'One person, one vote' means change

Tensions arise with first proposals for new district lines

Teton County proposal will ripple across southwest Wyo legislative districts

By Dan Neal

A proposal laying out new boundaries for Wyoming House District 22 would include all Teton County residents living west of the Snake River but no one living in Pinedale.
Teton County’s commissioners got together with a consultant using geographic information system maps and drew up the new district as part of a proposal offered to the Legislature’s Joint Interim Corporations, Elections and Political Subdivisions Committee when the committee met Wednesday in Rock Springs and Pinedale. Those meetings were the first of 10 the committee plans to hold around the state to hear local concerns and proposals about redistricting the Wyoming Legislature.
The process of reconfiguring the boundaries of legislative districts is known as “redistricting.” It is constitutionally mandated. The Legislature must redraw legislative district lines in the first budget session following completion of the decennial U.S. Census. Under the principle of “one person, one vote,” those districts must be nearly equal in population to ensure that each voter wields roughly equal power in legislative elections.
Since population grew in some areas of the state and declined in others since the 2000 Census, legislative district boundaries must change to reflect those shifts. Determining exactly how is a political process traditionally used by the party in control of the legislature to solidify the ability of its members to get elected.
In Wyoming, the Republican Party’s huge majorities in both the state House and Senate mean shifting district lines will affect its own members. There are some places, like Cheyenne, where the party can redraw the lines to include voters more likely to vote Republican in specific Senate or House districts. But in most areas, moving district lines will affect seats held by Republicans.
Those new lines proposed for House District 22 are the first example. They would ripple through the rest of southwestern Wyoming, requiring significant changes in districts in Lincoln, Sweetwater, and Uinta counties.
The Teton County proposal knocks out a sitting legislator, HD20 Rep. Kathy Davison of Kemmerer, whose community would be absorbed into House District 19. Davison’s GOP colleague Rep. Owen Petersen of Mountain View holds the HD19 seat.
Tension over the Jackson-based proposal could be heard in side-conversations in the Pinedale meeting, which was in the Sublette County Library. The HD 22 seat is held by one of the nine Democrats in the 60-seat House, Jim Roscoe of Wilson.
The Teton County officials made the argument that both Sublette and Teton counties witnessed significant growth over the past decade and those changes require dividing the district.
Some Teton County residents believe House District 22, established in the 2001 redistricting process, was created to split the Wilson vote to dilute the power of voters seen as more liberal, particularly on conservation issues. As a result, House District 22 presently includes part of the Wilson area, goes south to cover Alpine and Etna, then extends east and south into Sublette County, taking in Bondurant, Cora Pinedale and Big Piney. Most of the residents in the southern end of the present district, an area booming with natural gas development, are believed to view conservation matters differently than the majority of residents of Teton Valley, the home of two national parks and an economy that thrives on nature-based tourism.
Teton County Commissioner Hank Phibbs said the proposal worked out in Teton County roughly “squared off” the south boundary of HD22 at Star Valley Ranches, extending it east to Daniel and Cora in Sublette County.
Sublette County’s population grew 73% over the decade to 10,247. Under the 2010 Census, the ideal population for a House district is 9,394. To meet “one person one vote” tolerances, Sen. Charles Scott, a Natrona County-based senator on the committee, said no House district can have more than 9,863 residents, or fewer than 8,925.
That means Sublette County cannot be wholly contained within a single district. Two Sublette County officials, County Clerk Mary Lankford, and Commissioner O.G. Wilson, said they want to keep Sublette County “as whole as we can.”
And Bondurant resident Mary Winney, whose husband Bill Winney ran for the HD22 seat in 2010 and lost to Roscoe, said she did not want to be included in a district oriented to Jackson. “I don’t belong in Jackson,” she said. “Bondurant needs to stay with Pinedale.”
Phibbs argued for the proposed new lines by noting that many residents of Alpine, Etna, and Star Valley ranches commute to work in Jackson. That connection means the residents of the HD 22 proposed by the Teton County group share a community of interest. And that means the proposal meets one of the redistricting principles guiding the joint committee’s redistricting work. (You can see the Principles of Interest on the Legislative Service Office website.)
Rep. Keith Gingery, HD23, R-Jackson, offered a fig leaf to those concerned about the Teton County proposal’s ripple effects in districts further south in Lincoln, Uinta, and Sweetwater counties. Gingery (seen at top during the 2011 session) noted it was necessary to “add numbers to HD22” after taking the west bank of the Snake River, so the lines were extended south to pick up Etna and Star Valley ranchers.
“We took House District 16 (represented by GOP Rep. Ruth Ann Petrov) … and shrank it to the town corporate limits of Jackson. We pulled 22 up (from Pinedale),” Gingery said.
“The rest of it south, I hope other people will come up with a better way,” he said, noting he does not like the boundary changes proposed for HD 20. But “the numbers drive it,” he said, noting some Sublette County have to be included in a district that crosses county lines.
Joint Corporations Committee member Rep. Alan Jaggi, HD18, R-Lyman, said people across the state want to see legislative district boundaries follow county lines as much as possible. But that is impossible to do and still meet the district population requirements of the “one person, one vote” principle.
“Rather than say, ‘Keep us whole,’ come up with a plan,” Jaggi said. “Everyone in the state says, ‘leave us alone.’”

