Saturday, September 29, 2012

Governor Mead isn't prepared to talk about Medicaid savings. I am.

When Governor Mead spoke to reporters earlier this month about a Department of Health (WDH) study on the expansion of Medicaid, he talked only of the costs. Mead said it could cost between a wide range of 53 to 310 million dollars over a six-year period. Mead had “grave concerns” about the costs.

Likewise, I had “grave concerns” when I read the Governor’s comments because, based on my four years as a WDH deputy director, I knew there were huge cost savings to be realized through Medicaid expansion. Talking only of “costs” without acknowledging savings seemed like trying to tell the story of Jonah without any mention of a whale.

So, I read the report. It does talk about savings. Two weeks ago in this column, I did as well.

Mead’s office was displeased with my suggestion that as much 700 million dollars would be saved over the same six-year period. Perhaps I should have been less exacting and offered as wild a ranging guess as did the authors of the report. I could have said savings would definitely range between $1 and 700 million. Mead’s staff did acknowledge there would be savings but the administration hasn’t determined how much. That was rather surprising given that the Governor is expressing “grave concerns” about the costs. But since his analysis is not completed, I offer my own based on the Medicaid cost study and my experience with many of these programs.

What we were doing before Obamacare wasn’t free. The legislature appropriates millions to care for those without health insurance. The most expensive example is mental health and addiction treatment. Most people needing treatment were previously uninsured or had inadequate coverage. Consequently, the 2013-2014 budget for these treatment programs is 114 million dollars. With Obamacare, coverage for treatment is mandated. With Medicaid expansion this entire amount, in my opinion, could be saved. Potential savings in this one program more than offsets even the highest and wildest six-year cost projection.

The study concedes all persons currently benefitting from Wyoming’s Prescription Drug Assistance Program would be covered under Medicaid, saving 12 million dollars.

The report identifies several other costly programs to significantly reduce or eliminate if the Governor chooses to expand Medicaid. The State Hospital’s “proposed general fund appropriation for the 2013-14 biennium” is 76 million dollars. The report acknowledges, “Medicaid expansion under the ACA could reduce the general fund outlay for the Wyoming State Hospital; some persons currently served would become eligible for Wyoming Medicaid, which will receive considerable federal funding.” Additional savings will be garnered in the Children’s Health Insurance Program, the Wyoming Life Resource Center, breast and cervical cancer screening, the Wyoming Colorectal Cancer Screening Program, and the Office of Rural Health.
The report goes on to discuss savings likely to come from several other programs. “These include (dollar amounts are budgeted general fund appropriations for 2013-14) Public Health Nursing ($12 million), Immunization Program ($9 million), Maternal and Family Health ($4), and Oral Health Programs ($1 million).” Medicaid expansion would cover some of the services currently provided under these programs.
Finally, there are uncompensated costs for treating the uninsured, costs shifted to the insured, raising their premiums. Taxpayers pick up the tab when costs are shifted to state employee health insurance. The report finds, “The expansion of Wyoming Medicaid would lead to a reduction in the number of uninsured and likewise reduce uncompensated care, which could in turn reduce Wyoming’s expenditures on employee health insurance premiums.”
True, my estimate of near 700 million dollars savings may be off. First, the Governor has an interest in minimizing the savings in order to support his narrative that Medicaid expansion is too costly. Second, each of these programs has a constituency. Some even have lobbyists. There are still a lot of politics to be played. Along the way, neither the Governor nor legislators should be touting the costs without conceding the savings when it’s clear the savings swallow up any projected costs just as that whale swallowed up Jonah.

