Saturday, July 28, 2012

Mead thinks insuring the uninsured is not the right thing to do?

Matt Mead is at it again. The governor of some of the people says he’s not inclined to allow the federal government to provide health insurance for thousands of Wyoming citizens who cannot otherwise afford health insurance.

The governor is putting GOP politics above the needs of Wyoming families who go without health care. To be fair, Mead hasn’t rushed to the front of the line of Republican governors who have already said they’ll not accept the offer of the Obama administration to insure their uninsured. But he’s headed there and wants to ease us into the decision.

Mead says it doesn’t make sense to take federal dollars to insure the uninsured. He is ignoring his responsibility to rise above partisanship and represent all of us, especially uninsured families. He’s also ignoring what it costs to walk away from Medicaid expansion under the Affordable Care Act (ACA).

Here’s how the law works. Either Wyoming or the dreaded feds (Mead’s choice) will create a health insurance exchange. When uninsured persons go to the exchange they’ll qualify or not, based on income, for either Medicaid or a subsidy (available to those making between 100 and 400% of the federal poverty level, i.e. FPL) to help purchase insurance on the private market. Because of the ACA, low-income families will find health insurance affordable. Note: It costs the federal government more to provide subsidies than to provide Medicaid.

Governor Mead admits 30,000 Wyoming people are currently uninsured. Many will be eligible for either Medicaid or subsidized insurance. For the most part, these are hard-working people. Some work more than one job. Their low-wage jobs don’t often provide health insurance. Under Medicaid or the subsidies, these families will have insurance at little expense to state taxpayers.

The federal government will pick up the entire cost of Medicaid expansion for the first 3 years. After that, the federal match will gradually drop to 90%, where it will be remain. The Wyoming Department of Health acknowledges the expansion of Medicaid to all citizens below 138 % of FPL will save the money we are now spending. Savings to the state budget will be achieved because many of the programs previously created to provide services for the uninsured, such as the nearly 100 million spent on state funded mental health and substance abuse treatment, can go away as uninsured families obtain coverage.

Governor Mead may have the authority to reject Medicaid but he cannot reject either the health insurance exchange or the subsidies. To justify his plans to reject Medicaid coverage, Mead says we can’t count on the feds, they might pay initially and then quit paying later. But why would the fed’s stop paying for Medicaid when that would actually cost even more. One non-partisan study concluded, “The federal government would see significant savings by not having to pay for the Medicaid expansion in states that choose not to participate. But it would end up spending even more covering private insurance subsidies for some of those no longer eligible for the entitlement program.”

Nonetheless, he says we shouldn’t insure these people now only to tell them later they have no insurance. “That’s just not the right thing to do,” he told the press. To the contrary, rejecting federal funding of health insurance for these people is “just not the right thing to do.”

Understandably Mead is a Republican who hopes Romney will be elected on his promise to reduce the number of people with health insurance. But if the federal government pays nearly all the cost because it can save money doing so, and as many as 30,000 uninsured Wyoming families would then be covered, we have to ask, “Why, governor, do you think uninsured people are better off with no insurance at all than with coverage that, at the very worst, might last only a few years.

If you are the governor of only some of the people, that may make sense. It doesn’t make sense to anyone else, especially the uninsured.

Tuesday, July 24, 2012

Stephen Stills understands Wyoming politics

“There’s something happening here, what it is ain’t exactly clear…” Who’d have thought Stephen Stills’ words could describe Wyoming politics?  “We better stop, hey, what's that sound. Everybody look what's going down.”

That rumbling sound your stomach makes when you’re hungry, you know…that growl? That’s the sound we are beginning to hear. “There’s something happening here, what it is ain’t exactly clear…”

The rumbling started with the cawing of the CROWS (Conservative Republicans of Wyoming) and turned into a growl with the formation of a new political party called the Country Party. They’ve been quietly gathering signatures. They needed only 7500 to become a ballot qualified political party. They got them.

CROW believes they can purge the Republican Party from within. The Country Party has given up on the GOP. From their perspective, it’s become hopelessly infected with leftists. And they know who you are. They are targeting Senators Tony Ross and Wayne Johnson as well as Representatives Dan and Dave Zwonitzer and Bob Nicholas. “Nobody's right if everybody's wrong.” Those five Republicans have a combined total of 50 years in the state legislature. All of a sudden, their own party says they have to go?

As Stills wrote, “There's battle lines being drawn.” Actually, there is something happening here, and what it is…is perfectly clear. They are tired of Wyoming being a one-party state. If the Democrats aren’t going to challenge the Republicans, the Country Party will. The Democrats failed to recruit candidates to run against Ross, Jonson or either of the Zwonitzers. But all four will have trouble on their right this fall.

“Paranoia strikes deep. Into your life it will creep. It starts when you're always afraid.” The CROWs and the Country Party fear politicians who try to do what they believe is right. They don’t like representative democracy. They like doctrinal democracy. No compromises, take no prisoners, no hold barred. It’s their way or the highway.

But there’s something else happening here and what it is ain’t exactly clear. There are two candidates out in the streets collecting voters’ signatures to get on the fall ballot as independents. Charlie Hardy of Cheyenne is running for the U.S. House of Representatives. Dr. Phil Roberts of Laramie is running for the U.S. Senate. Each will make effective challengers for the incumbents Rep. Cynthia Lummis and Sen. John Barrasso.

What’s especially interesting is that two well-qualified people have chosen to skirt the normal political parties and run as independents. “Everybody look what's going down. Stop, now, what's that sound. Everybody look what's going down.” That is a far healthier development for Wyoming politics than the circular firing squad being formed by the state’s right-wingers.

What’s happening among Republicans is a symptom of what has gone wrong in American politics. We have no difficulty recognizing it when we see it in Washington. We need to be as honest when we see it here. CROW and the Country Party believe the state would best be served by purging the Republican Party of thoughtful, moderate members. “There’s battle lines being drawn. Nobody’s right if everybody’s wrong.” These are doctrinaire voters and candidates who eschew compromise and seek purity. If you like what’s happening in Congress, you’ll love it when the “all-or-nothing-crowd takes over at the state capitol building.

The emergence of strong independent candidates is something altogether different, far more interesting and healthier for the system.  This fall, Wyoming voters won’t be able to say they didn’t have a choice between partisan-purity and independent thinkers.

“Everybody look what's going down
Stop, now, what's that sound
Everybody look what's going down
Stop, children, what's that sound
Everybody look what's going down”

“For what it’s worth” politicians love to quote Jefferson. “That government is best which governs the least.” They conveniently leave off the rest of his sentence. Jefferson actually said, “That government is best which governs the least because its people discipline themselves.” To say it another way, “Unless the people discipline themselves, government can govern neither least nor best.”

Saturday, July 21, 2012

Why I'm voting "no" on the 6th penny rec-center

Cheyenne needs a rec-center, just not the one on the 6th-penny ballot. The construction of the rec-center Cheyenne needs is already underway, being built by the Cheyenne Boys and Girls Club. The “Vote For The Rec Center” website ( asks us to approve the 33 million dollar proposal without any mention of the work already underway by the Boys and Girls Club. It makes no sense to build both.

Cheyenne should put resources into making certain the Boys and Girls Club facility succeeds, not in taxing people to build a competing center.

