"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.

The contortions of Wyoming politics

Contortionists! That’s it. Think of Governor Mead and the legislature’s leadership as contortionists and you can fathom what they’re doing by denying the benefits of Obamacare to Wyoming’s citizens.

Contortionists are performers displaying dramatic ability to bend and flex. Contortionists are circus acts. Contortionists have extraordinary flexibility, putting themselves through intense and painful gyrations.

Thinking of the Governor and some legislators as “contortionists,” explains why some believe contortionists apply snake oil to their joints to achieve flexibility.

What else explains the bending and flexing these politicians are engaged in with their partisan response to Obamacare? First the Governor abdicated his responsibility to the legislature. When the Wyoming Department of Health (WDH) advised legislators that expanding Medicaid to the uninsured would save the state tens-of-millions of tax dollars, these otherwise self-appointed fiscal conservatives displayed dramatic flexibility, rejecting the opportunity to save those dollars in order to make an anti-Obama statement.

The circus act continues. The Labor, Health and Social Services Committee is poised to send the uninsured into the private insurance market for coverage. What could possibly go wrong?

Calling it a “free-market solution,” instead of the “predatory solution” it is, the committee co-chairs, Senator Charlie Scott and Rep. Elaine Harvey, are twisting themselves into unusual positions. Before WDH experts finished a study evaluating alternatives, Scott and Harvey had a bill drafted to send the uninsured to private insurance companies for health coverage.

Senator Scott earlier blocked creation of an insurance exchange which consumers in other states find helpful in weighing the market’s confusing options. Exchanges have also achieved lower rates through transparency. But Wyoming legislators find Obamacare so radioactive they refused to create a Wyoming-specific exchange.

The Wyoming Insurance Department then refused to regulate private insurance companies to assure compliance with the consumer protections of the ACA. In that non-regulatory environment some legislators are willing to send their constituents into the shark-infested private insurance market to fend for themselves.

I lobbied for insurance companies for twenty-two years. Having continually defended their practices against legislators who believed the state should regulate and control the companies, these politicians are showing a dramatic ability to bend and flex their traditional views of insurance companies in order to avoid the documented benefits of Obamacare.

Private insurance companies had to be coerced by the Affordable Care Act to reduce their administrative costs to 20% or give rebates to consumers. The private companies have always had notoriously high administrative costs attached to them, which was one cause of escalating premiums.  Companies have rebated millions to consumers when they couldn’t control the overhead.

Senator Scott abhors Medicaid. He calls it “too expensive.” Medicaid’s administrative costs are a meager 4%.

After the Scott-Harvey bill was drafted, WDH issued a report studying the “free market solution” and three other options. The negatives included added costs of start-up and loss of control over rates and benefits among others.

Read the entire report at www.health.wyo.gov/Media.aspx?mediaId=14365.

Political considerations likely sidelined Option Four, managing the expansion group as the existing Medicaid eligibility groups. This is the soundest of all options but was the one rejected during the last session despite taxpayer savings of at least 47 million dollars, the one WDH says will “increase the number of individuals covered by the Medicaid program, without increasing its state general fund contribution to the program” while reducing the costs of uncompensated care and improving Wyoming’s health infrastructure.

It’s also the option WDH determined “would mean reduced complexity of operations” simplifying or eliminating “any administrative processes needed to manage this new group.”

WDH found, “This option allows the State to provide the most generous benefits package at a relatively low cost to State General Funds due to the enhanced federal match rate.”

Legislators know, the governor knows expanding Medicaid through the ACA provides the best healthcare while saving the most money. How are we to understand the Governor and legislature rejecting this option? It’s neither their interest in social justice, nor fiscal responsibility. Contortionism is the only explanation, well, other than partisanship.