So far, it is hard to tell what will come of the Republican congress and the Trump administration regarding the ACA. Because the State's budget picture was so precarious at the end of 2016, I did not bring back my 2016 grant bill (see below) in the 2017 session. However, I intend to continue evaluating ways to increase access to primary care and mental health services. One success was my presentation at a 2016 Joint Interim Labor Committee of a proposal to increase the availability of telepharmacy services. This idea became a Labor Committee bill, and passed the 2017 session (SF 62).
In the 2016 session I did not support expansion of the Medicaid program for the following reason: In 2011 President Obama considered making cuts to the Medicaid program as it existed then, as "entitlement spending" makes a significant contribution to the federal government's budgetary problems. After the ACA passed, and the Affordable Care Act offered a 100% payment for Medicaid expansion, these funds were essentially untouchable during the rest of President Obama's term in office. However, there have been dozens of attempts to repeal the ACA since 2012. My concern this year was that if Wyoming did decide to expand Medicaid in 2016, the 100% match provision could be repeal if/when a Republican president is elected this fall, leaving the state in a tough financial position. All previous Medicaid expansion bills that I supported had sunset dates designed to make it a short-term bridge program; in my mind we were too close to the "repeal danger" date to support expansion in 2016.
I continued to work, during the 2015 interim, on other ways to increase access to primary care and mental health services. My Healthcare Access Improvement Grants bill did not get enough votes for introduction during the 2016 Budget Session, but it received the aye votes of 33 representatives, so I intend to continue working on it for re-introduction in 2017.
In the 2015 General Session I was the prime sponsor of two bills aimed at increasing the number of healthcare providers in the state: HB 88 Health provider recruiting programs and HB 107 Interstate Medical Licensure Compact. Here are some links to articles about HB 107 in the Wyoming Tribune-Eagle and on the Liberty Group website.
The current Medicaid program is not sustainable, as we spend one out of every five General Fund dollars on Wyoming's share of Medicaid expenditures. The biggest expenditures are for adults in nursing homes and with developmental disabilities. The Department of Health is continuing to work on reform efforts as directed in 2013 legislation that I helped present on the floor of the House.
When we consider the optional ACA expansion of Medicaid to childless non-disabled adults between the ages of 19 and 64 it is important to remember that not all national-level discussion of Medicaid expansion applies to Wyoming. For example, many commentators have stated that Medicaid patients will have worse access to care than private-pay patients as, nationally, only about 40% of doctors take Medicaid. This is not the case in Wyoming, where we are fortunate to have about 98% of doctors taking Medicaid. On the other hand, the oft-quoted argument that putting people on Medicaid will reduce the number of emergency room visits is not correct either. In Wyoming, Medicaid patients visit the emergency room three times as often as patients with regular insurance.
At present, although I was totally opposed to the ACA (you can read my 2012 article that I wrote after the Supreme Court decision), we are spending some $20 million a year of Wyoming taxpayer money from the General Fund on those childless adults ages 19-64 now. If we expand Medicaid, then about 90% of that expense can be shifted to our federal tax bill (which the IRS will continue to collect from you whether we expand Medicaid or not).
I had the following discussion of the pros and cons of expanding Medicaid on the Log section of my website, and have moved it for easier access below:
THE FEDERAL GOVERNMENT IS BROKE.
You're right. However, the Obama administration has shown itself unwilling to rein in entitlements, so we may as well get our federal tax dollars back from Washington between now and 2017 (under a new administration), instead of sending our money to the feds for them to redistribute to California and New York. It's true that these specific would-be Medicaid funds don't go to some other state's Medicaid program, but I haven't noticed that the feds are sending back any of my tax payments yet. Considering the "war on coal" and the cuts to the Abandoned Mine Lands funds, if the feds are only willing to send our money back this way, I'll take it, and use the General Funds we've been spending on healthcare services to the poor in some other way.
THE FEDERAL GOVERNMENT WON'T BE ABLE TO KEEP ITS PROMISE OF PAYING 90% OF THE MEDICAID COST.
I agree, so I will not vote for any expansion that doesn't include a "trigger," cancelling our program as soon as the federal contribution drops below 90%. I will also include a sunset date, so the program will not continue without re-evaluation under a new federal administration.
PEOPLE SHOULD GET A JOB, AND NOT EXPECT OTHER PEOPLE TO PAY FOR THEIR HEALTHCARE.
