a lot of people that find themselves in the nonprofit or social services sector have some part of their background that they are trying to reconcile with and it’s appropriate to your name. And so for me, I always knew I wanted to be in a role to help others. I initially thought I wanted to be in counseling and I wanted to do that direct service with folks but frankly, I didn't have the boundaries for that. It was too much for me to take in on top of my own baggage that I was bringing to that. And so I encourage people who are looking for leadership opportunities and thinking about how they bring something special to the table that they also do a little bit of a gut check on their readiness and their boundaries. What I found great pleasure in was being a volunteer coordinator. And then doing public speaking and grant writing and fundraising and being more on the administrative side. Those are ways that I could contribute to causes that I feel strongly about: child abuse prevention, violence against women, healthcare access for all. Those are things that I could bring to the table that were a little different than my good friend who's a forensic interviewer who listens to just absolutely horrendous stories every day and can still get up in the morning. That was not me, but I owned that, I learned that about myself. So I encourage people to think about that. And I also think, you know, the current crisis is showing me over and over again what I already knew about the nonprofit sector. We are resilient. We are creative. We are used to doing a lot with nothing, and we're about ready to have to do a lot more, with a lot more nothing. But I know that we will get through this because people who find themselves in these positions are there for a reason. And, like you, I'm amazed every day the stories that are coming before me that are demonstrating that resiliency.
Fr. Justin: If you're talking to somebody, and I think a lot of the audience that listens to this show, The Social Leader, falls into this category, they're actually not working in nonprofits, they're not folks who are directly on the front line working with the poor or working in some sort of social setting. There's a lot of volunteering going on, a lot of Board service going on, but for somebody in their context, at their company, in their division, how can they advance the social good from within their own job? What kind of attitude or mindset or actions does somebody need to take to accelerate their social leadership?
Brenda: I think that's a great question and I guess for me, it would come down to the words authenticity and consistency. So if you find yourself at a cocktail party in the upper echelons of society, I don't find myself there often, but if you do: Are you speaking about your beliefs, your values in a way that's consistent if you were if you were working with in a volunteer capacity with someone who just came in off the street into Thelma’s Kitchen? You have wonderful corporate volunteers and I think sometimes people segregate their lives a little bit depending on their social circle or others. And so, being consistent, not being annoying or aggressive certainly, but being consistent in your values and beliefs. If you work outside the nonprofit sector, you have an even greater opportunity because you're able to educate folks who are not getting exposure to the way a lot of people in our community live. So bringing them along, walking alongside, helping them find ways to contribute, but being consistent. And then the last piece I would say is really getting informed about policy advocacy. I worked so long in the nonprofit sector without understanding that I was working so hard all year round to get something passed or changed that could be undone just like that with a stroke of a pen in the legislature in Kansas or Missouri or even at a local level, city or county government. We really have to start thinking about understanding what elected officials role and responsibility is to us as constituents and and to us as a community in our quality of life and in understanding that connection and learning how to write a letter to your legislator and learning how to pick up the phone and overcoming that fear and understanding that they work for us. And we need to remind them of that sometimes. Many of them understand that and they're wonderful but others are there for other reasons and we need to hold them to account.
Fr. Justin: Well, I really appreciate the insights that you've shared and appreciate the depth of the conversation. I just want to encourage people again, to get educated, to stay consistent. As you said, just because you're in the corporate setting, you're a hiring manager, you're a foreman on a construction job, everyone has the opportunity to be a social leader within their own sphere. And that's not just about charity and volunteering. That's about showing up. That's about like you said, Brenda, being consistent, being educated, and using your voice, using your privilege, and using your power to help other people. And so thank you for being such a wonderful example of a social leader and thank you for coming on The Social Leader, episode number six with us today. I hope that I can have you back sometime soon.
Brenda: Likewise, Father Justin. This is my first go with this type of a format and I really appreciate how kind you've been to me and all of the good work that you're doing in the community. Thank you.
Fr. Justin: Thank you so much Brenda. For all of my friends out there in the community,I want to remind you that this show is presented by Reconciliation Services and sponsored by Thelma’s Kitchen, Kansas City's first donate-what-you-can restaurant where right now we are literally feeding hundreds and hundreds of people every single day. If you'd like to get involved with Thelma’s Kitchen, you can go to ThelmasKitchen.org and you can sponsor a meal for folks right now. We also have a list online of the kind of practical things that you can buy and send or things that we need to continue doing our work. And not only that, but you can go to rs3101.org and see Reconciliation Services and the broader work that we're doing which includes Thelma’s kitchen, all the social and trauma therapy services that we talked about today with Brenda, as well as The Social Leader. Friends, before we leave, I want to tell you one last thing. We are getting ready this fall to launch a brand new program called The Social Leader. It's a leadership development program for anybody who wants to accelerate their social impact, no matter where they are in leadership. The program is launching this fall. Sign up on the email list and make sure to be the first to find out about when that program launches, of course, when we can all get back together in person again. So thank you again. The show has been presented by Reconciliation Services. I'm your host, Father Justin Mathews, and I look forward to seeing you next week on The Social Leader. Have a wonderful, wonderful day.