Indian voting-rights victory is a gift to future generations

By Gary Collins

Long ago I asked my late father, Floyd Collins, a Northern Arapaho tribal member, why his generation failed to challenge the discriminatory election system in Fremont County.

He could not answer me with words, but his eyes expressed regret.

Gary Collins

Years later, a small group of American Indians, including me, joined forces with the American Civil Liberties Union to challenge the county’s at-large voting system in court and won. The outcome of that lawsuit will allow thousands of disenfranchised Fremont County residents to cast a meaningful vote in the election for County Commission.

We take pride in our accomplishment, and feel satisfied knowing that the Indian people and the tribes will finally have a representative at the top tier of county government, while maintaining their own sovereign identities.

However, the work is not done; one important hurdle remains.

On July 27, U.S. District Court Judge Alan B. Johnson will hear arguments in federal court in Cheyenne on how best to redraw county voting districts to comply with the law. Unfortunately, the county has submitted plans that we find unacceptable.

In his decision last spring, Judge Johnson instructed the Commission to craft a districting plan that complies with the law and requires “the election of county commissioners in Fremont County by district rather than at-large.”

Instead, the county submitted plans that would retain at-large voting, violate Wyoming law and also appear to involve gerrymandering. As well, the plans could create problems for voters in the Lander and Riverton communities.

The county’s preferred plan calls for an American Indian-majority district and at-large voting in the rest of the county. An alternative plan calls for an American Indian-majority district and at-large voting elsewhere, with each at-large commissioner living in a separate district.

We believe that Judge Johnson was clear when he called for single-member voting districts, and the county’s hybrid at-large plans should be rejected.

We also believe the county’s districting plans fail to satisfy requirements that voting districts be “compact and contiguous.” Instead, the plan would cobble together far-flung sections of the county into districts that appear designed to help some current commissioners retain their positions.

We are also puzzled why the commissioners’ proposed districts unnecessarily split the vote in Lander and Riverton. Under the county’s alternative plan, Lander faces the possibility of no representation on the County Commission.

We also think the Commission should explain why it has not done more to inform the public about its districting proposals.

Given the heightened public interest in the voting issue, and the impact the new districts will have on county elections, we expected the commission to hold public forums or publish drawings of their plans in the local news media. It did neither.

Instead, some commissioners have been grousing publicly about possible election delays and the burden late elections could place on the strained county budget.

In fact, the Commission could have avoided special elections and additional costs by submitting satisfactory districting plans at the outset. To now give the impression that the plaintiffs are responsible for any cost or delay is unreasonable.

We genuinely hope that election delays are not necessary. If they are, we hope non-Indian voters will be patient. We also hope they will remember that American Indians in Fremont County have been waiting since 1924 – the year Indians became U.S. citizens — to cast meaningful votes in the county’s most important election.

No matter what happens, we feel great pride in our victory in the voting-rights case. We also feel gratitude in knowing that we can finally tell our children and grandchildren that we fought for and won their election rights.

Gary Collins is a geologist and an enrolled member of the Northern Arapaho Tribe.

Wyoming’s finances: Five points to improve stability

by Dan Neal, Equality State Policy Center executive director

Everyone knows that the mineral economy booms and busts. Because Wyoming’s state and local governments rely heavily on mineral extraction revenues, booms and busts in the mineral economy mean booms and busts in our government’s capacity to invest in the people and infrastructure of our state.

Good, you say. If I have less, then government should do with less too. But let’s hold that thought for a moment.

In Wyoming, the total number of jobs available is closely connected to state and local government activities (including school districts). Data collected by the Wyoming Department of Employment’s Labor Market Information program in the Third Quarter of 2009 (the latest available is here) show that state and local government jobs as a percent of total employment range from 8 percent in Teton County to 44 percent in Niobrara County. This is a slight decline from the First Quarter of 2009, when the range started at about 12 percent in Teton County and ran up to 50 percent in Niobrara.

For the Third Quarter of 2009, state- and local-government jobs accounted for 20-25 percent of the total jobs in 10 Wyoming counties, and for 30-36 percent in four more. State and local government jobs accounted for 15 percent or less of total employment in only four counties.