The Health Department estimates that 40% of the expansion population works full time, and 40% works part time at jobs without insurance coverage. Think of fast-food workers, roofers, cleaning ladies, day care providers, etc. One hundred percent of the federal poverty level for a single person is $11,670, which is 30 hours a week at minimum wage. The rest of us already pay for much of their healthcare, as providers raise our rates to cover the cost of their care. Hospitals are only able to collect a very small percentage of the money they spend on uninsured patients. Currently the care provided to uninsured patients (and a new group--people who can't pay their deductibles) falls on the shoulders of two groups--one, people who get treatment and can afford to pay for it themselves or using insurance (including the many businesses that self-insure) and, two, local taxpayers through the county or hospital district budgets. More than half of the hospitals in the state are in the red on operations, particularly in rural areas, and are only in the black as a result of hospital district funds (i.e., taxpayers) or transfers from county commission budgets (i.e., taxpayers). It seems to me that the cost for preventive and critical care for the state's indigent should be spread more broadly.
PEOPLE WHO DON'T HAVE A JOB SHOULD GO OUT AND GET ONE.
Many of these people have health conditions that prevent them from working. The Medicaid expansion should be considered a three-year special program to get these Wyoming citizens into better health so they can go back to work. Of course, then they still might not have insurance, so the job training feature of the Medicaid bill will try to get them to a higher level of employability. The single homeless adults with severe mental ilness are not very employable, and their lack of healthcare exacerbates their problems, often to the detriment of their community.
My hope is that under a new federal administration in 2017 the ACA will be repealed, Congress will begin working on entitlement reform, Congress will begin working on reform of tax deductibility of health insurance, Congress will reform the Medicaid program to allow for state block grants or, even better, Congress will reduce taxes so Wyoming citizens can make use of the money they send to Washington without having to subtract all the overhead expenditures that support the federal health and social service administrators. Until then, I'll just try to be practical.
Wyoming continues to have a severe shortage of primary care and mental health providers in many parts of the state. After the 2014 session ended I called together a group of people in the healthcare field to brainstorm various ideas on how to increase the number of providers. We have met twice so far, and I believe we are coming up with some good approaches that we may be able to implement to improve the situation. More on that later as our ideas develop.
In the Labor committee I worked on HB 82, Interstate sales of health insurance, which passed both chambers and was signed bythe governor. This bill will enable Wyoming residents to buy a health insurance policy that is sold in another state, if they find a policy that seems better or less expensive. I also was the floor manager for the Labor Committee's Medicaid reform bill, which I commented on in the Budget section.
Wyoming has significant challenges in the healthcare system. The State's spending on healthcare has doubled in the last ten years. Almost one-third of our state is either uninsured or on Medicaid. Half the state is considered a health professional shortage area.
While I believe the private sector can provide the care that Wyoming wants and needs, the legislature needs to make sure that our laws strengthen and improve the ability of providers to provide care, and the ability of people to pay for that care. I want to encourage insurance pools, increase the number of healthcare providers in Wyoming, and make Medicaid programs more cost-effective.
So far, I have not had a chance to work on increasing the number of healthcare providers. There will be some opportunity to look at that issue when the Department of Health brings its proposed budget to the Labor committee in the fall.
In June the Supreme Court released its decision upholding most of the Affordable Care Act ("Obamacare"). You can read my article "Now what? Obamacare and Wyoming" here. It is not a short article, because the healthcare system is complex. The problems cannot be solved with slogans and sound-bites.
In the 2010-2012 there were only three legislators (out of 90) who listed healthcare experience on their internet information form. I have a Master's degree in Healthcare Administration, and will be able to make a significant contribution to evaluating and improving our healthcare situation in Wyoming.
Worse and worse! See my notes in the legislative log for the 2017 session. As long as our tax structure remains so reliant on the energy/mining sector we will continue to live with boom-and-bust cycles. The "rainy day" fund (the LSRA, or legislative stabilization reserve fund) is intended to balance out the revenue downturns but, unfortunately, it is not large enough to do that job fully.
As is pretty well known by now, the revenue picture for the State of Wyoming is worse than it has been for some time. The main sources of revenue for the General Fund are (1) investment income, thanks to the creation in 1975 of the Permanent Wyoming Mineral Trust Fund, at 40% of the General Fund income, (2) sales taxes, at 36%, and (3) severance taxes at 13%. The main sources of revenue for the K-12 school system are property taxes (nearly 2/3 of which comes from the energy/mining sector) and federal mineral royalties, with school construction being funded primarily by coal lease bonuses.
