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 Sen. Enzi will be talking to a Cheyenne civic group via video tape today. The video covers the many issues concerning health care in Wyoming, such as, affordability, medical malpractice, and accessibility. The Sen. also discusses what he is doing to promote Wyoming's issues in health care to the rest of the country.

Leadership Cheyenne was created through the Chamber of Commerce to identify prospective and current community leaders, learn more about the community, gain networking opportunities, exposure to additional leadership skills, and understand civic trusteeship.

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Below is the script of the video:

Thank you for inviting me to speak with you tonight about the state of healthcare in Wyoming. I wish I could be with you, but the Senate is in session and I have to be here in Washington.

Many of the challenges we face with healthcare in Wyoming have to do with the nature of where we live. Ours is a rural state, and because of this we face a number of unique difficulties with respect to the accessibility and affordability of health care.


Let's talk about affordability first. Many of our state's citizens don't have the health insurance they need to make routine visits to their doctors, let alone to specialists. Extending health insurance coverage to Wyoming's uninsured is a major priority of mine.

Out of the 50 states, Wyoming ranks number-36 in the percentage of population without insurance, and number-47 in the percentage of businesses that offer health insurance to employees.

As you probably know, small businesses are the lifeblood of our economy in Wyoming, but they're the businesses that have the most difficulty finding affordable health insurance options for their employees. If a small business can't provide health insurance, then its employees have two choices - go without it, or try to buy a policy on their own. Buying insurance on your own is more expensive than buying as part of a group, so you can see why we have so many uninsured citizens in Wyoming.

I believe that if we can find a way to increase the ability of small businesses to offer health insurance, we will decrease the number of uninsured in Wyoming and across the nation.

I'm looking at a number of ways to help small businesses provide health insurance to their workers. I'm looking at refundable tax credits, medical savings accounts, association health plans, and some other ideas. None of these provides a complete solution, and each has its own shortcomings. However, taken together they are a good starting point. Doing nothing is not an option.

It is clear in everyone's mind that health care is not getting any cheaper. There are several different reasons for this, but there are no easy solutions. The biggest reason for increased costs are new technologies, new treatments and new medications that didn't even exist ten or twenty years ago. They are expensive but without them you die. And their use is commonplace today.

The number of health insurers in Wyoming has continued to decline, while the number of uninsured has increased. Every time we do something legislatively that requires more paperwork, the cost goes up. Each time the cost goes up, more employers are forced out of the market. These combinations have made it even more difficult to find affordable health insurance for many in Wyoming. Finding solutions that can lower the cost of health care and provide people with innovative solutions has been a priority of mine in the Senate.


Another way I'm trying to keep healthcare affordable is by reforming the medical litigation system. There have been a lot of stories in the national news lately about this, but those stories are not isolated instances - they are symptoms of a nationwide crisis.

When a doctor is accused of malpractice, even if they are held blameless, it can cost hundreds of thousands of dollars to defend them in court. As punitive damages awarded in court cases continue to climb, so does the cost of providing this insurance. Since doctors have only one source of revenue, they have no choice but to try to pass the cost of malpractice insurance on to the consumers and then on to the insurance companies that pay for health services.

If a doctor has to pay $150,000 a year for insurance, and I'm hearing from more and more who have to pay that or more - and they have never had a lost claim, but others in their specialty have, and the costs are shared. That's what insurance is about - sharing risks. But they pay $150,000 a year seeing 3 patients an hour, 40 hours a week. They work more than that, but much is hospital visits and follow-up - and they do that 50 weeks a year, and $25 of each visit goes to pay for insurance. WOW! This makes health services more expensive and makes health insurance premiums higher as well. This is a situation that threatens to spiral out of control as more and more malpractice suits are filed.

Just the other day, there was a story in the Washington Post about the crisis in Wyoming. There are only two firms left in Wyoming who provide liability insurance to physicians, and the premiums for doctors in Wyoming are two to four times more expensive than those for doctors in California. It's hard enough to recruit physicians to Wyoming as it is, and huge liability insurance premiums don't make it any easier.

As a result of all of this, Wheatland and the surrounding communities just lost their only obstetrician. A woman with a complicated pregnancy now has to make almost a three-hour round-trip drive to Cheyenne to get the specialized treatment she needs. This is the price we all pay for a system that encourages frivolous lawsuits and unlimited damages. We need to put a stop to it.


I will also work toward strengthening Medicare and adding a prescription drug benefit to the program. This also is a priority of the President's, as you heard in his State of the Union address.

The fact that Congress has to pass a law to add a prescription drug benefit is part of the problem with the Medicare system. Medicare is not flexible enough to self-adjust and adapt to the complex and constantly changing nature of health care delivery. Prescription drugs play a much greater role in treating disease today than they did when Medicare was created nearly four decades ago - but unlike private health plans, Medicare has not changed with the times.