These percentages show the minimum impact of state- and local-government spending because they do not include private-sector jobs generated by public investment in infrastructure, such as jobs building schools and highways, or investment in people, such as home-health-service jobs generated by health programs.

It’s easy to see from these numbers that state- and local-government spending provides significant employment in Wyoming. Consequently, if cutbacks in government investments in infrastructure and people will result in public or private sector layoffs, the overall economic situation simply becomes worse.

The Equality State Policy Center believes Wyoming could achieve greater economic stability by taking the following actions:

1. Track the costs of tax exemptions and exclusions. Wyoming has a thorough process for appropriating state funds. Unfortunately, we have not followed the examples of many other states whose budgeting also involves tracking revenues lost due to tax exemptions and exclusions (exclusions are items or activities not taxed; for example, Wyoming does not impose a sales tax on services).

Very few of the tax exemptions currently in our laws require reporting of the money involved, and in the case of so-called tax “incentives,” there is no evaluation whatsoever of whether the promised economic activity occurred to offset the exemption. How can Wyoming policymakers and the public decide whether a particular exemption or exclusion is worth it if they don’t know the cost?

2. Increase severance taxes on coal, oil and gas. Although markets for Wyoming’s coal, oil and gas look strong far into the future, there will come a day when our state’s non-renewable mineral assets are depleted or no longer marketable.

A University of Wyoming study showed that modest increases in severance taxes could be enacted without a negative effect on production or jobs. Wyoming’s coal industry already has proven it can compete successfully under a higher severance tax – formerly 10.5 percent compared to 7 percent today.

3. Tax alternative energy sources such as wind and solar. Wyoming’s future as an energy-producing state seems assured, non-renewable or renewable. But as the latter begins replacing the former, our state will need to adjust its tax policies accordingly.

4. Save most of the money. Our state needs to invest in research to determine how much it needs to save to provide the infrastructure, programs and services Wyoming residents will need in the future. But we already know we haven’t saved enough: the $4 billion Permanent Wyoming Mineral Trust Fund seems large but represents only about half the state’s biennial budget. Sovereign-wealth funds built up through production of fossil fuels in Alaska and other countries hold much greater promise of ensuring that future residents benefit from the natural resources produced during our lifetimes.

5. Create a framework for planning into the future. While no one has a crystal ball, we need to invest more in research and analysis about future energy revenues. Currently, the Consensus Revenue Estimating Group projects state revenues twice a year, looking toward the next budget. But we need to be looking five, 10, 20 years down the road to make sure revenues will meet needs.

Wyoming’s financial footing is fundamentally sound. But with additional investment in reporting and planning, we can better ride out the booms and busts and help ensure economic stability and opportunity for decades to come.

Interior’s new rules are good for Wyoming

by Kim Floyd, executive director, Wyoming AFL-CIO

Those of us who live in Wyoming share a fierce love for our state – its rugged beauty, its open spaces, abundant wildlife and energy resources. Like most of you, I’ll fight to see it protected, and like many of you, I’m sometimes surprised when I hear something out of Washington, D.C. that supports the values I hold dear.

Kim Floyd

Wyoming’s economy, and our nation’s energy freedom, is dependent on oil-and-gas development. But did you know that our number two economic driver is hunting, fishing, angling, recreation and tourism?

Besides bringing a great deal of money into our state from non-residents, these world-class outdoor opportunities are central to why we live here.

This time of year, we all spend more time outside fishing, hiking and exploring the backcountry. Early hunting seasons are just around the corner and many of us are already out scouting for game.

There are precious few other places in the United States where people like you and me and the 18,000 members of the Wyoming AFL-CIO who I represent can enjoy the benefits of a good paying job while also spending weekends and vacations in some of the best hunting and fishing grounds in the world. We are lucky to live in this special place.

My members strongly support policies that strive for balance between energy development and conserving our land and wildlife resources. The AFL-CIO and our partners are actively working to help protect Wyoming’s special places like the Wyoming Range and Little Mountain in southwest Wyoming. We also recently joined the opposition to a proposed land swap in Natrona County that would have traded acreage outside Casper for 14,000 acres of prime elk and mule deer habitat on Muddy Mountain. Hundreds of hunters and anglers spoke out against this deal, we were happy to see the petition withdrawn.