The State budget that was passed in the 2013 session (for the 2015-16 biennium) was only slightly higher than the one passed in 2011. Frankly, the State budget is virtually unintelligible, but if you want to take a look here are a few links:
--The governor's requests (Summary and by Agency).
--The budget bill put together by the legislature after input from the Joint Appropriations Committee, approved by both chambers and signed by the governor is on the Legislative website. Look at either HB 01 or SF 01 for the year in which you are interested.
You should be aware that this budget still doesn't show all the money that is spent on State functions, as most of the funds for WYDOT and Game & Fish come through their Commissions, and do not require approval of the legislature or the governor. In addition, UW and the community colleges are mostly funded by student tuition; only the money that comes from the legislature is shown on these two websites.
I have two goals regarding the budget: to keep the State budget flat, and even reduce it, and to make the State budget more understandable to the citizens.
At the end of the Budget Session the legislators have to vote on the amendments adopted by the joint conference committee. Once each amendment has been adopted, even if by a 31-29 vote, then it is part of the budget. When the legislators vote on the budget they are voting on the budget in its entirety; it is not possible to vote aye on certain parts of the budget and nay on other parts. As a result, sixteen representatives (of which I was one) and ten senators voted against the 2015-16 budget. There were over 20 amendments to the budget that I didn't think were prudent or desirable. They would be too long to describe here, but if you want to know, you can send me an email.
The Medicaid program uses almost $1 out of every $5 spent in the Wyoming general fund. I presented the Medicaid reform bill (SF 60) on the House floor in 2013. We will be working with the Department of Health on Medicaid reform during the interim.
Thoughts from my 2012 campaign:
A lot of Wyoming's revenue comes from the energy sector. With natural gas prices down, the Governor has asked the State to evaluate an 8% budget cut. These cuts will be painful, but there may be a silver lining if the situation forces us to evaluate what the government really needs to do. Not only is the best government the government closest to the people, but problems should be addressed at the lowest level of society possible--individuals, families, social and religious organizations, and communities. There may be opportunities for communities and individuals to play a more important role in public health, education, the arts, and other cultural fields.
Healthcare and education spending make up almost 60% of the State budget. With my years of experience in those fields, I will be able to make wise decisions about any cuts in these areas.
House District 7
Since I first ran for the legislature in 2011, I have felt that the main issues District 7 needs me to focus on are the state budget, healthcare, education, and economic development. Here are my thoughts on those issues from 2012 to the present.
I encourage voters to pay attention to the Laramie County School District #1 budgeting and spending decisions. The state's funding goes to the districts in the form of a block grant (for the most part), and so it is up to the District to decide how best to use those funds. So far, LCSD1 is not significantly impacted (other than by the failure of the legislature to fund construction of the new Carey Jr. High, which was a different funding issue), because we are one of the few school districts to continue to grow in student numbers.
The major issue this year is the impact of the state's revenue downturn on K-12 (and college/university) funding.
In 2015 I sponsored a bill to change the authorization process for public charter schools. Although it did not make it out of committee, I am continuing to look for ways to offer more educational options to Wyoming's children.
I spent quite a bit of time in 2014 and during the 2015 session trying to get the attention of the State Board of Education. The Social Studies standards were up for revision, and I think the current and new (and approved) standards are inadequate. Unfortunately, the attention of the public was focused on the math and English standards that the Board looked at in 2011 and will begin looking at again in two more years, and then the Board and the public focused on the science standards, which did have some problems. Amidst all that commotion, one of the only four Social Studies standards was changed from "Students explain the historical development of the U.S. Constitution and how it has shaped the U.S. and Wyoming governmental systems" to add the words "and treaties" after the Constitution. When other states require students to become familiar with Athenian democracy, the Roman republic, the Magna Carta, John Locke, George Mason, James Madison, and the Federalist Papers, among other things, I was certainly not going to vote to prohibit Wyoming from using standards developed out of state.
I will continue trying to improve the process for adoption of standards by involving parents, college and university faculty, and employers. We need to be sure not to just add layers of bureaucracy that add little value, and we do need to keep teachers involved across the state. I had to develop Social Studies standards when I taught at Noah Webster Christian School; it is a very time-consuming process, so we need to not expect classroom teachers and local school board members with full-time day jobs to tackle standards development on their own time after dinner for months on end.
We also need to be able to compare our students' progress with that of students in other schools and states. It is easy to assume that our great teachers and our great kids are doing all they can if we haven't compared their success to what is possible elsewhere. Currently our students take two national tests: the ACT in 11th grade and the NAEP in 4th grade, 8th grade, and 12th grade, although the NAEP does not provide individual scores for students or schools.
If you're curious, in 2012 there were nine states that had all 11th graders take the ACT; our students were very slightly above the average score for that group in math, reading, and science, and just slightly below the average for that group in English. On the 2013 NAEP 4% more of our 8th graders tested proficient or advanced in math than the national average (38% vs. 34%) and 3% more of our 4th graders tested proficient or advanced in reading than the national average (37% vs. 34%). We do spend 50% more per student than the national average ($15,849 vs. $10,560), so the question might be--are we getting the maximum benefit for our effort? If not, why not?
You may have heard it said that the states are the laboratories of democracy. I think charter schools might be the laboratories of the education system, so I am planning to bring a charter school bill during the 2015 session. The model legislation from the National Alliance for Public Charter Schools is 30 pages long, so I am trimming it down to suit Wyoming, and will be talking with various people interested and knowledgeable about the topic over the summer and fall.
A big problem on the horizon for school construction and maintenance is the expected reduction in coal lease bonuses for the State. This is money that mining companies pay to the federal and state governments when they lease public land for coal mining. Coal lease bonus money contributed $447 million to school district capital construction in the 2013-14 biennium. It is anticipated that after 2017, with coal companies reading the handwriting on the wall, there will be no more coal lease bonus money, so that will have a big impact on our ability to maintain and build schools.
During the 2013 legislative session we passed two bills on education accountability (HB 72, regarding the assessment of teachers and principals, and HB 91, which looks at student assessment). I do not serve on the Education committee in the House, but I have been assigned to the Education Committee of the Council of State Governments-West. I will be attending their meeting in on August 1st to see if the other western states have any good ideas that we could adopt.
Also in 2013, the Legislature passed SF 104 to change the position of State Superintendant of Education from an elected position to an appointed position. Although it is clear that there are significant problems in the Department of Education, I voted against the bill, as I did not feel it was the appropriate approach to addressing the issues.
During my campaign I discussed the need for more healthcare providers. In 2013 I met with the Dean of the UW Nursing School to find out more about the BSN and Advanced Practice Nursing programs, and what the challenges are in expanding them. I am also on the Family Practice residency taskforce, evaluating our medical residency program. I will be looking at improving our ability to recruit providers and keep new graduates in-state.
Our state's expenditure per pupil is the 4th highest in the nation, yet more than 25% of our students need remedial classes in college. We are not getting the value we want for the money we are paying.
We don't need to spend more money on fancy facilities. We do need to make sure that our teachers know what they should be teaching. Our current standards are vague. For example, the Wyoming government standards say "Students are able to thoroughly discuss the contributions of important historical figures and events." Do we care who and what? Other states specify the Magna Carta, the English Bill of Rights, Hobbes, Locke, Montesquieu, George Mason, Thomas Jefferson, and James Madison. More specific standards would not only provide the students with a better education, but also would enable us to save some of the money we're spending on reviewing, re-teaching, and hiring administrative staff.
Teaching is unlike most other professions--if you do a bad job it may not be obvious for several years. We have to give new teachers, especially, the mentoring and evaluation they need to succeed in the classroom. Feedback should come throughout the year, not just after the student test scores come out. We will insist on quality teachers, but the teachers and administrators need to know they have our support when they discipline disruptive students. Finally, not all students fit into the same box. Our children need to have opportunities to take both advanced math and auto shop if that's where their strengths and interests lie.
Wyoming needs more training programs for healthcare and technology professions. The Wyoming Department of Workforce Services says our state colleges are only graduating two-thirds of the number of nurses we need in the state. A more highly-trained workforce will provide better services to the people of Wyoming, and enable businesses to grow and be more productive. In addition, our children would be able to enroll in the training programs they want here in Wyoming, and then will be more likely to stay here after graduation.
Ultimately, parents are responsible for their children's education, even if they choose to delegate that responsibility to public or private schools. I support homeschooling and charter schools as other educational choices.
I am on the Select Committee on Capital Financing and Investments. Some of the statutory changes we made this year were to improve reporting on the state's public purpose investment programs and to standardize the interest rates for economic development loans (indexed to Treasury bill rates).
With the current challenges in the carbon-based energy sector, there has been a lot of discussion about renewable energy. Here is a link to the University's Wyoming Renewables website. About 11% of the energy produced in Wyoming comes from renewables (mostly wind, which we have a lot of). We are the only state with a wind production tax ($3.7 million of revenue in 2015, compared to about $762 million from coal, oil, and gas severance taxes). Sadly, even the wind revenues were down in 2015 (less wind--see article)! I have attended several meetings of the Wyoming Infrastructure Authority to learn more about transmission lines and pipelines. A major challenge with the sale of wind energy is the federal regulatory obstacles to building transmission lines.
The property taxes we pay in Wyoming primarily go to the public schools and county governments. Mineral producers pay 64% of the total property taxes in the state, commercial property owners pay 18%, residential property owners pay 16%, and agricultural producers pay 1%. Economic development helps the state in several ways: there are more and better jobs for individuals, and the property tax base goes up because a manufacturing plant with lots of equipment has a higher valuation than an empty field full of tumbleweed. If the commercial valuation goes up, while we are losing money from the coal producers, then counties will not have to raise residential property taxes to make up for the loss.
The State Treasurer manages over $16 billion in non-pension funds--you can read the report on the Wyoming State Investment Portfolio website. The biggest funds are the Permanent Wyoming Mineral Trust Fund, the Permanent Land Funds, and the State Agency Pool (this is basically the General Fund money while it's waiting to be spent on salaries, supplies, etc.). About half of the total can be invested in stocks; the rest must be invested in bonds. (A bond is basically a loan and is called a "fixed income" because the bond is paid back at a fixed percentage rate, unlike stocks, which can go up and down.) The bond funds invest in things like U.S. Treasury bills, mortgage loans, and international bonds in places like Brazil, Chile, Indonesia, and South Africa. The FY 2013 return for our U.S. fixed income funds ranged from -4.78% to 6.45%.
Investments in Wyoming make up 2.2% of the 2013 market value of all the Treasurer's funds. I support investing more of the state portfolio in Wyoming businesses as a way to encourage economic development. I prefer using loans (most state loans are for 1 to 2% interest rates, which would be an average return for our 2013 fixed income funds) rather than grants, and the Treasurer, the State Loan & Investment Board, and the Wyoming Business Council should use professional diligence to determine whether or not the loan would be a good investment for the tax dollars we have in these funds.
During the 2013 session we raised the fuel tax $.10/gallon. TI voted in favor of this, as I believe roads and highways are one of the functions of the government (Article 16, Section of the Wyoming constitution). The fuel tax had not been raised in 15 years, and is essentially a user tax, which I think is the fairest way of funding roads. The legislature will be looking at WYDOT's budget during the interim to see what additional funding or budget cuts will be needed.
During the 2013 session I attending a special training hosted by the Corporations Committee on internet deregulation. I will be following up on the local broadband study. [The 2013 Broadband Summit will be at the end of October; I hope to attend this year as well.]
I have been assigned to the Economic Development and Trade committee at the Council of State Governments-West, and the Labor and Economic Development committee at the National Council of State Legislatures. At the CSG-W meeting in July we will be looking at ways to grow state economies. The NCSL meeting in Denver in May will address workforce development, immigration, and healthcare reform, among other topics.
Wyoming's highways are so underfunded that WYDOT is beginning to turn paved roads back into gravel. We have to maintain the roads that connect our communities. In the past decade the cost of building and maintaining highways has tripled, but state funding for highways has barely changed. Instead, we have quintupled the amount of money we are setting aside in savings. Rather than sending more money off to be invested in the stock market, why not invest in Wyoming roads and construction and engineering workers?
These days the internet is the electronic equivalent of a highway. If we want to maintain our rural communities--enabling people to work, learn, and receive services in their communities--we need to improve our broadband coverage. The State of Wyoming, as a major buyer, can encourage the private sector to expand broadband coverage throughout the state.
State government spending in Wyoming relies heavily on the mining industries. We should support this sector, as well as the agricultural and tourism sectors. In addition, though, we need to attract new jobs to Wyoming and encourage our local entrepreneurs. This can be done by maintaining our business-friendly climate, improving our broadband services, and expanding our employment training programs. The State also should continue to encourage overseas exports, and technology transfers between the University and the private sector.