RYAN TAYLOR: Medicaid and North Dakota Healthcare

Real people, real issues, real close to home.

In October, 2010, I was campaigning for my third term in the North Dakota senate in the town of Rugby, the biggest city in my district with a population of 2,900 people. I was going door to door–introducing myself, leaving my brochure, asking to earn their vote. This particular afternoon, I was at one of the mobile home parks, and I came to a home with a young girl outside raking leaves. She said her dad was inside, so I knocked on the screen door, saw a young father inside peeling potatoes with a toddler nearby, and I said, “Hi, I’m Ryan Taylor, I’m running for the state senate. I just wanted to visit a bit and hopefully ask for your vote.”

He stopped what he was doing, looked up at me and said, “Are you Bud’s boy?”. Coming from a fella so much younger than my dad, younger than me, stopped me cold. I said, “Yeah, I am Bud’s boy.” He said, “I used to take care of your dad.” You could have knocked me over with a feather. My father had passed away about five months before, after spending a year and a half in long term care at the Rugby hospital with advanced Parkinson’s, dementia and the many difficulties of age. I visited Dad regularly and knew many of his caregivers, but this kind young father worked the night shift and I had not had the honor of meeting him.

He invited me in, and I sat down and visited with him a good long while about Dad, his work at the hospital, his new work at the manufacturing plant where he had just changed jobs, his family and some of our work in the senate. It helped me realize that when we discussed things on the senate floor like ‘FMAP’  and reimbursement rates for Medicaid and our long term care providers, we were talking about the care for my father and the other residents, half of whom, on average, depend on Medicaid for that care. It was about the wages this gentle caregiver would earn to do that physically demanding, emotionally difficult work and support his family. It was about the very financial viability of that rural hospital and clinic, the largest employer in my rural senate district. Medicaid hits close to home.

Now, far from home, after working behind closed doors and in the dark for several weeks, the U.S. Senate has now come out with their ideas to re-vamp health care and health insurance, including Medicaid, in the United States. Thirteen men have authored a proposal that will impact one-sixth of the U.S. economy–without hearings. It has become clear why the plans were kept under wraps: the proposals from the Senate make deep cuts to the programs that help us all care for the most vulnerable in our society: children, pregnant women, people with disabilities and seniors in long term care. The Senate cuts to Medicaid are even deeper than the cuts that passed in the House version last month.

The health reform proposals fundamentally change the Medicaid system. Medicaid has been in place for nearly 52 years. Many of us have lived our entire lives knowing that there is a safety net that will help to hold up those of us with the fewest resources and some of the toughest health challenges. The proposals take away the guarantee that the federal government will contribute a certain share of care for each person who needs it. In its place is a proposal to place a per person limit  or “per capita cap” on the federal share. How this plays out is that care will have to be cut, or a state budget will have to fill in the gaps. At a time when the North Dakota Legislature has just made significant budget cuts and the majority Republicans refused to even revisit previous tax cuts to out of state corporations and oil companies, things do not look good for the 118,000 people that we care for through Medicaid or Medicaid Expansion.

If the Senate bill passes, and then passes the House and is signed by the President, North Dakota will have some unsavory options to try to make up for cuts. States could raise taxes (unlikely), make other budget cuts (unimaginable for colleges, local governments, and agencies already hard hit), reduce Medicaid “optional” benefits through waivers, limit coverage of high cost enrollees, or reduce rates paid to providers including hospitals, doctors and medical caregivers, clinics, schools, and more.

No matter which version, House or Senate, of health care reform is considered, cutting services or limiting the numbers of people who can receive services will be a fact of life or death for these people who receive care thanks to Medicaid:

  • About 1 of 3 kids in our state who can be seen by a doctor when they’re sick, including children with special and complex healthcare needs
  • About 1 of 3 people with disabilities
  • Half of all people living in long term care facilities
  • 19,000 North Dakotans who are covered under Medicaid Expansion, about 58 percent of whom live in rural areas

Medicaid Expansion, by the way, would be totally phased out over 6-7 years. Cutting Medicaid Expansion could burden North Dakota hospitals with $542 million in loss of revenues and $24 million in uncompensated costs as it gets phased out. This could be a life or death situation to our rural hospitals like the ones I supported as state director for USDA Rural Development, who have rallied under Medicaid Expansion, but could find themselves back on life support. Hurt yet again would be Indian Health Service facilities in the state who are already under-funded. Medicaid Expansion reimbursements have allowed them to add staff and become more stable. Losing Medicaid Expansion would send them backwards.