For another report on this meeting, see the Jackson Hole Daily.

Medicaid is helpful and should be protected

Put the bat away

By Barb Rea
ESPC health policy volunteer

Advocates and providers who work with low income seniors and families and individuals with disabilities should be aware of what went on at the Wyoming Legislature’s Join t Labor, Health and Social Services Committee meeting May 9-10in Evanston.
I am concerned about the ongoing attacks on Medicaid and the Affordable Care Act and the misguided belief that we can reform health care without the aid of a strong federal partner.
On the bright side, new committee members are getting intensive education from experts on health care and health reform.
Other aspects of the committee’s work were not so bright. Committee Co-Chairman Sen. Charles Scott, R-Casper, felt the need to add his personal interpretation to almost every piece of information presented. He painted Medicaid as a perennial problem in the state, and assured the committee that the new federal health care law, which he dismissively terms “Obamacare,” will be repealed or at least defunded. He also continues to portray his pet project, Healthy Frontiers, as a viable program which could be used to replace both Medicaid and the benefits offered in the new legislation.
The truth is that Medicaid is an efficient way to provide health care to many low income, elderly, blind and disabled individuals in Wyoming. Like the promise we made to the elderly with Medicare, Medicaid is the promise we made as a nation to provide healthcare to the poor, disabled, blind and elderly. Individuals who qualify for this program are guaranteed the right to comprehensive healthcare.
We learned from the experts testifying at the meeting that the federal taxes we pay in Wyoming are essentially subsidizing low-income care in other states. Wyoming’s Medicaid program has always provided bare minimum services to the fewest people possible under federal law. Other states use the program to leverage more federal dollars into their healthcare systems and provide more health care for people who would otherwise depend on emergency rooms when they are ill or injured.
Our state leadership seems intent on making sure we provide fewer services and use more state money to do it, just to send a message to Washington that we can do this ourselves.
Senator Scott used every opportunity to imply, incorrectly, that Medicaid enrollees tend to overuse the system and are always trying to game the system to get more than their fair share—making Medicaid more expensive than private coverage. At one point he digressed at some length about rules which would hypothetically allow mothers to quit their jobs so their children can qualify for Medicaid. Then, Scott said, the mothers are able to go get their jobs back and their children go right on receiving health care, “and there is nothing we can do about it.”
Scott’s attitude was bolstered by the state’s new Director of the Department of Family Services, Steve Corsi, who made a stunning assertion that 30% to 40% of people who enroll in Medicaid in Wyoming, come dressed like he was (black suit and new haircut) and driving an Escalade, “and there is nothing we can do about it.”
Senator Scott let the committee’s disgust percolate until Wyoming’s Medicaid Director, Teri Green, was able to question the validity of Mr. Corsi’s numbers. Mr. Corsi later apologized for using an inflammatory example and a “guesstimate.”
Later we learned from another presenter, that nationally less than 10% of Medicaid payments are claimed fraudulently, and in Wyoming the figure is less than 6%. Moreover, research tells us most of the fraud by far (80%) is committed by providers (primarily medical-device and pharmaceutical companies). Less than 10% of the fraud is committed by patients. Click here to read Health Insurance Fraud: An Overview
National research verifies that Medicaid is far less expensive than private coverage, but Sen. Scott continues to cite numbers to the contrary, numbers that have never been publicly vetted and do not seem logical to the people who manage Medicaid. (See below for links to this research)
Rather than persistently portraying Medicaid as a problem, the committee should be looking at Medicaid as a key component to stabilizing the entire health care system. It will help ensure that everyone has insurance coverage. Complete coverage, in turn, is part of the solution to stabilizing the market by eliminating the cost shifting that occurs when the uninsured seek and receive emergency care.
Under the Affordable Care Act, Medicaid eligibility will be simplified and expanded so that it covers all low-income people who earn up to 133% of federal poverty level ($1207/month). The state will be responsible for part of the cost of care for about 6,000 Wyoming individuals who are currently eligible for Medicaid but have not applied. These people are probably not enrolled because they are healthy, so they are not expected to add a huge burden to the state budget. The expansion of the program to finally include all low-income adults will be almost entirely paid for by the federal government (100% till 2017 and dropping to 90% in 2020).
Does it really make sense to opt out so our tax dollars can go to other states?
Don’t we want our poor citizens and blind neighbors to have access to the healthcare they need when they need it?
If Medicaid were privatized, as Senator Scott seems to be advocating, those federal matching dollars would disappear, and the costs would be shifted to state and county budgets or to those who pay premiums for private insurance. We would be paying both federal taxes that don’t come back to Wyoming and higher premiums.
If we want to accept the federal match available under the Affordable Care Act, we will have to guarantee that we will provide a program in Wyoming that will be at least as strong as the Affordable Care Act. We will have to pass a law that provides comprehensive coverage to all our citizens. Would we be able to achieve this with a private insurance industry that has been pushing poor and sick people off their roles systematically for decades? This practice is the reason we had to develop Medicaid and Medicare in the first place. We need those public programs to make our system work, and we need them now more than ever.
If we want our Medicaid program to run more efficiently, we should just ask Tom Forslund, our new, capable Director of the Health Department, to make it so, not try to reinvent the wheel. Medicaid will be a big part of our state budget because it serves an important function for our friends and neighbors who need healthcare and for those who provide healthcare services. We should prepare for the larger numbers it will cover instead of pretending poor people’s healthcare needs can be legislated away.