Back in May, Interior Secretary Ken Salazar finalized reforms to the oil-and-gas policy on public lands designed to encourage the BLM to inspect parcels of land before leasing them, to lease in already-developed areas, and to allow for more public input. This clear-cut legislation will help minimize red tape and bureaucratic delays when industry and environmental groups clash over their agendas.

Most important to me and the membership of the Wyoming AFL-CIO, these reforms will protect our Wyoming way of life. I’m optimistic that they will help us achieve the balance that is so needed between energy development and conservation.

I hope you’ll join me in thanking Secretary Salazar for not forgetting his Western heritage and for implementing common-sense policy that is good for Wyoming and good for our nation.

Kim Floyd is executive director for the Wyoming AFL-CIO, the state federation of labor representing 55 unions throughout the state.

A matter of trust: state lands and sovereignty

by Benjamin Barr, Wyoming Liberty Group

Somewhere around the Fourth of July, Governor Freudenthal threatened to sell an attractive parcel of state land located in the confines of Grand Teton National Park.

For more than a decade, Wyoming has worked to strike a deal with the federal government to exchange other parcels of federal land for this piece of trapped property.

Try as it may, no deal has been struck, leading the governor to openly suggest selling the land with a price tag hovering around $125 million.  No takers have yet been announced.

Governor Freudenthal’s statement sparked some fears over environmental spoilage if the property in question were to be sold to private interests.  But much of the outrage over this controversy misses key points.

When territorial Wyoming agreed to become a state, it entered into an agreement with the federal government to take certain lands in trust for the benefit of state schools.  Today, the state owns close to 4 million acres dedicated as school trust lands.  They are used in many ways – agriculture and natural resource development are prime examples.  Having taken these lands in trust imposes certain legal obligations on the state.  As trustee, Wyoming is legally required to put them to their highest and most beneficial use.

Like any other trust arrangement, trustees cannot waste the resources of the body of the trust or act in a manner contrary to the interests of the beneficiaries.  Here, that means producing the most productive returns for the children of Wyoming.  In the Grand Teton National Park example, the land island is just such a trust parcel and Wyoming – to be true to its fiduciary duties – must act swiftly to ensure a healthy return on the land.  To do otherwise would be to fundamentally neglect the responsibility it holds in managing such property.  But there’s more to the legal story.

Wyoming would do well to think of the Grand Teton National Park issue beyond the limited context of the school trust doctrine.  If the state is to take sovereignty seriously, and we hope someday it will, Wyoming must be creative in the use of accompanying legal doctrines to end federal imperialism.  The state land trust doctrine presents just such an opportunity.  Lands held in trust by the state as part of federal land grants receive heightened protection by federal courts when state uses collide with overreaching federal policies.  This is not mere speculation – states have reached serious victories on this front.

What the state land trust doctrine means for Wyoming’s someday-battle for sovereignty is that it offers a proven lever of power against federal meddling.  That is, when federal policy prohibits Wyoming from using its state trust lands in a productive way, state sovereignty can win out.  Should Wyoming need to link its islands of state trust lands together to produce more profitable results, intervening federal public lands and obnoxious policies might just go by the judicial wayside.  To be more vivid, imagine the day when sensible use of state trust lands beats intervening federal policies.  That day can be reached.

These approaches can only happen if the state takes its trust obligations seriously and its sovereignty concerns even more so.  Mere saber rattling about the Tenth Amendment and endless streams of resolutions to Congress won’t get the job done.  Returning to first principles, embracing unique protections found in Wyoming’s legal landscape, and being aggressive in court can make headway here.  Doing so would reclaim a fundamental trust – between the true sovereigns and state government.

Benjamin Barr is an attorney specializing in constitutional law with the Wyoming Liberty Group, 501(c)(3) nonprofit think tank and policy center based in Cheyenne.

Guest opinion: Restraining order a dangerous move for all of us

By Jim Angell, executive director, Wyoming Press Association

A state district judge made history of sorts the other day – but not in the way you’d really like to see.