Backwards: who would think that in a country as strong, advanced and admired as the United States, we would even think about going backwards when we have been taking care of each other for over half a century. Backwards: that is what these proposals are. Senator Heitkamp has pledged not to vote for bills that would take us backwards. Wouldn’t it be grand if Senator Hoeven could link his arm across the aisle and be part of a team of two U.S. Senators working for North Dakota’s people first. If you think that is how we should move forward, please contact Senator Hoeven’s office and let him know that.

 

Guest post by Ryan Taylor, former state senator. Written with Karen Ehrens, health and healthcare advocate.

Carlson Continues Vindictive Behavior Over Committee Chairs

While the issue at hand for Legislative Management yesterday was to determine how to handle Governor Burgum’s vetoes, Rep. Al Carlson retreated to his usual vindictive behavior on a separate topic. Carlson attempted to remove Senator Erin Oban as Chair of the Interim Education Committee. This is his second attempt to block Democrats from chairing committees. Both attempts have been voted down in bipartisanship.

Rep. Carlson is not good at hiding the fact he is still bitter about losing the Chairmanship of the Legislative Management Committee in 2015 and again in 2017 to Senator Ray Holmberg. Holmberg garnered the support of Senate Republicans and Democrats in both the House and Senate. He did it by promising a return to the tradition of the interim committee work. The traditional way of thinking that studying issues and challenges should be removed from partisanship. Who strayed from that tradition? Al Carlson. Holmberg was willing to put decency and partisanship aside for production and progress on matters important to North Dakota. A majority on the committee agreed with that approach.

For a better understanding, look at Carlson’s actions following the interim Human Services Committee work from 2015-2017. He and his cronies in the House voted against the bipartisan committee report and recommendations because it was Chaired by Democratic Rep. Kathy Hogan. Then during the regular session, he removed Hogan from Appropriations and placed her on committees he thought she’d be less effective on. Few of the solid recommendations brought by the interim committee were adopted.

Carlson always tries to justify his bitter, vindictive, partisan behavior. Then he has the audacity to accuse the Democratic lawmakers of being the ones who play politics. So why does Carlson say he wanted Senator Erin Oban removed as Chair of the Education Committee? Get this, because her husband is Executive Director of North Dakota United, the state’s teachers union. A conflict of interest he claims. He wanted Oban, who was a teacher, to be replaced by Rep. Mark Owens who until this session never served on the Education Committee. Clearly, Carlson doesn’t care about experience, only the party affiliation.

A conflict of interest because of what your spouse or family member does for a living? That’s new. Does Carlson feel that way about Senator Dwight Cook whose wife works in the Tax Department while he Chairs the Senate Tax Committee? Does Carlson feel that way about Senator Dick Dever whose son works in the Department of Commerce and whose wife worked for the Legislature? Does Carlson feel that way about Rep. George Keiser whose wife works at the Ronald McDonald House and frequently testifies before the Legislature? I don’t mean to bring this to your attention for malicious reasons. I’m sure they all do great work in their jobs. Not once has this concern been raised before by Carlson. Know why? Because it shouldn’t matter. 

Cooler heads prevailed, and Carlson was defeated yet again in the Legislative Management Committee. The interim committees chaired by Democrats and by Republicans can get back to the tradition of working and studying together. Carlson can round up his House followers and vote against the committee reports chaired by Democrats in two years and continue his tradition of petty partisan politics above good public policy recommendations. But first, Carlson needs to win reelection in a town tired of his behavior.

Family Farmers Oppose Massive Cuts to SNAP Budget

Family farmers joined the CEO of the Great Plains Food Bank on a farm near Amenia, ND today to give their opposition to proposed budget cuts to the SNAP budget. President Trump’s budget contained $193 billion in cuts to SNAP over the next ten years. Congress is now considering the budget. The event was held to spread awareness and call for bipartisan negotiations on food security.

