Opioid epidemic in Utah

In Utah, and across the nation, we have seen the rise of an opioid epidemic that continues to explode exponentially. It is a topic we have been uncomfortable discussing, but is clearly an issue that must be discussed.

There have been a few legislators locally and nationally who have tackled the opioid epidemic head on. We applaud their efforts – and recognize that there is much more that needs to be done.

In some ways America’s approach to the opioid problem is similar to the famous poem written by Joseph Malin in 1895 titled, “The Ambulance Down in the Valley.” You remember the story of the tiny town, which boasted of a mountain lookout with magnificent views of the valley. While the scenes were spectacular, the cliff was unacceptably dangerous. Many local citizens and passing visitors alike had tragically fallen from the cliff to the valley below.

Some of the citizens in the town advocated for putting a fence around the cliff, but others more persuasively made the case for simply parking an ambulance down below in the valley.

“For the cliff is all right, if you’re careful,” they said,

“And, if folks even slip and are dropping,

It isn’t the slipping that hurts them so much

As the shock down below when they’re stopping.”

So day after day, as these mishaps occurred,

Quick forth would these rescuers sally;

To pick up the victims who fell off the cliff,

With their ambulance down in the valley.

So, the citizens relied on the ambulance to deal with the ever-present and potentially lethal problem.

Then an old sage remarked: “It is a marvel to me

That people give far more attention

To repairing results than to stopping the cause,

When they’d much better aim at prevention.

Let us stop at its source all this mischief,” cried he,

“Come neighbors and friends, let us rally;

If the cliffs we will fence we might almost dispense

With the ambulance down in the valley.”

As it relates to our opioid cliff, we have added many new tools to the ambulance down in the valley, including vital overdose-reversing injections, needle exchanges, and counseling and rehabilitation programs for those who have become addicted. Unfortunately, we have done far too little to build the fence at the top of the cliff. It is time for a fence-building discussion between families, churches, legislators, doctors, health care providers and drug companies.

The opioid cliff is but one ledge where we would be wise to focus more on fence-building instead of ambulance production. Many of our state and federal programs designed to deal with poverty, homelessness, long-term unemployment, health care and hunger have spawned fleets of ambulances parked in the valley of government assistance.

As James Malin concluded, “To rescue the fallen is good, but ’tis best

To prevent other people from falling.”

We must get better at building fences in our communities, and when appropriate through government. In areas where we lack effective solutions, it is usually because we avoided the uncomfortable conversation.

For Sutherland Institute, this is Boyd Matheson. Thanks for engaging – because principle matters.

This post is an edited transcript of Principle Matters, a weekly radio commentary broadcast on several radio stations across the country. The podcast can be found below.

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Doctors

A glance at Utah’s Medicaid expansion

Activists have been pushing to expand Medicaid in Utah for some time now. Pressure to do so increased when a large portion of Obamacare was predicated on Medicaid expansion. Multiple legislative sessions in Utah held many debates – sometimes contentious – about whether the state should expand Medicaid, and if so, by how much. Full expansion was rejected, as was Governor Herbert’s Healthy Utah plan and the Legislature’s compromise bill Utah Cares.

Finally, in 2016 the Legislature passed a form of Medicaid expansion. It balances various stakeholder concerns regarding providing insurance to the neediest Utahns in a way that protects the taxpayer. Here is the new population covered by the expansion:

  • Parents with dependent children earning up to 60 percent of the federal poverty level (FPL)
  • Adults without dependent children earning up to 5 percent of the FPL who are:
    • Chronically homeless
    • Involved in the justice system through probation, parole, or court-ordered treatment for substance abuse or mental health treatment
    • In need of substance abuse treatment or mental health treatment

With the amount of money allocated to expansion, officials expected it to cover 16,000 people, but costs were underestimated. Since the funding is fixed rather than open-ended, there can’t be cost overruns like those feared with the previous expansion plans. Instead, about 10,000 people will be covered by the new expansion plans.

Since Medicaid is a federal program and the majority of the money comes from the federal government, Utah must ask permission to enact this change. Expansion was passed in early 2016 and then a public comment period was held throughout the following summer.

 

Click here to dig deeper into this issue at Utah Citizen Network.

Governor Gary Herbert and Pamela Atkinson launch the 2016 Homelessness Campaign

The Pamela Atkinson Homeless Trust Fund receives non-tax-deductible donations from individuals and businesses on their state tax form. All donations to the fund go directly to service organizations statewide. The annual tax campaign highlights the opportunity Utahns have to donate directly to the trust fund, which enables vital assistance and services to individuals and families experiencing homelessness.

Sutherland goes live on Utah Legislative Update radio show

Utah Senate President Wayne Niederhauser and Stan Rasmussen of Sutherland Institute (photo by @utahsenate)

Wayne Niederhauser and Stan Rasmussen (photo by @utahsenate)

Sutherland Institute’s Stan Rasmussen joined Senate President Wayne Niederhauser last week in the studio to talk about health reform and charity care on “Niedertalk” on KHQN (1480 AM).