Wednesday, September 26, 2012

Sermon from Sunday's "Blessing of the Animals"

This morning I want to tell you two stories. The first is from the Book of Genesis.
And God said, “Let the earth bring forth living creatures of every kind: cattle and creeping things and wild animals of the earth of every kind.” And it was so. God made the wild animals of the earth of every kind, and the cattle of every kind, and everything that creeps upon the ground of every kind. And God saw that it was good.
Then the Lord God said, “It is not good that the man should be alone; I will make him a helper as his partner.” So out of the ground the Lord God formed every animal of the field and every bird of the air, and brought them to the man to see what he would call them; and whatever the man called every living creature, that was its name. The man gave names to all cattle, and to the birds of the air, and to every animal of the field.
God said, “See, I have given you every plant yielding seed that is upon the face of all the earth, and every tree with seed in its fruit; you shall have them for food. And to every beast of the earth, and to every bird of the air, and to everything that creeps on the earth, everything that has the breath of life, I have given every green plant for food.” And it was so.
God saw everything that he had made, and indeed, it was very good.
The second is a legend of the life of St. Francis.
Once upon a time, Francis (later to become St. Francis) was visiting a small town called Gubbio in Italy. The villagers told him of a hungry wolf that had been terrorizing the town at night. Inasmuch as many of Gubbio’s residents were farmers, this wolf brought terrible hardships upon the town. He stole chickens and turkeys and even some mammals like goats and sheep. The wolf had even attacked people.
St. Francis was not known for being particularly brave, but he knew that he had to do something. He knew in his heart that he could help the town and small shop owners if only he found a way to communicate with the wolf about his feelings. But the wolf had never shown any interest in talking about his feelings. He was simply hungry and whatever he found to eat satisfied him. But Francis was a man of God, and his faith assured him that God would take care of him, watch over him, and not let anything happen to him. He also believed that God put us all on earth to care for animals and others in need.  And so he was determined to find this wolf and to talk with him.
As he and a friar walked along the trail, it wasn’t long before the wolf appeared, teeth bared and growling menacingly, preparing to attack. Slowly he stalked Francis.
Francis saw the wolf and watched him carefully but did not back down. He faced the wolf and the two took one another in, sizing each other up, each for his own purpose. Francis acted first. He made the sign of the cross and the wolf immediately stopped growling and closed his mouth. Francis spoke softly, “Come to me Brother Wolf, and in the name of Jesus Christ I am asking you to not hurt us.” To the friar’s amazement the wolf lowered his head and walked submissively toward Francis. When he got to Francis, the wolf lay down at his feet.
Francis and the wolf sat down beside one another. Francis explained to the wolf that his hunting routine was hurting a lot of the townspeople. He told him that the animals he was killing belonged to someone who needed those animals in order to make a living. Francis respectfully asked the wolf to stop. The animal showed Francis that he understood by moving his body back and forth, wagging his tail like a dog, and offering his paw as a sign of understanding and agreement.
Francis asked the wolf to come to the town and meet the people so that they would no longer be afraid. The wolf agreed. When they got to the town, the townspeople greeted Francis and the wolf. They learned that the wolf had been killing their livestock for one simple reason. He was hungry. So they promised the wolf that they would feed him and care for him, that he would have a safe place to live, food to eat and that he would live the rest of his life as a welcome part of their community.
Both the wolf and the townspeople lived together peacefully as they had agreed until the death of the wolf, which was deeply mourned by all.
Who was this wolf?
This wolf is a symbol…a metaphor for all who are in need. The wolf is of whom Jesus spoke in Matthew 25. As we do unto the wolf we have done unto Christ…as we do unto God’s creation, all of it…the earth, the air, the water, the animals, plants and other human beings…as we do unto creation…we do likewise unto the Creator.
This morning we take a day of worship to bless creation. We bless the animals and the harvest of our community garden. The harvest is blessed, as are all partnerships between. With the sun and rain God sends, we have tilled the soil, planted seeds and have harvested the garden, dedicating it to the work of those in our community who feed the hungry, house the homeless, visit the lonely.
Likewise, we bless the animals, our pets, and our friends who have given so much joy to us. By this blessing we bestow nothing on these animals that God has not already bestowed. By this blessing we affirm our belief that they, like each of us, have a soul, a purpose and a life as important to God as any of our own.
We bless the animals gathered here today as a symbol of blessing all of God’s creation and re-committing ourselves to the covenant made with God that we humans will act responsibly as the stewards of the animals, the earth, the air and the water.

Saturday, September 22, 2012

Is winning all that matters?