The current Farm Bill expires in September of 2018. Under President Trump’s proposal, 25% of SNAP’s funding would be shifted onto state budgets in the next Farm Bill. As I’ve stated before when it comes to transferring Medicaid funding onto state budgets, North Dakota is in no fiscal position to undertake this additional funding. Without the available budget, the legislature might not be inclined to fully fund what is necessary leading to cuts in security.

According to Brandon Delvo of Farmers Union, approximately 27,000 North Dakotans live with hunger daily. Steve Sellent, CEO of Great Plains Food Bank, said: “Many North Dakota children, seniors, and adults are still missing meals and proposed cuts to the SNAP program would have a devastating effect on tens of thousands.” Food security is essential for these families to prosper and become more independent.

The event was held at Bill Hejl’s farm and organized by Ryan Taylor, former State Senator and USDA Rural Development State Director. Taylor has been to Washington D.C. to speak with North Dakota’s Congressional Delegation about the budget changes. We’ve seen a growing divide between rural and urban America. A recent poll in the Washington Post showed residents of each view the other as not holding the same values. Taylor said he believes the Farm Bill is a chance for not only rural and urban residents to come together, but also Republicans and Democrats.

Senator Hoeven And Senate GOP Are Keeping Us In The Dark

Demand transparency. Your Healthcare is at stake.

Attorney General Opinion States Governor Burgum Overstepped his Authority

News breaking out of Bismarck this afternoon is Attorney General Wayne Stenehjem issued an opinion stating Governor Doug Burgum overstepped his authority. The opinion comes after House Majority Leader Al Carlson’s request to see if Governor Burgum’s vetoes after the 65th Legislative Session adjourned were constitutional. The opinion means action will likely be taken.

It will be interesting to see how the Legislative leadership decides to handle this news. Rep. Al Carlson and Senator Rich Wardner have already discussed calling their members back to Bismarck to attempt and override Burgum’s vetoes. They decided they’d wait for Stenehjem’s opinion. Well, now they have it. I’m sure Carlson feels vindicated.

The thing that is important to keep in mind is the Legislature only has three days remaining to meet until 2019. Carlson and Wardner publicly stated they intended to keep ten legislative days at the beginning of the session. Unfortunately, what has become routine is mismanagement and petty squabbles that drag out the session. If Carlson and Wardner decide to attempt veto overrides there will only be two days remaining.

Why only having two days left is significant is because legislation requires three days to go through the proper process. In other words, if a dramatic policy shift occurs federally – think health care reform – then the legislature cannot call themselves back to address it. It would require the Governor to call a special session.

Of course, the other option could be action through the Courts.

We will have more at ND xPlains as the story develops.

Polling Intended to Build Up Kevin Cramer

I’ve had some readers tell me they have been called to take a poll over the last few days. Judging by the volume of people I know who have received the poll indicates it is a decent sample size. One of those individuals said, “it was obvious they were building up Kevin Cramer.” Apparently, the poll is being conducted by Central Marketing Research. Below is what I’ve learned from a couple of people who have taken the poll.

Kevin Cramer really wants you to know he does town halls. In fact, it seems like that is one of the top items he intends to run on. I’ve pointed out before, Cramer is padding his stats here. Some are town-hall-in-name-only because sitting on a radio show with a friendly right-wing host shouldn’t count as a town hall. He obviously views this as one of his strengths.

Cramer is also trying desperately to spin one of the many unpopular positions he took at the beginning of this year. You may recall in January, the Republican-led House of Representatives unexpectedly voted to weaken the independent ethics office. Cramer joined those trying to gut the ethics rules for the incoming Congress. Less than 24 hours later, after pressure from the public and President Trump himself, House Republicans reversed their vote. Some have asked why Cramer wanted to weaken ethics oversight of Congress. They often point to the fact he paid his wife and at one time his children using campaign donations. By including the question in this poll, he is clearly worried of his earlier vote.

The poll asked favorable and unfavorable views of Rick Becker, Rick Berg, and Tom Campbell – all of whom have shown interest in running against Heidi Heitkamp who was also included in the poll. It is interesting to note all three of them likely have the ability to self-fund a campaign. Becker from his plastic surgery business, Campbell from his farming operations (of which he’s received millions in farm subsidies), and Berg through his association with Goldmark Properties (though he has been ashamed to publicly admit it in the past).