Judge Peter Arnold on Friday became the first Wyoming judge in recent memory to issue a restraining order blocking the publication of a story in a newspaper.

In issuing a type of order generally reserved to prevent the release of national secrets, Judge Arnold told the Wyoming Tribune-Eagle it could not publish a story raising questions about the performance of a community college president during a student trip to Costa Rica.

I’ve been involved in the news industry in this state for more than 25 years – and neither I nor any of my colleagues can remember a judge taking such an extreme step to block the release of information compiled by a public body. And there’s good reason for that.

When the founders created the First Amendment, they knew exactly what they were doing – they were removing from all governmental entities the ability to control the media except through extraordinarily strong tactics such as the restraining order. They knew that putting the government in a supervisory position over the press would have disastrous consequences.

As a result, the granting of a restraining order sought by a government entity to stop the release of information is something that is rarely seen. To have a judge approve such a request is rarer still. Not even in the case of the “Pentagon Papers” did judges block the publication of information.

If allowed to stand, this ruling should be of concern to every resident of the state of Wyoming. Because it clears the way for a government agency, citing privacy concerns, to control the information that a private entity can share with its customers. Right or left, Democrat or Republican, Teton or Niobrara, this ruling should be troubling to everyone in the state.

Let the Spigots of Free Speech Flow

By Benjamin Barr

On Thursday, the U.S. Supreme Court rendered justice to the American people by freeing them of many government chokeholds on free speech.  Citizens United v. FEC concerned a basic question with deep consequences for us all:  Does government posses the authority to ban movies critical of candidates for public office?  For many individuals with even a basic understanding of the Constitution, the answer is easy – the First Amendment protects a full range of speech, even if it is critical, distasteful, or crude.  Unhindered by the chains of the First Amendment, the Federal Election Commission has been busy banning movies, commentaries, and advertisements critical of candidates since the inception of the now-infamous McCain-Feingold legislation in 2001.

Citizens United is non-profit corporation that decided to produce a documentary about Hillary Clinton in 2007.  In January 2008, Citizens United was ready to distribute the documentary but feared its speech might be illegal under federal election law.  There was truth in that fear:  Citizens United was banned from distributing the movie and accompanying advertisements under an “electioneering communications” ban in the Bipartisan Campaign Reform Act.

Many in the self-titled reform community have decried the Citizens United opinion as an assault on American democracy.  Indeed, Senator Feingold penned an opinion piece critical of the Court’s ruling, worried that elections will soon go the way of NASCAR races. But what is missed in the ballyhoo is that most corporations are small businesses, often single-person entities, not multinational conglomerates.  Some are non-profits wanting to share their perspective on issues and candidates.   Are we really worried about the neighborhood barber or Boys and Girls Club running advertisements endorsing a local candidate?  Beyond this, 26 states already permit corporations to speak freely in state elections and there has been no evidence that these states suddenly became beholden to corporate interests as a result.  All we see is more speech, which we ordinarily welcome in a free society.

It is quite remarkable for a federal government of limited powers to claim the power to ban speech in the first place.  But it proves even more horrific to learn that the same government would never really define what speech was being banned – leaving those determinations instead to the friendly speech bureaucrats at the Federal Election Commission.

Prior to the Citizens United challenge, the Federal Election Commission was no stranger to continued losses in the federal courts because it regularly ignored the basic civil liberties of our people. From Davis v. FEC to FEC v. Wisconsin Right to Life, Inc., and countless lower court losses in-between, the FEC has run roughshod over the First Amendment.  After having lost in Wisconsin Right to Life and being instructed by the Supreme Court to structure its regulations in a way favoring speech and making it simple for citizens to understand, the Commission created a two-prong, eleven factor test to decide whether speech would be banned.  The result was a coronation of the Commission as Speech Czar while inhibiting free debate.

Oddly enough, the very Commission entrusted with enforcing this nationwide political purity code could not even understand it.  In the midst of the 2008 election season, the National Right to Life Committee asked for an advisory opinion about whether its planned advertisements concerning Barack Obama would be banned.  After a month in careful consideration, the Commission could not decide whether the speech was banned, regulated, or simply free.  When the Commission could finally render an opinion on the question, still another month later, it came far too late.