The NFL goal posts are 18 feet 6 inches wide. What if, in the fourth quarter, a team winning by two points could change that as their opponent prepared to kick a last second field goal? Suddenly the width diminished to, let’s say, 9 feet, three inches. Vince Lombardi famously said winning is all that matters but even football couldn’t survive those sorts of unfair rule changes. Neither can democracy.

What will democracy look like for our grandchildren? Will it be a vibrant political system honed by an honest debate over ideas, leading to the selection of decent, honest people to represent us? Unfortunately, that is less likely as some decide winning is all that matters. 

The Wyoming Secretary of State’s office reports that of 15 open state senate seats, the Democratic Party is contesting only three. The Democrats fielded just 22 candidates for 60 open house seats. It’s now official. Wyoming is less competitive at the ballot box than Cuba.

We all get it. The role of a political party is to elect their candidates. Still it is out-of-bounds to fundamentally alter the political system and the rules to favor one party over the other. It’s a game that both parties play to some measure depending on who has the votes. But the tactics threaten to end democracy as we know it.

The first casualty was the fairness doctrine. Old enough to remember when radio and TV stations were required to give equal time to both sides of political issues?  Fairness is no longer an issue, not even a goal. The media found right wing entertainment sells far more than thoughtful dialogue. FOX News was spawned. Search the radio dial in Cheyenne. You can’t hear much other than right-wing propaganda.

Wyoming institutionalized one-party rule with sub-districting, exchanging a system that required legislators to represent everyone in their county to single-member districts. It was nonsense to think someone in south Cheyenne couldn’t represent people in east Cheyenne. Today, few even know which district they live in or can name their legislator. But, soon the GOP may have 100% of the legislative seats. The places where that happens don’t call themselves democracies.

Nationally the attack on democracy is equally ominous. In Pennsylvania, the legislature passed a so-called Voter ID law, the purpose of which the GOP floor leader admitted, “is gonna allow Governor Romney to win the state of Pennsylvania.” In Ohio Republicans control county elections by virtue of a law allowing the Secretary of State to break ties among equally divided election boards. The GOP Secretary of State’s vote assures GOP counties remain open longer. Counties traditionally voting Democratic must close early. And Florida…well we all know what happens there.

The Supreme Court opened the floodgates for special interest and corporate dollars, transforming elections into a cynical form of auctioneering. The U.S. has a voting age population of 210 million. Fewer than 50 of them contributed 57% of the $230 million raised by super PACs.

Money floods the campaigns of those who need little. According to, Wyoming Senator John Barrasso, with token opposition, received more than 6.5 million dollars since 2007. Does a guy who wins with 75% of the vote need that kind of money? Campaign contributions used to be about the candidate’s needs. Today it’s about the needs of the contributors.

Disenfranchisement of average voters seems to be the ultimate goal. Curious isn’t it, how all of this coincides with the decline of the middle class. We might ask more about the connection. The disparity in political contributions certainly reflects the economic differences between the 1% and the 99%.
With fewer people competing for local office, a political system flooded with special interest dollars, and voting laws closing the doors to regular voters, we’ll no longer have a democracy. Among those trying to game the system, the real battle will eventually come down to whether democracy is replaced with an oligarchy or a theocracy. Then we’ll see whether winning is all that matters.

Saturday, September 15, 2012

Medicaid Expansion will save (not cost) Wyoming tens-of-millions

A recent headline told readers, “Optional Medicaid expansion could cost the state $58.5M.” Governor Mead ignored significant conclusions of the report telling a reporter he is “concerned about the costs for the non-optional expansion of Medicaid programs that are mandated in the health-care law.”

The governor’s claim that the fiscal impact of insuring approximately 30,000 Wyoming citizens under the option to expand Medicaid would cost the state millions was not supported by the report. If you read the entire Wyoming Department of Health document, which you can read at, you’ll find the program will save Wyoming taxpayers hundreds of millions of dollars.  

The study estimates a projected cost range of $53 million to $311 million over six years, 2014-2020. (Page 21) Unfortunately for the naysayers, the report didn’t stop there. The headline should have read “Obamacare Will Save Wyoming Millions Through Medicaid Expansion.”