It is not clear who paid for the poll. I’m inclined to think Cramer’s campaign is behind it judging by the message testing against Heitkamp and for Cramer. The other option could be the Senate Republican PAC. However, you should remember just two months ago Republicans began to grow weary of Cramer after repeated public blunders including criticizing women for wearing white pant suits and defending White House Press Secretary Sean Spicer’s remarks on Hitler. Republicans began to woo Tom Campbell who said he’ll run for whatever is available in 2018.

Regardless of whether Cramer or the Senate Republicans paid for the poll, we know the race will be one to watch. What will be very telling is next quarter’s fundraising reports. Heitkamp raised $1.6 million in the first quarter compared to Cramer’s $322,000. Will Heitkamp grow her cash-on-hand lead? Will Cramer find something to run on besides holding “town halls?” We’ll be watching.

Senator Hoeven Owes North Dakota an Explanation of the Secret Senate Health Care Bill

A lot of people thought the TrumpCare plan rushed through the U.S. House was going to be dead on arrival in the U.S. Senate. The plan, supported by Rep. Kevin Cramer, will push an additional 23 million Americans off of health insurance according to the nonpartisan CBO. Well, the effort to make massive changes to private health insurance and Medicaid coverage is potentially moving forward. A group of GOP Senators has been holding working meetings away from the public on health care reform. According to reports, they may wrap up their final bill this evening. Here is the kicker: Senate Republicans have no plans of letting the public see their changes. 

Why on Earth do our elected officials think it is somehow okay to make significant changes to something we all rely upon – like health care access – and keeping us in the dark? That is a question U.S. Senator John Hoeven needs to answer. Recently, people around North Dakota have asked, “Where is Hoeven?” They are not only referring to his silence on the health care overhaul, but also to the fact he has not held a town hall to interact with his employers, North Dakota citizens.

Here are a few more questions Senator John Hoeven should answer for us in regards to their health care plan:

  1. If the Senate health care plan forces an estimated 23 million Americans off of health insurance, will you vote for it?
  2. If the Senate health care plan raises premiums on older Americans, will you vote for it?
  3. Your colleague, Senator Bill Cassidy, estimates North Dakota would see a 400% increase needed in state dollars to fund Medicaid Expansion. Do you support pushing that burden onto the State of North Dakota?
  4. Will you vote for a bill if it makes insurance more expensive for 8 million veterans?
  5. You always talk about “Jobs, jobs, jobs.” If the Senate health care plan makes it more difficult for Americans to retain health insurance while switching jobs, will you vote for it?
  6. If none of these provisions are in the Senate bill, what is? There must be something negative you don’t want the public to see.
  7. Do you support the strategy of keeping secrets from the people who employ you?

We deserve these answers and to have a say in the policy that impacts each and every one of us. As I mentioned above, Senator Hoeven likes to focus on jobs. Health care makes up a significant portion of our economy. Those who are employed in the field deserve to know what the plan is and how it might impact their career. All of us as consumers deserve to know what is in the plan and how it might impact our long-term health.

Rep. Cramer Votes to Reduce Consumer Protection from Wall Street

While the James Comey hearing captured our attention yesterday, the U.S. House of Representatives passed the repeal of oversight for Wall Street institutions. Rep. Kevin Cramer has been a vocal proponent of the changes. The Financial Choice Act, as they’re calling it, would remove increased oversight of “Too big to fail” banks and diminish consumer protections created by Dodd-Frank (2010). To cover up this roll back, proponents point to the changes community banks will receive under the new law.

You may recall, Dodd-Frank was created and implemented after the 2007-2008 market collapse. The law’s intent was to prevent risky, deceptive, and unfair financial practices that, in part, led to the largest financial crisis since the Great Depression. Greater oversight of Wall Street and new consumer protections under the Consumer Financial Protection Bureau (CFPB) were key components of the measure. Both of these components are weakened under the act pushed by Cramer.

All of these pro-Wall Street and anti-consumer changes are pushed under the guise that the bill was intended to help community banks. Regulations and red-tape on lending for local community banks will be reduced. That is a good thing. However, if you want to help community banks simply do it. There is no need to couple these changes. The outright rollback of oversight on Wall Street alone is unpopular, and politicians like Cramer in Washington know that. This is why they placed the changes in the same bill.