The result of trusting our free speech rights to unelected bureaucrats in Washington, DC, instead of jealously guarding them ourselves, has resulted in a constitutional boondoggle of the most shameful variety.  Faced with navigating two-prong, eleven factor speech codes, thousands of pages of FEC interpretations, and criminal sanctions, most citizens have remained home, silenced.  But ignorance of fundamental liberties by the government can last only so long.  In a Republic premised on the idea that the robust exchange of ideas about our public servants is a cherished and welcome event, the Court reached the correct decision in re-opening the floodgates of speech.

Benjamin Barr is an attorney specializing in constitutional law with the Wyoming Liberty Group.  Barr drafted a brief on behalf of the Wyoming Liberty Group and was cited by the Supreme Court in Citizens United in support of its decision to strike down unconstitutional federal election laws.

Elk Jerky a Small Token for Wyoming’s Military

by Governor Dave Freudenthal

In November, I visited a fine group of Wyoming service men and women in Kuwait, Iraq and Afghanistan. Their sacrifice, and that of their families, is often on my mind, along with all of our other military in harm’s way.

Their pride in their mission, serving Wyoming and the nation, was evident. Understandably, many of them expressed how much they are looking forward to returning to their families and communities. Given the time of year I visited, more than a few mentioned that they were missing hunting season.

Back home in Wyoming, some folks wanted to do something special to remind them of the deep sense of gratitude we feel for our military. We wanted to send them a piece of elk season.

Fortunately, there were plenty of folks in Wyoming ready to lead the effort.

We are now shipping 185 pounds of elk jerky to Kuwait, thanks to Brian McCarthy’s NX Bar Ranch in Sheridan, where volunteers harvested two cow elk. (Of course, I can’t imagine too many folks not jumping at the chance to go hunting.) After the NX Bar prepared the elk, Willard Pearce of Pearce Processing in Casper volunteered to process the elk and prep it for shipping. He even threw in 45 pounds of pepper sticks.

Thank, too, to the Wyoming Game and Fish Department, specifically Scott Edberg, Tim Thomas, Matt Withroder and Jay Lawson, who coordinated the effort. Thanks to the Wyoming Game Wardens Association and the Wyoming Biologists Association for helping with shipping.

I hope you will keep the military in your thoughts and prayers. I hope you can help too, whether your contribution is large or small. My sincere thanks go out to those who helped with this late-season care package. I hope it serves as an inspiration to you and a comfort to them.

Godspeed for their safe return.

From Two Wyoming Think Tanks

Link here to responses from the Wyoming Liberty Group, and from the Equality State Policy Center

LIBERTY GROUP RESPONSE TO DR. SHERARD

We agree that access to medical care is a goal that all should embrace.
Between the years of 1998 and 2008, Federal contributions to our
program increased 100%, while state contributions increased 242%. As
Wyoming continues down the federal funds rabbit hole, our share of the
tab, and their share of the demands, will only increase. We will
forever be fixing and fixating on a broken model, and never get around
to addressing the real medical needs of real people. As an example, I
point to Wyoming’s work on the SCHIP front. We have greatly increased
enrollment but done nothing to the number of uninsured children.
Meanwhile, the price of private insurance continues to increase
because children are siphoned out of private pools, further
exacerbating the affordability problem.

What is more, Wyoming residents have unique needs and a
one-size-fits-all approach clearly does not fit Wyoming. Wyoming has
been able to bear federal impositions due to ever increasing revenues,
year over year, going back to 2001. Obviously the boom times that have
made federal impositions bearable cannot continue in perpetuity. We
now face uncertain state revenue forecasts and it is simply
irresponsible to allow state spending patterns to be decided in
Washington DC.

Dr. Sherard makes the point that 42% of Wyoming births are paid for by
Medicaid, as well as 42% of nursing home services. His point seems to
be implying that these people would have been left out in the cold if
not for Medicaid payments. More importantly, what kind of financial
incentives does this create for doctors and nursing homes? What have
government funds done to the price structure of these services?