Links to Medicaid vs. private insurance research
“Trends and Indicators in the Changing Health Care Market Place: Medicaid Payment per Enrollee by Acute and Long-Term Care, 2003 http://www.kff.org/insurance/7031/ti2004-1-15.cfm

“Trends and Indicators in the Changing Health Care Marketplace: National Prescription Drug Expenditures, Percent by Type of Payer, 1994-2004” Kaiser Family Foundation http://www.kff.org/insurance/7031/ti2004-1-16.cfm

“Comparison of Expenditures in Nongroup and Employer-Sponsored Insurance” Kaiser Family Foundation http://www.kff.org/insurance/snapshot/chcm111006oth.cfm

“MEPS Topics: Health Care Costs/Expenditures” Agency for Healthcare Research and Quality http://www.meps.ahrq.gov/mepsweb/data_stats/MEPS_topics.jsp?topicid=5Z-1

“Comparing Public and Private Health Insurance for Children” Center on Budget and Policy Priorities http://www.cbpp.org/files/5-11-07health.pdf

“Medicaid, Private Health Insurance and the Uninsured” John Holahan, The Urban Institute http://aspe.hhs.gov/medicaid/jan/Holahan.pdf

“Expanding Medicaid a Less Costly Way to cover More Low-Income Uninsured Than Expanding Private Insurance” Center on Budget and Policy Priorities http://www.cbpp.org/cms/index.cfm?fa=view&id=429

“Administrative costs on Health Plans: A systematic review of current studies” Deloitte Center for Health Solutions http://www.deloitte.com/view/en_US/us/Industries/health-plans/1fdbe665e4e06210VgnVCM200000bb42f00aRCRD.htm


Editor's note: Barb Rea is an ESPC volunteer and represents the organization in the coalition Consumer Advocates: Project Healthcare.

