Saturday, May 7, 2016

Medicaid expansion, tobacco, and seatbelts

It is possible to significantly reduce state budgets without slashing programs for the poor and elderly. What if the legislature crafted an effective public health policy? Avoidable health problems are costly. Good public policy reduces the impacts on lives and budgets.

The costs of preventable health problems trickle down. Health insurance premiums rise. Taxpayers pay for those who choose not to buy insurance or have incomes so low they cannot afford coverage.

The legislature’s piecemeal approach to health policy is not based on data and science but a senseless brand of libertarianism and partisan politics permitting people to endanger themselves, their children, and others.

The Wyoming Department of Health employs the best and brightest minds working on health issues. They study data and know the science. Within their area of expertise each could inform legislators on healthcare solutions.

These experts are rarely asked. Legislators without expertise in health matters draft bills and debate them, playing fast and loose with the facts. Most lawmakers are less interested in accurate data and science than in playing politics with the lives of their constituents.

The Labor, Health and Social Services Committee is again “studying” healthcare. Rep. Elaine Harvey, Committee co-chair, said the study wouldn’t include expanding Medicaid to cover 20,000 uninsured Wyoming people.

I repeat. Most legislators are less interested in accurate data and science than in playing politics with the lives of their constituents. If they were interested in real solutions, they’d address the uninsured, seatbelt laws and tobacco use.

Making sure people have health insurance is the cornerstone to health planning. The Institute of Medicine says, “Evidence from the scientific literature overwhelmingly shows that those without health insurance, children as well as adults, suffer worse health and die sooner than those who have coverage.” Uninsured adults suffer a 25% higher mortality rate than the insured. The misery falls on the sick but those costs fall on the taxpayers.

Certain diseases compound the risk. Uninsured cancer patients die within five years twice as often as the insured, much of which is tobacco-related. Despite consistent science showing the enormous amount of suffering and costs attributed to tobacco use, legislators appear more obligated to tobacco growers than to their constituents.

Tobacco is a high-cost killer.  The American Cancer Society says a quarter of a billion Wyoming taxpayer dollars are spent annually on tobacco-caused illnesses. Legislators claiming concern about Medicaid costs ignore tobacco costs Wyoming’s Medicaid budget $45 million a year.
Can legislators do something to reduce tobacco-related costs? Yes, if they heed science rather than tobacco lobbyists and increase the legal age to buy cigarettes, ban smoking in public facilities, and raise tobacco taxes.

Wyoming taxes tobacco at a lower rate than all but 10 other states. If we doubled the 60-cent tax we’d get into the middle of the pack. ACS projects a $1.25 per pack tax generates 23.26 million in annual revenues.

More important is the impact on smokers. Forty-five hundred adults would quit, priced out of smoking. Approximately forty-seven hundred kids wouldn’t start smoking if cigarettes cost more.

Choices? Science or lobbyists? Life or death?

Serious efforts to lower healthcare costs demand an effective seatbelt law. Wyoming has a limp secondary law. You can’t be cited for failure to buckle-up unless stopped for another offense. As a result, Wyoming has one of the highest traffic fatality rates in the U.S. In 2012, more than half of those killed on state highways weren’t buckled up.

A 2014 Transportation Research Institute study found fatalities rise radically when states choose secondary seatbelt enforcement. That’s the science. But legislators listen most to the foolish suggestion that requiring seatbelts is government interference with freedom, however much their lives or the lives of their children may be shortened as a result.

When legislators feign concern about high costs of healthcare, ask what they’re doing to lower costs. Are they making certain people are insured, reducing use of tobacco, and buckling up?

We reap what we sow. Improving people’s health reaps a huge harvest.

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