Dr. Sherard also points out that 8.8% of physician reimbursement is
from Medicaid. One question to ask is; “why are so many doctors taking
care of so many people (42% of births and nursing home patients), and
having to make 91% of their income from other sources?” In reality,
100% of physician reimbursement comes from the 58% who pay out of
pocket or have private insurance since they are also the ones who pay
the taxes Medicaid uses to pay the 8.8%.

Dr. Sherard does hit the nail on the head in blaming cost increases.
Thus is the nature of government programs. Subsidies increase costs.
By destroying the price mechanism, and distorting competition,
government programs like Medicaid have guaranteed that it is not only
the poor who cannot afford healthcare, but many of the rest of us.

We agree that Wyoming’s EqualityCare program is one of the most
conservative in the nation. To the extent that we have kept it this
way, we have avoided many of the fiscal and logistical nightmares that
other states face.  We also agree that sitting back and waiting on
revenues to recover is an unacceptable approach.

A first step in this would be to repeal current laws that make it
illegal to buy insurance issued in another state. There is no
legitimate basis for these laws and their only purpose is to protect
industry leaders from competition. This would save the average Wyoming
family up to $1400 and cost the state nothing.  A second step would be
to abolish insurance mandates. Serious attention should be paid to
licensure in Wyoming. Of course, tort reform is also a good idea.
At the end of the day, I agree that access to medical care is
important. I agree that changes to our system in the near future are
imminent (or at least should be).  I also agree that we must proceed
with extreme caution as we are dealing with quite a Gordian Knot.

There is a saying about roads paved with good intentions and we should
take care not to walk them.

WORKING WITH – AND BECAUSE OF – EQUALITYCARE

Commentary from the Equality State Policy Center

Dr. Sherard’s editorial on EqualityCare/Medicaid highlights one aspect of a larger issue facing the Equality State as budget cuts loom: the relationship between jobs and government spending.

The top priority in a down time is simple: keep people working.

EqualityCare/Medicaid stands at the juncture of employment and spending. If people are not employed, there’s a good chance they’ll have to turn to EqualityCare for health care, driving up enrollment and costs.

On the other hand, as Dr. Sherard points out, EqualityCare spending does not fall into a black hole. That $500 million helps employ people in our state’s hospitals, nursing homes, pharmacies, and doctors’ offices. Since slightly more than half of Medicaid funds come from the federal government, the program brings in money from outside Wyoming to circulate through our state’s economy.

A 2006 Kaiser Foundation study showed that pulling in the federal funds had a positive effect on all states’ economies – not counting the effects of better health on workplace productivity and students’ educational efforts.

This is not to say that we taxpayers should spend the moon on EqualityCare/Medicaid. The Equality State Policy Center has long stood for accountability and efficiency in government. We agree with all of Dr. Sherard’s suggestions for improving EqualityCare, and further recognize that it may be necessary to spend more money now to achieve cost savings in the future (e.g., converting to electronic medical records).

But simply slamming shut the checkbook is not a solution either. If cuts in EqualityCare/Medicaid mean more people in the emergency rooms of our public hospitals – which are partly taxpayer-supported – and laid-off caregivers who then must seek assistance themselves, then we taxpayers have lost yardage. Nor would it be economically productive to bankrupt families with elderly relatives in nursing homes.

Our government in a democratic society provides a way to do things together that would be impossible or wildly inefficient to do on our own. Yes, we could arrange with our neighbors to get our street paved, or a sewer line installed, but who among us has time or expertise to handle the arrangements, much less make sure our street meets up with the next one?

Similarly, our society has chosen not to allow babies, the developmentally disabled, the aged, and others with serious health problems to live lives of chronic illness and deprivation because they cannot afford appropriate care.

Through a program like EqualityCare/Medicaid, we can band together to meet needs such as caring for an aged relative with dementia, or a child with developmental disabilities.

As Dr. Sherard noted, Wyoming’s EqualityCare program is one of the most restrictive in the country, providing assistance to only the most vulnerable people. Maintaining this assistance will keep their situations from getting worse, and help the entire state’s economy as well.

Medicaid and Wyoming: Why it Matters

by Dr. Brent Sherard, Wyoming Department of Health Director and State Health Officer

Access to quality medical care is a goal we should all embrace for ourselves, for our families and for all Wyoming residents.

Wyoming EqualityCare, our state’s Medicaid program, pays for the healthcare many of our state’s low-income and medically vulnerable citizens desperately need.  Medicaid is roughly a 50-50 financial partnership between states and the federal government. The federal contribution is calculated every federal fiscal year using the relationship of Wyoming’s average per capita income to the national average per capita income.

Approximately 81,000 Wyoming residents qualified for the program in the last fiscal year, which represents 15 percent of our population.  Wyoming EqualityCare accounts for about 12 percent of the entire budget of Wyoming’s state government, annually spending about $500 million.

Any big change to the program or adjustment to its budget affects us all in one way or another. The money does not just disappear down a bureaucratic black hole; it is spent with local doctors, hospitals, nursing homes and other healthcare providers in every Wyoming community.

The impacts on healthcare due to Wyoming EqualityCare are far-reaching and significant:

·         There were 8,015 births to Wyoming residents in 2008.  Of these, 42 percent were paid for by Medicaid.

·         Medicaid pays for 42 percent of nursing home care expenses in Wyoming.

·         Providers who serve developmentally disabled clients receive nearly 100 percent of their income from Medicaid.

·         Medicaid pays for approximately 12 percent of hospital care in Wyoming.

·         8.8 percent of Wyoming physicians’ reimbursement is from Medicaid.

Over the last year Wyoming has seen a dramatic increase in Medicaid expenditures, primarily due to increased enrollment and higher costs.  With Wyoming’s unemployment rate at 7.4 percent, the highest rate the state has seen in 20 years, more people are qualifying for Medicaid.

With declining state revenues, difficult decisions may be needed about this program.  It is important to carefully consider how potential budget cuts affect not only Medicaid clients, but also the Wyoming healthcare system overall.  National healthcare reform efforts are also looming on the horizon, and it’s hard to predict how our Medicaid program in Wyoming will be affected.

Wyoming EqualityCare is one of the most conservative Medicaid programs in the United States. For example, coverage for parents and caretaker relatives with dependent children is available only when family income is less than approximately $8,000 per year for a family of four. Children and aged, blind or disabled individuals are covered at higher income levels. There is no coverage for single childless adults unless they are aged, blind or disabled.

To maintain Medicaid’s viability in Wyoming, many complex issues need to be tackled.  For us to simply sit back and wait for state revenues to recover is not acceptable. We can and must do better. Possible solutions include:

·         Incentives for clients.  People need to take responsibility for their own health.  They should eat more responsibly, exercise more, discontinue tobacco products, take advantage of immunizations and early childhood health screening, and be more diligent about other health screening opportunities such as mammography, colonoscopy and other routine procedures.

·         Incentives for healthcare providers. Our primary healthcare providers need to be adequately reimbursed for promoting healthy lifestyles and ensuring our Medicaid clients receive these services.

·         Emergency rooms should be not be used as primary care clinics.  The expense incurred in an emergency room is astronomical when compared to the expense incurred for a similar condition in a healthcare provider’s office.

·         Quality and consistent prenatal care is paramount in obtaining good obstetrical outcomes and should continue to be a strong focus for Medicaid.

·         With limited resources it’s critical that people are well educated and understand what can and should be done to care for their particular problem.  This also includes an understanding of the cost of care and how it relates to their current illness, an aspect of medical care that has been essentially ignored by those who are healthcare consumers.

·         Redundant and duplicative medical procedures must be minimized or eliminated to help curb medical costs.  This can be at least partially addressed with the broad implementation of the electronic medical record.

Whether it’s the debate on Capitol Hill in Washington, D.C or the decisions to be made in Wyoming about Medicaid, we all have a stake in the outcomes. Children must have access to a healthcare system where medical problems can be diagnosed early, when interventions will be most meaningful.  Young women must receive appropriate prenatal care to ensure healthy babies.  And let’s not forget the elderly and frail, people with developmental disabilities, or those struggling with mental illness.  These are all important people in Wyoming who deserve the best care possible.

So let’s proceed with caution when it comes to Wyoming EqualityCare. Our ultimate goal must be to ensure continued access to quality care throughout our great state.

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