Wyo’s “Healthy Frontiers” pilot program will never replace Medicaid

By Sarah Gorin
ESPC health policy volunteer

Many Wyoming legislators derisively refer to the Patient Protection and Affordable Care Act (the federal health reforms) as “Obamacare.” This would be a humorous addition to the political debate if these same legislators had an alternative proposal, but at the moment the alternative appears to be “No Care.”

Much has been made of Wyoming’s pilot health care reform program, “Healthy Frontiers.” The program was initially funded by the 2010 Legislature, enrolled its first participants at the end of 2010, and received additional funding from the 2011 Legislature to expand to 200 participants.

Currently, Healthy Frontiers has enrolled just under 20 participants from the targeted pool – individuals participating in state job training programs, whose incomes are under 250% of the federal poverty level, and who live in Cheyenne or Casper (where selected medical providers have agreed to begin implementing the program).

Healthy Frontiers is a health care plan. It is important to understand that it is not health insurance. Healthy Frontiers emphasizes primary care and chronic disease management, with the goal of reducing medical costs over time by taking care of conditions before they develop into expensive crises. This logical approach is being implemented in many model programs across the country, and the ESPC has no quarrel with it.

But Healthy Frontiers also requires participants to pay into to a “personal health account” (not a health savings account for tax purposes), based on income. The ESPC has maintained from the beginning that the required contribution is unrealistically high, based on Wyoming’s Family Economic Self-Sufficiency Standard, which shows the incomes needed to support basic household expenses on a county-by-county basis.

The state also contributes to the personal health account as the client meets certain milestones in the program, such as establishing a relationship with a primary care provider and maintaining compliance with treatment regimens.

Further, the ESPC’s analysis shows that although program proponents hold out Healthy Frontiers as a cheaper alternative to Medicaid, it easily could cost the state more if fully implemented.

The rhetoric from some legislators and Governor Matt Mead about Healthy Frontiers is seriously overblown given the current status of the program. With only a handful of participants to date, and zero data on the workability of the financial requirements or on clinical outcomes, it is wildly premature to talk about this extraordinarily modest program as a substitute for anything.

The problem with the program is a microcosm of the larger health care issue. Americans have made a commitment to providing care to everyone, to not let their neighbors die in the street. But we haven’t yet figured out how to pay for that commitment.

The Affordable Care Act is the first step in that direction, trying to get everyone covered with public or private health insurance so they can pay for their care.

Healthy Frontiers clients earn a painfully low income. Since Healthy Frontiers is not health insurance, if its clients need care above and beyond what is provided by the program, the cost of that care will fall – unpaid – on Wyoming’s hospitals and private providers.

By contrast, Medicaid actually is insurance and pays providers for clients’ care. If you were a health care provider in Wyoming, which program would you like to see behind the consumers coming through the door?

Wyoming’s lawmakers need to lay aside political agendas and focus on solutions that will help our residents access quality health care when they need it and keep our state’s hospitals and providers solvent.

Microsoft carries the day with technology committee

The Legislature's Select Committee on Legislative Technology and Process voted Wednesday morning to adopt Microsoft's Exchange to handle its email system.

The executive branch recently chose Google but Legislative Service Office staffers believe the Microsoft platform provides more security and better integration with other technology plans, including the use of SharePoint.

In a memo to the committee, the LSO staffer Jamie Schaub made this assessment:

"After the 2011 General Session, we analyzed the extent to which Google could be integrated with SharePoint, because seamless integration with email is critical to provide automated workflows for many legislative processes as part of the new system. We determined that there are many features within SharePoint that we will not be able to fully utilize if we choose Google. We also believe we would add risk and uncertainty to our SharePoint project by trying to integrate a non-Microsoft solution for our email environment. Finally, there are several executive branch policies in place that could limit the use of legislators’ mobile devices if we use the executive branch’s system.

"Based on this analysis, we recommend selecting Microsoft Exchange as the legislative branch’s new email platform. Please let me know if you have any questions. We are very excited about the potential to create more efficient and effective technology support for the legislative branch through these initiatives. "

Sen. Leland Christensen, R-SD17, Alta, questioned the security of Microsoft's Hotmail versus Google. But LSO staffers said several states, including California, decided against using Google because of security problems.

The select committee set its next meeting June 29 to discuss its interim topics, which include
reviewing and recommending rule and process changes to improve the "open and transparent operations of the Legislature."