Supporters of the 6th-penny-plan say they will attempt to raise money for “scholarships” for low-income families. That’s not a plan. It’s certainly not an open door for the community. If taxpayers are funding a rec-center, its ability to adequately serve those who cannot afford existing recreational facilities should be at the center of its mission. Proponents answer concerns some have about the future costs of maintaining a rec-center, saying they will recover “94% of operating costs and consequently will have a relatively minor impact on the level of tax support.” Really? That’ll put a heavy reliance on membership fees at a rate far above what is affordable for families who should have equal access to a taxpayer-built center.
Then there is the issue of location. Proponents claim the location is yet to be determined. They assure it will be decided only after the voters give approval. At the same time, the site plan shows it will be built on land north of Prairie Hills Golf Course. The proponent’s website says the 6th-penny-rec-center is, “Tentatively planned in center of county population density just south of Cahill Park in Ward 3. Infrastructure and land is paid for at this location, however, other locations are also being considered closer to downtown.”
But there is apparently no consideration of a south or west side site. Location says a great deal about those who are going to be primarily served. Despite assurances there will be an open, transparent site selection process following the vote, we both know the location has already been determined. Kids living in other parts of town will be asked to take the bus and hope they have a “scholarship” so they can get through the door.
The Boys and Girls Club facility is already in Phase 1 of construction. A $195,000 Community Development Block Grant enabled them to begin at the corner of West Jefferson Road and Walterscheid. This site includes 12-acres, allowing for the construction of basketball and volleyball courts, a playground and picnic shelters. Plans include a large recreational and learning center, especially designed to be a place for youth.
The location means it will serve an under-served part of town while investing in the south side of the city.
Currently the Boys and Girls Club is located in a city-owned building at 1700 Snyder. They lease it from the city for $1 per month. In that inadequately small facility, they serve more than 500 children ages 6 to 18. There are as many as a hundred a day in the building. Imagine what they will do with their new center?
If the proponents of a new rec-center for Cheyenne are serious about providing a recreational program for all children and their families, they should sit down with the Boys and Girls Club and figure out how to support their plans. The taxpayers could build a facility with 6th penny funds and then lease it to the Boys and Girls Club for $1 per year. The Club has already demonstrated it has the ability to successfully manage such a facility and to serve a wide array of children.
If the voters helped build it, the Club could maintain and mange it and the entire community would be better off.
Until the proponents of a new rec-center can show they have a genuine plan to serve under-served kids and families at a location providing meaningful access, I am voting against the rec-center.

Saturday, July 14, 2012

Medicaid Expansion Would Save Wyoming Millions

The enormous investment Wyoming made in mental health and substance abuse treatment in the last decade puts the state in a position to cash in big on the implementation of the Affordable Care Act (Obamacare). Governor Mead and state legislators should weigh the opportunity before rushing to join other Republican governors rejecting federal funding of Medicaid expansion.
Today Wyoming taxpayers spend more than 95 million dollars each budget period on mental health and substance abuse services. If Wyoming implements the Medicaid expansion under Obamacare, most of that money can be returned to the general fund. Here’s why the new law provides our state with such a windfall.

More than 86 million are state general funds and another nine million are tobacco settlement funds. Almost all are provided to community mental health and substance abuse centers across the state. For the most part the people needing those services are uninsured. Those with insurance, have woefully inadequate coverage for these services. As a result, the taxpayers have been footing the bill.
Wyoming has invested heavily in an effort to provide necessary treatment and the funding grew significantly during the last 10 years largely because of the meth crisis. People needed treatment and if they couldn’t afford it, that presented a public safety problem. But insurance didn’t cover the cost. So the state had no choice. Now that Congress enacted Obamacare,  we have a choice.
If the state opts for the expansion of Medicaid under the new law, most of Wyoming’s uninsured families will have insurance. Insurance will be required to include treatment for mental health and substance use disorders.

Before the new law, psychiatric or substance abuse disorders were pre-existing conditions for which a person could be denied insurance. No more. Nor can insurance companies impose lifetime limits. Mental illness and addiction are treatable, but rarely curable. That’s why the current limits on treatment are as irrational as they are unfair and counterproductive — but until now the hallmark of commercial medical insurance.

The Affordable Care Act treats psychiatric and addiction illnesses like any other health problem, removing obstacles to treatment. Obamacare combines the requirement that insurance policies cover these services with the individual mandate for health insurance. As a result more people will have insurance and their insurance, not the taxpayers, will pay the cost of mental health and substance disorder treatment.

That’s why the Supreme Court decision upholding the act was good news for Wyoming families whose loved ones suffer from these conditions. But the celebration is premature should Governor Mead or the legislature choose to sacrifice these families to a doctrinaire opposition to the President.

Rejecting the Medicaid expansion under Obamacare would cost Wyoming taxpayers hundreds of millions of dollars first because in the initial three years, the federal government will pay the entire cost of the expansion. After that, the federal match drops gradually to 90% where it will remain. As a result most of the 80,000 Wyoming families currently uninsured will have insurance. If Wyoming opts out, our federal tax load will not decrease. The taxes we pay will go to help citizens of other states while our own people go without. Doesn’t make sense.

