The Conversion of the Apostle Mead

After four years as governor, he had a vision. Matt Mead saw that, unlike him, not everyone was born with a silver spur in his or her mouth. Mead’s conversion occurred almost without notice. Quietly the governor became a supporter of Medicaid expansion. Suddenly he was concerned about the thousands of Wyomingites who lack healthcare.

Having been against Medicaid expansion before he was for it, Mead never explained

his conversion. But, this sort of conversion is without meaning unless those who

followed him when he was leading them in the wrong direction are also converted.

One of the all-time great conversion stories is found in the 9^th chapter of “The Book of the Acts of the Politicians” of the Sagebrush Gospel. It’s the story of the conversion of Saul a/k/a Matthew Mead. It goes like this.

While still breathing specious arguments against Medicaid expansion, Matthew came unto the legislature, saying the Empire couldn’t be trusted to pay its share, that Medicaid expansion was sinful. As he was going along and approaching the 2015 legislature, suddenly a light flashed around him. He fell to the ground and heard a voice saying to him, “Matthew, Matthew, why don’t you care for Wyoming’s working families who have no health insurance?”

Now there was a disciple in Cheyenne called Sancus, named after the Greek god of honesty. The disciple took Matthew aside. Sancus explained the state of Wyoming was losing tens-of-millions of dollars, leaving thousands of people without health care, and that many of the state’s hospitals were in danger of closing their doors. They cared for the poor despite the financial losses they incurred.  The disciple explaineth that expansion of Medicaid would solve many of the state’s health-related problems while saving the taxpayers millions and building the state’s medical infrastructure, adding millions of dollars to the economy of local communities.

Sancus proclaimed, “Let those with ears hear!”

Matthew had heard all these things before, but in the glaring light the words suddenly made sense. He saw a vision. He became aware he was elected governor of all the people, not just some.

For days he was with the disciples in Cheyenne and began to proclaim the truth in the halls of the legislature. “Verily I say unto you, I know I have persecuted those who believe in Medicaid expansion. But now I say unto you I share their concern about taxpayers sending money to the Empire that goes to other states for healthcare. Render unto Wyoming people that which belongs to Wyoming people!”

All who heard him were amazed and said, “Is not this the Governor who made havoc among those who could not afford healthcare? Has he not gone to the courts and the legislature to make certain these folks never receive care?”

Mead confounded legislators. They had campaigned for seats in the Temple (which Jesus called a “den of robbers”) by repeating Mead’s very words promising constituents never to expand Medicaid. Then the Apostle Matthew sayeth, “We are now in this place with roughly 17,600 people falling in the (Medicaid) gap. Most are working but still can’t afford insurance. As of now, 4.5 million denarii ($90 million US dollars) that would have come to Wyoming have gone to other states.”

All who heard him marveled and said, “Duh!” And the multitudes said, “Matthew, if you really believe, go forth and leadeth.”

Governor Mead deserves thanks for joining those who understand the importance of expanding Medicaid. If the legislature is going to have the same conversion experience, he will need to explain why he was wrong before. Not a single fact has changed. Only Matt Mead’s views have changed. Why?

When the Apostle Paul saw the light, he wasn’t quiet about converting. He persuaded others to convert by explaining how he’d been wrong before. Neither should the Governor be quiet.

Memo to Governor Mead: “You led them in the wrong direction for three years. How do you plan to get them to turn around and follow you now?

Charlie's hoping to go 0 for 5

How many times does a legislator have to be wrong for his colleagues to look for someone else to follow?

The answer can be found in the Sagebrush Gospel of Matthew. “Because so many could not pay their medical bills, the state of Wyoming had been robbing Peter to pay Paul. Peter and Paul came to him and said, “Lord, if another member of the legislature misleads us, how often should we continue to follow his advice? As many as seven times?” Charlie Scott said to them, “Not seven times, but, I tell you, seventy-seven times.”

A hard count discloses Senator Scott used up his quota. Call the “Guinness Book of World Records” folks. Is it possible that one member of a legislative body could be wrong so many times on a single issue and still have a following?

It started in what seems a "long time ago in a galaxy far, far away." Initially Scott predicted Congress wouldn’t even pass the Affordable Care Act. They did. Then his defective crystal ball told him the 2010 elections would result in Republican majorities in both houses of Congress and they would repeal the law. That didn’t happen. Next he put all his eggs in another basket. Charlie foretold the Supreme Court would find the law unconstitutional. Nope. He then prophesied that Mitt Romney would become president and repeal the act. That didn’t work out so well either.

For three years, most Wyoming legislators have allowed Charlie Scott to lead the debate over Medicaid expansion. He was batting 0 for 4 before this debate began and hasn’t gotten a hit yet. Even the Colorado Rockies would have cut him by now. But then baseball is a team game. Legislators, on the other hand, choose whether to pull their own weight. Too many are willing to allow someone else to do the heavy lifting.

On this issue, they’ve acceded to Scott despite his consistently wrong calls.

This year is different. Governor Mead has finally decided to lead on Medicaid expansion. Republicans now must choose between the recommendations of their Governor and those of their erstwhile, consistently wrong senate colleague.

The choice should be easy. After all, a majority voted just last year to ask the Wyoming Department of Health experts to study the question and report their recommendation. That was an important step. You see, Medicaid is an enormously complex, often not completely mapped jungle of federal statutes, rules, and decision makers. Getting it right requires the skills of someone who is consistently correct.

WDH did what the legislature asked. They negotiated with the federal government and developed a recommendation. It’s a recommendation that meets the criteria established by the legislature last year, conforms to federal law, and will finally resolve this critical debate.

But, it isn’t good enough for Charlie Scott. He wants another “at-bat,” hoping to go 0 for 5.

In truth, Scott doesn’t want to expand Medicaid. He believes it is socialism. He is hell-bent on making a political statement out of the lives of those who do not have adequate healthcare because they have no health insurance.

His tactics have changed. Instead of fighting expansion head-on, Scott is asking his colleagues to ignore the Health Department experts and follow him once again. As the scripture says, “Not seven times, but, I tell you, seventy-seven times.”

What Charlie won’t tell the legislature is what the experts are saying. Charlie Scott’s “alternative-universe” bill will never be approved by the federal government. Charlie knows that. His scheme is to mislead his colleagues one more time and get them to pass his proposal. Then he can blame the feds when they determine it does not meet the requirements of federal law.

The 18,000 uninsured and the Wyoming hospitals that are losing tens-of-millions each year providing uncompensated care are hoping the legislators who represent them believe in what George W. Bush once said. “Fool me once, shame on - shame on you. Fool me - you can't get fooled again.”

Time to open presents

How exciting is this time of the year? Christmas is the season of gift giving. The time has come to gather round the proverbial Christmas tree and hand out the gifts. This year’s tree is a beautiful blue spruce. Oops, maybe not. I see now it’s a beetle kill tree from the Medicine Bow National Forest painted over. How nice of someone to keep us from thinking about that nasty climate change at this festive time of the year.

Well let’s get right to the presents. 

Ah look. The first one is for the Wyoming legislature. They say good things come in small packages. It’s a small bit of compassion. How wonderful. Legislators can certainly use it.

There are approximately 18,000 low-income people in this state who have been denied health insurance and access to healthcare only because they found themselves collateral damage in a partisan contest between Republicans and President Obama. With this little gift of compassion, perhaps enough legislators will be able to rise above all of that and actually take care of their constituents. I do hope the package is big enough.

Oh and here’s a gift for the taxpayers of Wyoming. It’s a gift from the Wyoming Department of Health. But the tag says, “Do not open until Medicaid is expanded.” If Medicaid is expanded, the taxpayers of Wyoming will receive a gift of ten-of-millions of dollars in health care, cost savings, and new jobs.

And who is this gift for? Oh, The Wyoming Liberty Group. It’s a beautiful new custom fly rod. Too bad most of them won’t be able to buy a resident fishing license for a while. But then with all that Texas money, they can afford the non-resident license. Good fishing. By the way, I hear some folks are actually taking your bait.

Did anybody get anything for WyWatch? These are the folks who use the Bible to foist their narrow religious views on everyone else. The problem is that their “views” come from a self-serving and erroneous reading of the Old Testament.

So this gift is perfect for my “Old-Testament-Christian” friends. It’s a Bible that includes the New Testament. That will certainly come in handy. I know they’re more comfortable using misinterpreted judgments of the Old Testament to lobby on behalf of inequality and discrimination. This gift will bring them out of their comfort zone.

Now that they have a Bible that includes the New Testament, they’ll be able to read the words of Jesus. “Love your neighbor as yourself,” for example.

Ah, here’s a package for State Senator Charlie Scott. It feels like a framed picture. Ah it is! Look. It is a photo of Charlie with his boyhood friend Methuselah. It says the photo was taken on Methuselah’s 969^th birthday, shortly before the Great Flood and a few weeks before Charlie was elected to his first term in the legislature. What a keepsake. The inscription reads, “Term limits are for sissies! Love, Methuselah.”

Here’s a package for CROW, the Conservative Republicans of Wyoming. Listen. Do you hear a ticking sound? Oh my. I see now. It’s not for CROW. It’s FROM CROW. Maybe we ought to have the bomb squad open this one.

Wait just a minute. Didn’t anyone get anything for the Governor? I thought about it but figured he’d already gotten his present on Election Day. Getting another four years to finally do something is gift enough. Wait there is one more present under the tree. It is for the Governor.

Shake it. Oh my. There are a couple of round things rolling around in the package. What could they be? Let’s read the note. Oh, it’s not what I thought. The note says, “For Governor Mead, two lumps of coal. You deserved a whole sack but EPA regulations allowed only for these two small chunks.”

I’d have bought a present for the voters of Wyoming but decided they have all they’re going to get and deserve whatever it is.

Merry Christmas everyone!

Serving vs. advocating for the uninsured

Brazilian Bishop Camara famously said, "When I give food to the poor, they call me a saint. When I ask why they are poor, I’m called a communist,” a colorful way of saying that while helping the poor earns praise, questioning the policies that keep them poor is not so welcomed.

Recently the trustees at Cheyenne Regional Medical Center voted 5-4 to require full co-payments from insured patients before receiving medical services. Uninsured patients are now required to pay a minimum of $180 when initially seen and $120 for follow-up visits.

After this column objected, CRMC responded with op-eds and letters-to-the-editor making good points about what the hospital is doing to help low-income and uninsured people obtain care. But, their PR machine should be used to persuade Governor Mead, not me. It’s Mead whose decision to forego Medicaid expansion makes the CRMC programs necessary even as his partisan decision forces CRMC to provide millions of dollars in uncompensated care.

CRMC invited me to learn more about their good works. I did and am impressed. I toured the hospital’s new Emergency Room and was assured no one would be turned away for inability to pay. If that happens to you, let me know.

I also spent time at the Cheyenne Health and Wellness Center, largely funded by CRMC, as is its pharmacy. Both are vital safety nets for low-income folks. This year the pharmacy will provide over 6.1 million dollars in prescription drugs to those who would not otherwise receive them. CRMC provides 80% of their operating costs.

The clinic will treat more than 6300 people this year, averaging $231 while an ER visit costs $754. It doesn’t take many ER diversions to save millions of your tax dollars. Equally impressive is the level of preventive care CHWC provides.

CRMC is to be commended for these programs and others, which are part of the maze of state and local programs, created to help the uninsured get care. However commendable those efforts, CRMC’s advocates miss the point. Tim Thorson, whose work with Circles demonstrates his concern for those in poverty, serves on the CRMC community benefits committee. His letter-to-the-editor argued it’s “a mistake to confuse the larger issues around Medicaid with what is a reasonable and necessary change in collecting payments at the hospital.”

Actually the two issues are inextricably intertwined. If the governor and the legislature expand Medicaid coverage, CRMC’s new collection policy wouldn’t be necessary. Those targeted by the policy would have insurance.

Consider the cost of not expanding Medicaid. Last year CRMC spent more than two million dollars funding healthcare programs for the uninsured. They wrote off $23 million in uncompensated care. Hospitals around Wyoming wrote off more than 200 million dollars. Yes, Medicaid is expensive but what we’re doing now isn’t free.

Without adequate insurance, low-income families are now required to bring large cash payments with them before they can walk through CRMC’s doors. Is that a problem? Four of the nine CRMC trustees thought so when they voted against the new policy. My column simply shared some the same concerns they voiced.

Trustee chairman Joe Evans voted “no” saying, "My concern is that we don't want people not to be seen because of the policy," Evans’ concern is valid. The bottom line is these fees will mean fewer people have access to care in Laramie County.  The Center for Advancing Health researchers found that one in five U.S. adults do not get needed medical care because they were worried about the cost or their health insurance would not pay for treatment.

CRMC is doing yeoman work meeting important community health needs. But where is their voice when the governor says he will not expand Medicaid? Where are the op-eds and letters-to-the-editor? CRMC’s PR apparatus would be more productive challenging Governor Mead’s partisan decision to deny Medicaid coverage to the uninsured rather than questioning efforts to challenge their payment policy.

Maybe they could invite the governor to witness the problems his choices have caused.