Those facts are substantiated on page 18 of the report where savings are curiously not used to calculate the cost reflected in the governor’s comments. There the report says, “We expect some of the newly eligible members who will enroll in Wyoming Medicaid starting in 2014 will be people who would have otherwise been eligible for other state-funded programs. This would result in reduced enrollment and costs for those programs, offsetting some of the cost of Medicaid expansion to the state.”

“Offsetting some of the costs” is their way of saying that if the Governor implements Medicaid expansion, there will be huge savings, as much as 700 million dollars over the six-year period. The potential savings far exceed any new costs because programs previously created to provide health care to the uninsured will become largely unnecessary and most of those costs recouped.

The report identified the following programs among those that could be drastically reduced or eliminated if Medicaid is expanded. The numbers in parentheses are the two-year budget reductions that would result: Prescription Drug Assistance Program (4 million dollars), some costly care at the Wyoming State Hospital (76 Million), Children’s Health Insurance Program (11 Million), mental health and substance abuse treatment (114 million), and other Health Department programs “some of which would likely see a reduction in covered population with the expansion of Wyoming Medicaid. These include (dollar amounts are budgeted general fund appropriations for 2013-14) Public Health Nursing ($12 million), Immunization Program ($9 million), Maternal and Family Health ($4), and Oral Health Programs ($1 million).” An additional 9 million dollars savings would result each biennium from costs currently incurred for uncompensated medical care provided the uninsured. (Report pages 18-20)
Note the additional costs on which the governor focused are incurred over a six-year period, amounting to a little less than 20 million dollars per biennium. Compare that to the costs savings of nearly 240 million per biennium realized when the legislature ends state funding for healthcare costs that will then be paid by Medicaid.
The report contains an important disclaimer that should be noted by the media, the governor, the legislature and the public. “From a state budgetary perspective, the cost estimates for Medicaid expansion…should be read in light of the possible cost offsets from these other programs discussed in the previous section.” (Report page 27)

The “cost offsets” can be called “possible” only if you assume the legislature will fund unnecessary programs. They won’t. In addition to the actual savings, thousands of low income working families would then have health insurance. They would receive preventive care, earlier diagnosis of serious disease and enjoy healthier lives while the state builds a more effective health infrastructure with the new dollars.

Taking the opportunity to insure the uninsured is the right moral choice. Now the governor knows it is also the right fiscal choice. Perhaps making the right choice will have to await the outcome of the November election. After that the nation can put the partisanship generated by Obamacare behind us and get on with the real and important work of providing health care.

Friday, September 14, 2012


In my column/blog last Saturday, published in the Wyoming Tribune-Eagle (WTE) under the title “Mead tows the party line even in the absence of facts,” I had a couple of my facts wrong. Those misstatements do not change my conclusion that the Governor joined GOP presidential candidate Mitt Romney in making an erroneous argument that the Obama administration has waived the work requirement for welfare recipients.  They need, nonetheless, to be corrected.

The column reported that on July 12, 2012, the governor sent a letter to the president at the request of the Romney campaign asking that the “authority to waive the work requirements for TANF” be reconsidered. The Department of Health and Human Services memo to which the Governor was responding is dated July 12, 2012. The letter was actually sent to HHS Secretary of the Kathleen Sebelius, a cabinet member of the Obama administration, on August 15, 2012. Otherwise the statement is accurate.

Second the column said “On August 24, (Governor Mead) held a press conference and once again repeated the falsehood.” The governor did not hold a press conference on that date to repeat the claim. On August 24th, much of the media and press, including the WTE ran an Associated Press story covering the letter Mr. Mead sent to Secretary Sebelius nine days earlier and after it had been posted on the Romney for President website. Because of that I mistakenly believed the governor’s comments had been made that same day.

Finally, there was a typo in the column. The published version said the Wyoming Department of Family Services “sent a memo from the administration on this very issue.” The sentence should have read, “DFS received a memo from the administration on this very issue.”

I regret these errors and am happy to correct them but stand by the premise of the blog/column. Governor Mead was recruited by the Romney campaign to write a letter supporting a claim that has been disproven. Mead did so while at least one Republican governor refused. 

I am still awaiting Governor Mead’s correction of his misstatement.

The revised version of the column has been posted below and it can be read at: