"Facts are stubborn things"

John Adams, America’s second president, figured facts are highly overrated in political debates. “Facts are stubborn things,” Adams said, “and whatever may be our wishes, our inclinations, or the dictates of our passions, they cannot alter the state of the facts and evidence.”

Contributing to the unhappy political environment of our times is not so much the vehemence of opinions as our inability to agree on the facts. Opinions should be fact-based. There was a time when facts were intransigent. Facts were unyielding to political passion, and as Adams and, “stubborn.” Not so now. Today facts yield to opinions. That which passes for fact is simply opinion repeated long and loudly enough to take on the countenance of fact.

That’s why Tom Forslund’s recent speech to the Wyoming Association of Churches was so refreshing. Forslund is the Director of the Wyoming Department of Health. His agency administers the Medicaid program in Wyoming, a program at the center of the great political debate over Obamacare, a political minefield during these days of partisan haggling.

With his intellect and the help of excellent staff work, Forslund mastered the facts. He explains Medicaid with a clear voice unaffected by the passions being generated elsewhere. Tom gives his audience facts upon which to base opinion.

The WDH head explained to the audience of faith-community leaders that Medicaid is a federal healthcare program enacted in 1965 to provide health insurance coverage for low-come individuals. Simply being low income doesn’t make one eligible. Applicants must fall into one of these categories; children, family care adults, pregnant women, aged, blind, or disabled.

Sixty-five percent of those enrolled in Medicaid are children. The national average is 49%. Child Medicaid clients are not nearly so expensive as nursing home recipients. Among people in Wyoming nursing homes, 64.4% are paid by Medicaid. Most are formerly middle class people who exhausted all their financial resources paying healthcare costs rendering them eligible for Medicaid.  There are 2400 disabled persons receiving Medicaid benefits with an annual average of $65,869.

The goal of the Patient Protection and Affordable Care Act (Obamacare), Forslund explained, is to expand healthcare coverage through four major strategies. Individuals are required to purchase insurance. Certain employers are required to provide insurance for full-time employees. Health Benefit Exchanges are created to provide a marketplace designed to enhance competition.

Finally, Congress sought to expand Medicaid to previously ineligible low-income people. That is the debate currently raging in Wyoming.

Forslund described the 83,000 uninsured living in Wyoming; 41% work full-time, 41% work part-time, 18% do not work, 36% are between ages of 19-34, 30% live below 138% of federal poverty level, i.e. $32,499 for a family of four

Forslund documented that the uninsured are in worse health than the privately insured. Uninsured adults are twice as likely to report being in fair or poor health as those with private insurance, a third of uninsured nonelderly adults have a chronic health condition, reduced access to health care, fewer diagnostic and therapeutic services, less preventive care, and a higher mortality rate compared to those with private insurance.

One-quarter of uninsured adults say they didn’t fill a prescription in the past year because they couldn’t afford it. In 2010, 27% of uninsured adults used all or most of their savings paying medical bills as compared to 7% of those with insurance.

That’s the context in which Medicaid Expansion is being debated in Wyoming. Without expansion Wyoming will unnecessarily spend $79.4 million in state taxpayer funds over the next seven years paying for mandatory expansion costs.

On the other hand, expansion saves Wyoming $47.4 million while providing health care coverage to an additional 17,600 people with a 4% administrative cost.  And the federal government covers 100% of costs for the first 3 years, gradually reduced to 90% over four years. Forslund acknowledged the federal government has never failed to pay its share of Medicaid.

Those are the “stubborn” facts and whatever our wishes or politics, they cannot alter the state of the facts.