Expanding Medicaid would protect a key state infrastructure — workers — says Sandy Shuptrine, a 12-year veteran of the Teton County Board of Commissioners. Pushing the Legislature to recognize the majority support in Wyoming for Medicaid expansion is an important first step in reform. (Flickr Creative Commons/Alex E. Proimos)

Being one of those who routinely “zooms out” when viewing Google Maps, I am inclined to address Medicaid expansion in Wyoming from a big-picture, overarching, perspective.  The issues I believe we need to focus more on are trust and compassion.

Sandy Shuptrine urges Wyoming lawmakers to recognize residents’ support for expanding Medicaid. (J. Kaplan Studios)

Whenever legislative debates and rationale are reported on the subject, distrust of the U.S. government is routinely mentioned. Really? In a state with a high per-capita federal subsidy ranking, that certainly seems disingenuous. Or perhaps what’s really at the root of it all is a powerful legislative leadership role that subtly discourages independent thinking and action when seeking to improve Wyoming’s financial distress. Nostalgia for the good old days will not solve our current problem. Clearly, traditional energy production is in decline, if not on hiatus, and responsible representatives will be seeking ways to soften the blow while keeping Wyoming healthy and strong.

It is true that dragging our legislative feet has diminished the potential financial infusion of Medicaid expansion monies into Wyoming’s coffers. Benefits still exist, however, with the result that accepting Medicaid expansion is supported by a broad array of Wyoming interests, including Gov. Matt Mead, hospitals, and a myriad of human-service organizations, not to mention the many thousands of lower-paid workers who are not eligible for either Affordable Care Act health coverage or Medicaid for the poor.

These working poor are some of Wyoming’s most valuable infrastructure — providing the engine and gears for the second largest segment of Wyoming’s economy, tourist visitors. We need a viable workforce and health-care system as part of our essential infrastructure and to ensure a desirable future for our state. Without Medicaid expansion the burden of continuing, unsustainable, unpaid, emergency health care continues to weigh heavily on our hospitals and, subsequently, on health-facility access around our rural state. Someone will pay, sometime, somehow.

Rather than leave less-able neighbors to fate or to destructive behaviors resulting from hopelessness, would it not behoove us to provide some compassion by helping them to adjust to changing times?  We can all aim for such a hand up to be one that contributes to enhanced future independence of Wyoming’s population. We can also work together to craft guidelines and assurances to strengthen a Medicaid expansion program for our state.

Round up the herd, including stragglers

The Wyoming open-range tradition of independence and self-reliance exerts strong influence on legislative attitudes and decision-making. I, too, appreciate the can-do outlook it creates. Leaving stragglers in the dust does not reap rewards, however. It also is tradition to round them up into the well-being of the herd and for economic gain.

While far from perfect, the Affordable Care Act has been a good-faith step to rein in escalating costs, offer coverage for millions of fellow citizens (a number hard to conceptualize in Wyoming, perhaps) and relieve hospitals of excessive emergency-care expenses that threaten their abilities to serve communities.  Surely, no one believes the effort to make health care more widely available is done to aggravate the general population or turn hair prematurely gray? With all due respect to the Lone Ranger, his example is not how we will improve the situation, either.

More trust and compassion just might. My experience is that working as a team, with a good dose of listening and patience, goes a long way toward minimizing known problems. In this case, that would be supporting Wyoming as a unique and refreshing place to live, work and visit in the 21st century.

Now is the time for Wyoming people to come together to make that possible. Pushing the Legislature to recognize the majority support in Wyoming for Medicaid expansion is an important first step. But next we need to come up with solutions to the high costs of health care and insurance for all of our citizens. Perhaps a series of meetings around the state, carefully put together to focus on potential practical solutions, could help health-care experts, citizens, and legislators alike see what the next steps should be.

Sandy Shuptrine has lived with her family and worked, usually several jobs at a time, in Teton County since 1971.  She was a County Commissioner for 12 years, currently serves as a Teton Conservation District Supervisor, and is a strong supporter of an informed democratic process — Ed.

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  1. Instead of just asking our legislature “leadership” to stop politicking, it will be more expedient to VOTE THEM OUT. Each senator or representative should be checked for his (…or the few hers) vote and then just choose someone new, especially if the incumbent was leading the no medicaid expansion charge like Charlie Scott or Drew Perkins in Natrona County and even the “me, toos” like Brian Boner in Converse County. Yes, that might mean not choosing the “R” – but there’s a first time for everything, folks!

  2. I think the hard left and the far right of the “not so great generation” are both equally guilty of Zooming Out and allowing a generally inferior and absurdly expensive health care system, compared to the rest of the educated world. Young people should be demanding that it is time to “zoom in” on how to manage a system that has become too expensive for people, states, and governments. Or move to ski towns and become apart of the working poor generation.

  3. Richard O’Gara is right to drill down to the root of our health care insurance problems — the cost of our health care.
    As for the “larger pool” solution: yes, it would spread our risk and prices out, but it would require other people with cheaper health care systems to subsidize us. I don’t see other states lining up for that. Insurance Premiums are set locally based on local costs. A national single-payer system seems to be the solution.
    Medicaid expansion isn’t a complete solution, but achieves several good things, including the health of low-age workers, the fiscal health of hospitals and providers, injection of millions of dollars into our struggling local economy and the benefit of everyone else who bear the cost of an insured population.

  4. Until Wyoming legislators realize that the healthcare costs in Wyoming are forcing many of its senior citizens to leave the state in search of lower health insurance premiums, we will continue to lose some of this states most productive citizenry. When workers are forced into early retirement due to employers shutting businesses down or job layoffs, many soon find that insurance costs are prohibitive to living here. States with lower rates become much more attractive for long term residency. When insurance premiums in Wyoming are competitive, most of us would choose to start here.

  5. Actually having a few free minutes to read all three of the articles concerning health insurance issues in Wyoming was an unexpected pleasure this afternoon. All authors had valid points, but the overall theme was that Wyoming can, in some fashion, fix its health care problems from within and that I think is an unrealistic assumption. Viable and affordable insurance requires, for just about any type coverage, a large population which allows underwriters to spread the risk of claims across a large pool of insured. Wyoming, obviously does not have a large pool to spread that risk and thus, high insurance premiums. Nothing new here but it is a permanent structural flaw which Wyoming cannot fix from within. Our population is not going to grow at any meaningful large rates of increase at anytime as far into the future as one would care to peer. A possible solution would be for the federal government to mandate that Wyoming be placed in a pool with a number of its surrounding neighboring states thus giving its citizens access to multiple suppliers of health insurance at, hopefully lower rates. While this may address the health insurance premium issue, it does not address the larger issue of sky high medical care costs and the continuing prospect of such costs increasing at unsustainable rates well into the future. I have had the pleasure over the past 10 years or more, to visit with and listen to a large number of Wyoming medical doctors and medical professionals discuss the very issues discussed herein. The interesting and compelling result was that when speaking “privately”, there was almost universal agreement that the only path to reining in health care costs was to move, as quickly as possible, to a national single payer system. Again, a solution from without, not within, Wyoming and one, that of course, rubs Wyoming citizens raw.

  6. Medicaid expansion makes dollars & sense. Political posturing with other people’s lives, makes Wyoming look mean. We are better than that, but legislators need to hear from constituents.