The changes in consumer protection blatantly interject politics in the process. Instead of having the ability to rapidly adjust to the fast-paced changes of the financial sector, the bill would require Congressional approval to consumer protection updates. We’ve seen how fast things move through Congress in Washington even under one-party rule. Nor could the CFPB charge hefty fines for unfair and deceptive practices. Remember Wells Fargo created millions of fake accounts to receive customer fees. When they got caught by the CFPB, they were fined $185 million dollars. Under Cramer’s changes, the CFPB would not be allowed to do so in the future.

On top of weakening consumer protections, House Republicans want the CFPB to go through the appropriations process for funding. Currently, the CFPB is funded through a formula of transfers in the Federal Reserve. This allows a level of independence. Republicans have wanted this change since 2012. Add the impacts of campaign donations and the banking lobby, and it isn’t a stretch to wonder if consumer protection will be a priority under the new GOP rules. Just look at how they’d like to treat people with preexisting conditions with Trumpcare for example.

Congress could ease the burden on community banks like those in North Dakota. They can do that without rolling back oversight of the too big to fail institutions on Wall Street. In this bill, the smaller local banks are being used as cover to give big breaks to big banks. Don’t fall for the bait and switch.

Tribal Input on Next US Attorney for North Dakota is Justified

A report in the Bismarck Tribune states, “the five federally recognized tribes in North Dakota want a say in who becomes the next U.S. attorney for the state.” The U.S. Attorney’s Office plays a pivotal role in the prosecution of the most serious crimes committed on the reservations. I support the tribal request, but question why all of a sudden? The answer could well point to Drew Wrigley’s aspirations.

Drew Wrigley

You’ll recall current US Attorney Chris Myers was interested in continuing to serve. That desire was impeded when former US Attorney and Lt. Governor Drew Wrigley sent his own resume to the Trump White House. Now, Myers would need to succumb to appointment hearings and Washington D.C. politics instead of simply doing the job. Myers has decided against that which is a loss for North Dakota.

The partisan nature can already be seen from Senator John Hoeven who publicly supported Myers until Wrigley came along. Hoeven was quick to retreat and throw support behind his former Deputy Chief of Staff Wrigley. Maybe pause a moment before asking Hoeven to be a reference on your resume, he might quickly flip-flop and support the other applicant in the process.

According to Tribal members, they want to make sure the next US Attorney can communicate and be a reliable partner in prosecuting crime on the reservations. If that is the case, history is not kind to Wrigley. What I’m talking about can be viewed in a 2010 Government Accountability report to the Committee on Indian Affairs. The report was completed at the request of former U.S. Senator Byron Dorgan, who chaired the Indian Affairs Committee, after information from the Department of Justice (DOJ) on Indian Affairs was absent. The numbers in the report are compiled from 2005-2009 when Wrigley was US Attorney.

Below is the compilation of numbers from those years. I want to emphasize the “declination” rate. A declination by a prosecutor means they make the decision to decline to file criminal charges based on the results of a law enforcement investigation. During that period, North Dakota had the second highest declination rate in the country at 64%. Nearly two-out-of-three cases were declined by Wrigley’s office.

U.S. Department of Justice Declinations of Indian Country Criminal
Matters (2005-2009)

Following that report, the Tribal Law and Order Act, sponsored by US Senator Byron Dorgan, required the DOJ provide these number on a regular basis. Here are the results from 2011-2014. Links to the reports are included on the year.

  • 2011 : 161 referrals; 38 declinations, 24%
  • 2012 : 146 referrals; 61 declinations, 42%
  • 2013 : 146 referrals; 52 declinations, 36%
  • 2014 : 188 referrals; 52 declinations, 28%
  • Totals: 2011-2014: 641 referrals; 203 declinations, 32%

Tim Purdon

As you can see, the declination rate was cut in half. The US Attorney during that time was Tim Purdon. It is no secret how Purdon did it. In fact, he wrote a law review article for UND laying it out. It wasn’t that attorneys in the office started to care – they had always cared. It was the reallocation of resources in the office and more time spent on the reservations themselves to make sure the investigations were thorough and complete so that prosecutions for crimes committed could be pursued. In other words, partnership, priorities, and reliability made the difference which is exactly what the tribes want in the next US Attorney.

