Health Care

Put a Bow on It

Put a Bow on It - July 7, 2019

State Representative David Perryman

There are phrases that are used to illustrate that whatever you call something, it doesn’t change what it is. In Shakespeare’s age, it was “A Rose by any other name is still a Rose.” Some areas of the country say, “Put a Bow on It.” In rural Oklahoma, when we recognize that using fancy names and wishing on stars doesn’t change reality. Thus, “Putting Lipstick on a Pig,” doesn’t turn a stinking swine into a princess.

The reality is that Oklahoma’s state government has put us in a bind. Over the past dozen years, reckless cuts to mental health funding and education have placed us in a situation that will take decades to recover.

Allowing the oil and gas industry to destroy our highways, roads and streets and proliferate the occurrences of earthquakes has placed a repair burden on counties and municipalities that they cannot pay.

Barring the ability of local government to protecting their citizens from the devastating effects of oil and gas drilling activities adjacent to their homes has collectively reduced residential property values by millions of dollars.

Refusing to increase the percentage of Oklahomans who have health insurance from 49th (leading only the state of Texas) by accepting federal funds continues to devastate Oklahoma hospitals, ambulance services and ancillary medical services.

The list goes on and on.

Enter Governor Stitt who announced that he plans to make Oklahoma a Top 10 State. That is a laudable goal, but doing so takes more than just providing lip service. As Oklahomans, we are a proud people. It rubs us the wrong way when anyone criticizes our home state.

The first thing that Governor Stitt needs to do is get past the partisan rhetoric and accept federal Medicaid dollars that we are sending to Washington D.C. Currently, all but 14 states are doing so and those 36 states that are doing so are not facing hospital closures and the bankruptcy of ambulance services. Better health outcomes by allowing more Oklahomans access to health care is a prime example of how to put Oklahoma on a path toward becoming a Top 10 State.

Better health outcomes include improved mental health services and substance abuse treatment. Oklahoma ranks 3rd in the nation (22.4% of all Oklahoma citizens) for citizens having some degree of mental illness.  Also, Oklahoma ranks 2nd in the nation (11.9% of all Oklahoma citizens) for citizens having substance abuse disorders. That means that between 700,000 and 950,000 adult Oklahomans need services. Many of those would be eligible for services if Oklahoma accepted those federal dollars.

Another step toward becoming a Top Ten State would be to improve funding to Oklahoma’s public schools, particularly across rural Oklahoma, by curtailing low performing charter schools that advertise for students and have dismal graduation rates. In fact, for the 2016-17 school year, the state’s largest virtual charter school – Epic – had a 36 percent graduation rate. Insight had a 30 percent graduation rate; Connections Academy, 44 percent and the Virtual Charter Academy, 43 percent.

The statewide public school average graduation rate was 83 percent. It doesn’t take a rocket scientist to discern which the best bargain is.

Now the Lieutenant Governor wants to improve Oklahoma’s state slogan and to make Oklahomans spend billions of dollars again replacing Governor Fallin’s hideous “scissortail” license plates, tell them that Becoming a Top Ten State will require real change that will affect the quality of life of all Oklahomans and that the answer is not just covering the situation up with a pretty bow.

Thank you for allowing me to serve Oklahoma. For questions or comments call me at 405-557-7401 or email me at David.Perryman@okhouse.gov.

We Are Better Than That

We Are Better Than That - June 16, 2019

State Representative David Perryman

Most Americans, including me, don’t know how social media algorithms work or how posts from across the political spectrum show up on Facebook or Twitter or Instagram. Like most red-blooded grandparents, what I really want to see is the latest photograph of any or all of my eleven grandchildren.

Nonetheless, last week up popped a message that said, “If you do not support our president, please find a country whose leader you do support and MOVE there.” My first thought was whether the poster had sent a similar message during the administration of the last president? Of course, the current political and societal division is not the first time that this sentiment has been vocalized. Those of us who are past our late fifties remember the “America Love It or Leave It” slogan from the Vietnam War era.

My next thought centered on why anyone would choose to promote a black/white, either/or false dichotomy in a country that is founded on equality and freedom of expression and freedom of ideas. Rather than urging citizens to relocate them and their families to another part of the world, we should be looking at the hundreds of concerns that unite us like a common desire to have better roads and better paying jobs. Those are issues that we should focus on collectively.

It makes sense that the more Oklahomans that are around the table the more likely the proposed solutions would be relevant and viable and it is incomprehensible that Oklahomans, of any political stripe, are not united on these issues:

Health Care and Health Outcomes. Oklahoma ranks second highest in the nation for its percent of uninsured citizens and fourth in the nation for its percentage of uninsured children. Nearly one in seven (545,000) Oklahomans are uninsured. That is 14.2% of our citizens according to the Oklahoma Hospital Association webpage. Consequently, Oklahoma hospitals provide more than $592 million in uncompensated care annually. The Governor and the Legislature should put aside partisan bickering and enact a legitimate solution to this situation.

Untreated Mental Health Issues. Oklahoma’s rate of mental illness is second in the nation. One in five Oklahomans (more than 630,000) is suffering from some form of mental illness. According to a 2014 Report in the Oklahoman, Oklahoma trails only West Virginia for the percentage of residents with a severe mental illness, and only Utah in the percentage of residents suffering from mental illness of any kind and with budget cuts over the past four years, the situation has gotten worse. Right now the only proposed solution is to reduce the uninsured rate by accepting federal dollars (like we do for about 40% of the state budget) through the initiative petition process.

It is time for Oklahomans to call upon all Oklahomans to bring all solutions to the table. Currently about 40% of the Oklahoma budget is made up of federal funds that pass through to agencies. Additional federal funding is available that will help both of these issues. Accepting federal funds at the rate of $9 for every $1 that would be invested by the state legislature is a win-win solution that addresses both physical and mental health outcomes. That is one solution. We should be all ears from any others regardless of party affiliation. What we cannot afford is divisive rhetoric that does not come with solutions. We are better than that.

Questions or comments, please call or write 405-557-7401 or David.Perryman@okhouse.gov.

An Apple a Day

An Apple a Day - January 13, 2019

State Representative David Perryman

We have all heard the common saying, “An apple a day will keep the doctor away.” What most of us don’t know is that it devolved from the 19th century Welsh proverb, “Eat an apple on going to bed, and you’ll keep the doctor from earning his bread.”

Both the original proverb and its more modern transliteration, touted the benefits of a healthy diet including fresh fruits and vegetables. But a more literal interpretation of the original version would indicate that physicians, pharmacists and other health care providers could be negatively impacted when trying to earn a living in a healthy society.

In Oklahoma, we need not worry about that. There is plenty of work to do. Our urgent consideration should be to address the root causes of our dire circumstances. Whether we first consider the rates by which Oklahomans are covered by some form of insurance or rates which Oklahoma citizens partake of healthy diets and exercise or rates of immunization, or availability of health care, we find that Oklahoma ranks near the bottom both in virtually all categories.

For instance, the “Physician Access Index (PAI)” published by Merrit Hawkins, nationally recognized experts in the placement of health care workers, examined, on a state-by-state basis, 33 benchmarks and metrics, including demographic, economic, health insurance coverage, physician, nurse practitioner and physician assistant workforce factors, that influence and determine patient access to medical services. The latest edition of that Index shows that Oklahoma’s overall score ranks dead last among all states.

However, do all these bad numbers, low rankings and unhealthy outcomes really matter? For instance, it is difficult to tell by the voting pattern of most Oklahomans that over the past 26 years the life expectancy of Oklahomans has dropped to the point that our state’s life expectancy is shorter than any other state in the country except Kentucky, according to an American Medical Association Report issued in April 2018.

It is appalling that Oklahoma’s elected officials continue to ignore reality and avoid addressing problems such as high uninsured rates; low reimbursement rates; discriminatory pharmaceutical prices and scores of other factors that need their attention.

For instance, Governor Fallin constant refusal to allow the Medicaid program to be made available to working Oklahomans whose employers do not provide health insurance and whose income is not sufficient to cover the cost of health insurance costs. This refusal has negatively affected Oklahoma hospitals, clinics, ambulance services and health care providers across the board.

            In similar fashion, Oklahoma’s elected State Insurance Commissioner has undermined the benefits of the Affordable Care Act by failing to properly regulate the rates and coverages of health insurance carriers. Oklahoma voters allow elected officials to take campaign contributions, defer control of their department to their donors and abdicate their duty to protect citizens.

Oklahoma cannot expect healthy citizens if insurance and pharmaceutical companies continue to run the show with a focus solely on net profit and not on health outcomes. Our state’s frail system of health care providers will never be strong enough to improve health outcomes so long as the delivery of quality of health care is undermined.

Last fall and spring when Oklahoma needed three sessions to address ten years of educational neglect, Arkansas used three days to adopt legislation preventing predatory and discriminatory pharmaceutical pricing. Arkansas was looking out for its citizens and communities by allowing small pharmacies to receive fair reimbursement rates. Oklahoma needs to do the same. I have filed a bill patterned after the Arkansas legislation to prevent drug stores from being harmed by corporate prescription benefit managers. It is a step that needs to be taken. Insurance Companies and PBM’s should not favor corporate pharmacies and thereby prevent rural physicians and druggists from “earning their bread.”