Economically it would mean millions of dollars available to Wyoming would not be available to bolster the state’s healthcare structure. These dollars don’t go into the pockets of people needing healthcare. They go to community healthcare providers who are able to expand the state’s healthcare system. These dollars go to work throughout the community. Can you imagine Wyoming turning down any other economic development opportunity of that scale? 

As though that were not incentive enough, if the state moves ahead with the Medicaid expansion, it can reduce the budget of the Department of Health by as much as 90 million dollars by 2014. Giving this much money to community mental health centers will largely be unnecessary, replaced by insurance coverage under Obamacare. Ninety million dollars in savings should be enticing as the state searches for ways to reduce spending.

Saturday, July 7, 2012

It’s time to be honest about what the law does and does not do.

Governor Mead could do the citizens of the state a genuine service by moving ahead with the creation of a health exchange under the Affordable Care Act. The first duty of an exchange should be to tell Wyoming people the truth about what the act does and does not do. After a less-than-honest debate, people are confused. It’s time to be honest about what the law does and does not do.

A poll taken after the Supreme Court ruling says that while half the country thinks it’s a bad law, 56% think it’s time to quit bickering and get on with implementing the law. Even better news for Wyoming is that Matt Mead agrees.

Governor Mead earned his spurs opposing the Affordable Care Act. So when he says it’s now time to roll up our sleeves and get to work, the legislature should listen. Three other Republican governors, known for their anti-Obamacare rhetoric, looked into their crystal balls and decided that while there was a season to be partisan, there was also a season to recognize the opportunities. Mitch Daniels of Indiana, Haley Barbour of Mississippi and Scott Walker of Wisconsin moved ahead of the pack to build heath exchanges in their state.

Unlike them, our state wasted precious months in a quixotic hope that the healthcare law would go away. The clock has been ticking. Important deadlines loom. It’s time to consider the opportunities the law has for improving healthcare for the people of Wyoming and give them a place to go for the truth about the law.

As Mitt Romney’s war to repeal the law continues, the truth will be a casualty as it has been from the beginning. Some of the talk from both sides has distorted the truth. But, let’s be honest among ourselves. Many of those who opposed the law have tortured the truth to death. Beginning before Sarah Palin’s lies about “death panels,” the debate has been characterized by outright falsehoods. Opponents have frightened small business people, saying they will face huge new costs and many will go out of business. Untrue. 

They have called it socialism and a government take-over of healthcare. Untrue. For those of us who believe there should be a single-payer system, this charge is unfathomable.They call it a middle class tax increase when, in fact, Obamacare includes the largest middle-class tax cut for health care in history. According to the independent Congressional Budget Office, 19 million people will receive tax credits averaging $4,800, making insurance affordable for the first time.

Intentionally imaginary is their claim that bureaucrats and not patients or doctors will make healthcare decisions. The truth? Obamacare gives you and your doctor the authority to make decisions now made by insurance companies. Before the law, insurance companies arbitrarily capped or cancelled coverage. They wasted our premiums on overhead and outrageous bonuses for CEOs. With Obamacare, all that changes. Patients and doctors, not Washington bureaucrats and insurance executives, now have more control over health care.  

They’ve said millions will be forced to give up current health insurance. Untrue. If you like the insurance you have, keep it, knowing that under Obamacare, your coverage is stronger. Lifetime limits imposed unilaterally by your insurance company are eliminated; children under 26, can stay on your plan; insurance companies can no longer discriminate against children with pre-existing conditions and starting in 2014, insurance companies will no longer be able to deny anyone insurance based on pre-existing conditions. Insurance companies will no longer be able to charge women more than men, 54 million Americans already have access to better preventive services, free of charge; and if you get sick, your insurance company can’t drop you.

The reason half the country tells pollsters they want the act repealed is they have not been told the truth. So, where can Wyoming people go to learn the truth? Here’s hoping the health exchange the Governor and the legislature establish will have the credibility to be just that place.