Take that past from 2005 to 2009 and then reflect back on the handling of the Dakota Access Pipeline protest. Former Governor Dalrymple and his Lt. Governor Wrigley didn’t even go down to communicate with the tribe before things escalated by out-of-state protesters. They made it a point to talk about the situation to editorial boards and on radio programs, but not with the tribe. It doesn’t appear much has changed over ten years.

To be clear; this isn’t about partisanship. The US Attorneys Office should not be about personal politics. We shouldn’t see this position campaigned for in the opinion sections of our area newspapers. Unfortunately, that has been the case in recent months. This is about results. The numbers are clear in this case. For those reasons, I get why all of sudden the five federally recognized tribes want to be heard in the selection of the next US Attorney for North Dakota. Wrigley put his own name out there and they maybe don’t want to see him appointed again. The tribes want a partner who will do the job, prosecute crimes, and keep their children safe.

Western North Dakota is Better Served When Different Views are Heard

I spent last week in Western North Dakota. The trip was set up because I was invited to speak at a gathering in Dickinson. 2014 was the last time I had been there when I ran for the Public Service Commission. I couldn’t pass up the opportunity to visit since so much has changed in those three years. Here is a recap of my observations.

The Tuesday night event in Dickinson was hosted by area Democrats but open to the general public. Ellie Potter of The Dickinson Press wrote about the panel discussion. After losing reelection last year, I have left behind any official capacity within the Dem-NPL so I wasn’t sure my input would was warranted. It didn’t deter the hosts from having me as they’re simply looking for different perspectives on what took place in the Legislative Session that otherwise might not be heard in western areas. It was a pleasure to participate. Following the event I spent a couple of days visiting with others over coffee or at happy hour.

Democrats have not fared well electorally west of Jamestown. Because of that, Republicans have had a monopoly on the dialogue in Western North Dakota. Perhaps that is more pronounced in Dickinson since the NDGOP Chair and the Senate Majority Leader both call it home. Devoid of perspectives different from the manufactured talking points created by advertising agencies and delivered by politicians can skew reality. The result is Western North Dakota receives the short end of the stick but are being told otherwise.

So what are our western neighbors hearing when the narrative isn’t being challenged? They’re hearing the Legislature has been prudent and weathered the current budgetary storm well. That Western ND is stronger under their sole leadership. That Democrats would have been awful for western counties. That the budget shortfall is because of factors outside of the leadership’s decisions in Bismarck.

Here is my challenge to the narrative being spun. The Legislature has not been fiscally prudent and the budget they passed this year to get us through the next two is unsustainable. If you thought the cuts to services, like the rural maintenance shop in New England south of Dickinson, and the rise in your property taxes (which you won’t notice until after the 2018 election) were bad this session, wait until 2019 if we don’t have a dramatic surge in economic activity.

Western ND had grown rapidly as oil prices were high and with it came growing pains. The Legislature failed to adequately address some of those pains because they wanted too much control in the Capitol in Bismarck. It is not enough to simply campaign on local control. In fact, Dem-NPL legislators moved to allow western oil-producing counties to keep more of the oil tax revenue to address their own rapidly developing challenges. There was no need for county and city commissioners to travel to Bismarck hat-in-hand and beg legislators for more assistance every two years. Instead, central and eastern Republicans refused, and western legislators caved. At least they’d be able to take a photo opportunity with a big cardboard check that they’d later use in campaign materials.

The budget shortfall is due to external factors and fiscal mismanagement in Bismarck. The dramatic increases in spending coupled with arbitrary tax cuts were unsustainable. Republican leadership was warned about this but ignored it. I’m not saying that as a former Dem-NPL legislator, I’m saying that as a voter. The voting public in ND rejected some of the tax cuts the legislature eventually passed on their own. They didn’t listen to you. Now it appears we are over reliant on one commodity for the budget.

Here is the thing; a good, honest, debate to better Western North Dakota won’t be had unless the North Dakota Democratic-NPL makes a good, conscious effort to connect with those neighbors. Just as I’ve criticized the national Democratic Party for ignoring states like ours, I need to criticize the state party for its lack of effort in western districts. The difference between the two is the lack of resources from the state party. I’m told there are efforts at both levels to correct this practice.

The monopoly of the debate doesn’t serve the general public well. Misleading claims go unanswered. Without having other views on the state’s functions readily available, elected officials can act without accountability. Having both sides of an honest debate leads to better outcomes in the long run. I look forward to continuing that conversation here.