We need to update the Medicare benefit package and enable the program's offerings to advance along with advances in healthcare practice. At the same time, we need to act to preserve Medicare for future generations. Already, 30 percent of Medicare funding comes from general revenues - and projected expenditures are expected to exceed projected tax and premium revenues after 2015. We need to act now, before the first wave of "baby boomers" hits the system hard and a Medicare crisis is upon us.

As a businessman, I am naturally predisposed to market-oriented solutions - but I recognize that the healthcare marketplace is not the most rational of markets. In fact, if an economics professor chose the healthcare marketplace for an Economics 101 course, I guarantee that he or she would lose his students completely by the end of the first week of class.

I also recognize that Medicare was established in the first place to provide healthcare security to a group of Americans who didn't have many options in the private health-insurance marketplace. For these reasons, the particular healthcare needs of the elderly who live in rural and frontier areas cannot be addressed with market incentives alone.


For instance, many of the Medicare reforms under discussion are based on expanding the role of managed care. Unfortunately, managed-care organizations are complaining that their reimbursement is too low, and they have been dropping out of Medicare in droves.

Only 2.2 percent of Wyoming's population is enrolled in HMOs anyway, so it should be no surprise that there are no Medicare HMOs operating in Wyoming. If the best way for a Medicare beneficiary to get a prescription drug benefit is to enroll in a managed-care plan, then the senior citizens of Wyoming are not going to have meaningful access. I plan to work with President Bush and my colleagues in the Senate to ensure that Medicare beneficiaries in rural and frontier areas have equitable access to a new Medicare drug benefit.


Accessibility is the other big challenge we face. The rural nature of our state makes it hard to access healthcare services. In Wyoming, the challenge isn't choosing from a number of doctors in your community - the challenge is finding a doctor at all.

For example, an ambulance ride in Wyoming means a completely different thing than it does in Washington, D.C. There are 11 hospitals in D.C., which is a 61-square-mile area. There are 25 hospitals in Wyoming, which is an area of 97,000 square miles.

That's a lot more ground to cover, and it makes the cost of an ambulance ride much higher. The distances involved make ground ambulance services ineffective if there is a severe accident. Air ambulance services are much more expensive, though, and an emergency requiring a "Med-Evac" helicopter can cost thousands of dollars more than an ambulance ride.

To deal with this problem, I've cosponsored legislation that reauthorizes federal funding for the state trauma care system. This bill will help train medical professionals and prepare Wyoming health workers to meet the needs of our state by providing specialized emergency care. The bill gives special consideration to rural areas in order to address the types of problems I just described.


Some of the access problems we have in Wyoming stem from the challenges we face in attracting doctors, nurses and other health professionals to Wyoming. There are a number of reasons for this problem. First of all, many healthcare providers can make more money elsewhere.

Medicare underpays rural hospitals, home health agencies, and other providers, at least as compared to their urban counterparts, and this limits the ability for these providers to maintain their services and their infrastructures. This, in turn, hurts their efforts to recruit and retain qualified personnel.

I read a report that we had a shortage of every kind of medical provider, including veterinarians. Finally, a report that understands the West! This shortage of healthcare professionals translates into a shortage of access to both routine and urgent healthcare services. Platte County has as many veterinarians as it has physicians, so maybe the animals are facing the same problems we are!

I have to remind my colleagues in the Senate, all of whom hail from more densely populated states, that all of our work to improve the quality and reduce the cost of healthcare is wonderful - but it doesn't mean much for a Wyomingite who can't get healthcare when he or she needs it. Not everyone can hop in a car and drive more than 100 miles to see a doctor, nor should they have to do so.

I spend a great deal of time teaching the East about the West. For instance, when the Lusk hospital closed, I went to the Senate floor. I gave a rousing speech about the community that now has to travel an hour and a half for emergency medical care. I got no reaction. Then it occurred to me that a broken leg in downtown DC during rush hour is an hour and a half from the hospital. I went back to the Senate floor, gave the same speech, but mentioned that Lusk residents were now 110 miles from emergency medical care. My colleagues were appalled and in a state of disbelief. Distance is a foreign language in the East.

I also remind my colleagues that there is a big difference between rural America and frontier America. People consider southeastern Minnesota to be a rural area, and I agree - but the Mayo Clinic is right there in Rochester, Minnesota. The Mayo Clinic has 60 affiliated medical facilities all around a three-state region. Those are just a few of many "rural" areas that don't have to worry about reasonable access to quality healthcare.

I've been involved on these issues since I've been in the Senate. Last year, I worked on expanding the National Health Service Corps, which places doctors in rural areas. I've also worked to pass the Nurse Reinvestment Act, part of which also aims to encourage nurses to work in medically underserved areas.

I'm also working on the shortage of pharmacists as well, and a bill I sponsored last year passed the Senate. I will be re-introducing that bill soon.

In the Senate, I serve on the committee that deals with public-health issues, and now that my party has regained the majority, I am chairman of the subcommittee on employment. I plan to use my chairmanship to find some more solutions to the problems of shortages of health professionals and inadequate access to healthcare in places like Wyoming.

As current and future leaders in Cheyenne, you've probably got some ideas of your own on this, and I hope you'll share them with me.