Jim Fell of Pacific Institute for Research and Evaluation also joined the show via phone to discuss lowering the legal blood alcohol content level.

Carl Graham, director of Sutherland’s Center for Self-Government in the West, talked about a recent energy development study; and Dave Buer, director of communications for Sutherland, introduced our Utah Citizen Network.

Read the rundown and listen to the audio here at The Senate Site.

 

What does the Obamacare delay mean?

In recent weeks and months, many businesses and school districts both inside and outside Utah began cutting employee hours in order to avoid paying fines that Obamacare would require for businesses with more than 50 employees that do not offer health coverage, beginning in 2014. But in an unexpected announcement from the Obama administration, those employees and their employers may be catching a break … at least for a year. All other aspects of the law that have not already been modified by executive action will continue to be implemented on schedule (unless the administration decides otherwise, of course).

So what does this announcement mean for the Obamacare law? At this stage, nothing is for certain, but here are a few opinions on the matter:

The cost of Obamacare to taxpayers will likely increase. Because the “employer mandate” was the primary incentive employers had for providing health care coverage under Obamacare, many businesses will likely hold off on providing coverage for at least a year. But the health care exchanges – and the taxpayer-funded subsidies for health care coverage that come with them – will still be launched this fall. The likely result will be that many who would have gotten health insurance from an employer under the employer mandate will instead be subsidized in the exchanges, increasing the cost to taxpayers.  Read more

How authentic charity care can work for Utah

 

We mentioned on this blog a few weeks ago that the cost of Medicaid services continues to escalate here in Utah and across the nation. This upward trajectory is not expected to change anytime soon. Although we support the use of block grants to address the Medicaid status quo, an even better solution to addressing the needs of indigent and uninsured Utahns is the concept of authentic charity care.

Authentic charity care is “medical care provided to those in need without cost to the patient and without payment or government reimbursement to providers … [and] relies on the volunteer services of medical professionals and the voluntary contributions of private donors.”  Read more

Defining necessity

 

I have seen an image going around Facebook that will make you think twice about your holiday spending. It juxtaposes a photo of obviously starving children, holding out their hands, with a photo of harried shoppers with arms and carts overflowing with electronic goods and toys. The caption says “DEFINE NECESSITY.”

Ouch – a punch to the gut. (Even for someone who’d rather pull out her eyelashes than go shopping on Black Friday.)

[pullquote]We should probably choose to give to those in need, whether in Africa or in our own communities, but ideally using the most direct means possible.[/pullquote]Then the devil’s advocate in me whispered: If those women weren’t buying those consumer goods, would that help the starving children? Is it possible that the United States’ huge appetite for spending somehow helps the Third World?

Well, perhaps. Many economists with far more education and experience than I have wrestled with similar questions. The world economy is incredibly complex, and various barriers to free trade certainly play a role in extreme poverty. Two other factors also loom large: political corruption and war. Read more

Turn Medicaid hot potato into a block grant

 

Source: Governor's Budget Recommendations, FY 2011

Despite the ongoing debt and deficit battles in Washington, our national leaders need to work together to address a political hot potato – Medicaid – to help get the nation’s fiscal house in order. For Utah, implementing a block grant to fund Medicaid is the way to go.

[pullquote]Block grants provide more flexibility to states in structuring Medicaid programs to match the unique needs of their residents. [/pullquote]Let me explain why.

Growing at 7 percent annually, Medicaid is the health care system for the country’s poor and disabled. In 2009, the federal government paid 66 percent of the $380 billion total outlay for Medicaid – which is now the single largest source of federal funding to the states. In turn, the states typically spent 16 percent of their general funds for Medicaid, second only to K-12 education. Read more

Don’t chop tax breaks for charitable contributions

 

Should government continue to give people tax breaks for donating to charities? Elder Dallin H. Oaks, member of the Quorum of the Twelve Apostles of The Church of Jesus Christ of Latter-day Saints, thinks so.

In response to more than a dozen proposals in Congress to reduce or eliminate charitable deductions, Elder Oaks testified yesterday before the U.S. Senate Finance Committee that “[t]he charitable deduction is vital to the private sector that is unique to America.” After making strong arguments to support this statement, Elder Oaks concluded with the following: Read more

Stepping up as conservatives to help Utahns in need

 

While I was waiting for a flight out of Salt Lake City, a young man, waiting for the same flight, sat down next to me and initiated a conversation. I soon found out that “Theo” was headed to meet his mom, whom he hadn’t seen in a while. I also learned he has Asperger’s syndrome, a high-functioning form of autism. I asked him how his disability was manifest and he said he struggled socially – which I thought was interesting because he had initiated our conversation. He said he used to have a hard time looking people in the eyes when he talked with them. He stammered a bit, almost nervous, but we had a delightful conversation. When we arrived at our destination he introduced me to his mom.

“Theo” lives in Birmingham, Ala., but his divorced parents both live in New Orleans. I asked why he lived away from his folks, and he replied, “Because that’s where I could get treatment for Asperger’s …New Orleans has nothing.” What “Theo” meant was that New Orleans didn’t have any public assistance programs to help him, whereas Birmingham did. Read more