Questions or Comments should be directed to David.Perryman@OkHouse.gov or 405-557-7401.

Careful What You Ask For

Careful What You Ask For

State Representative David Perryman

          The Christmas Season is upon us and for many, this time of year jogs family memories from decades ago. The holidays at my grandparent’s house were particularly full of life. In the late 1950’s they began using an aluminum Christmas tree that was marketed by a company in Wisconsin. For a little guy, it and the accompanying color wheel that splashed the tree with alternating shades of red, blue, green and amber, was a sight to behold.

Of course, the best memories are connected to cousins and aunts and uncles who came and went. There was Uncle Clarence who shared pockets full of lemon drops that he carried to keep his dentures from clacking.

Then there were the presents. Like the time that my grandfather who had four main goals in life: Maximize the yield on the wheat he grew; catch as many fish as possible as often as possible; make certain that neither the wheat nor the fish got in the way of dominos; and pull fast ones on as many family members as possible.

It was only fitting that the year he had asked for a shirt, that he opened a gift containing one that was “just like one I already have…smell and all.” Soon, after he realized that he was the butt of the joke, the unwashed shirt was replaced with his real gift, a brand new flannel to his liking.

In another case of “careful what you ask for,” Aunt Vivian and Uncle Edwin realized after they opened their third package containing a corn popper, that Vivian had probably mentioned that their old one had given up the ghost to a few too many people. Thank goodness for gift exchanges.

Unfortunately, some “gifts” are much more difficult to return. Currently the state’s health care infrastructure is in freefall and that fact is devastating to thousands of our fellow Oklahomans.

What Governor Fallin and the Oklahoma legislature have asked for is “savings” by not allowing more Oklahomans to enroll in Medicaid. The “gift” that Oklahomans are receiving from refusing to allow working Oklahomans whose employers neither provide health insurance nor pay wages adequate to allow the employees to purchase health insurance privately, is health outcomes among the worst in the country, an uninsured population that is among the worst in the country and rural hospitals and ambulance services that are being shuttered at rates among the highest in the country.

Uninsured Oklahomans hammer our state in two respects. The leading cause of personal bankruptcies are medical expenses and the leading cause of hospital closure is uncompensated care, defined as providing services for which payment will not be received. According to an October 2018 report issued by Wallethub, Oklahoma’s uninsured rate of 16.35% is second only to Texas.

Two reports released in the past week bear out the consequences. A Journal Record article reported that the United Health Foundation’s America’s Health Rankings show that Oklahoma’s overall health ranking dropped from 43rd to 47th, the largest drop of any state. Simultaneously, according to an Oklahoman article, March of Dimes report showed that more than half of all counties in Oklahoma are “maternity deserts,” defined as not having a hospital performing deliveries or an obstetrics provider.

With hospital closures and bankruptcies across the state, conditions are not likely to improve. Cities like Frederick, Sayre, Pauls Valley and Eufaula are learning first-hand how partisan choices destroy a community’s health care infrastructure and impact everything from health outcomes, to life expectancy, to economic development.

While Medicaid expansion may or may not be the solution, Oklahomans can no longer endure the consequences of leaders who “just say no” and do not provide leadership toward an alternative solution. It is now evident that we are getting just what they asked for.

Questions or comments, contact David Perryman at 405-557-7401 or David.Perryman@okhouse.gov.

A Path Toward Better Health Care?

A Path Toward Better Health Care? - November 11, 2018

State Representative David Perryman

Oklahoma’s health outcomes rank near the bottom of all states. According to an August 6, 2018, KFOR news story, WalletHub recently ranked the Best and Worst States for Health Care and the results were not favorable for Oklahoma.

Researchers analyzed data and weighed several factors like health care cost, access and outcomes to rank the states with the best and worst health care across the country. Overall, Oklahoma ranked 45th on the list. Oklahoma was one of the states with  the highest average monthly insurance premium, the lowest percentage of insured adults between 18 and 64-years-old, and one of the states with the highest percentage of adults with no dental visits in the past year.

Health care experts often look at the infant mortality rate as a key indicator to measure the health and well-being of a population. Unfortunately, Oklahoma does not fare well there either. Oklahoma’s infant mortality rate across all races has been growing since 2015 in Oklahoma and in 2017 was more than 30 percent higher than the national average. To make that worse, according to a January 2018 report, the mortality rate for black infants in Oklahoma is twice that of white and Hispanic infants.

Not only do more children die in Oklahoma, adults die earlier. For instance, there are counties in Oklahoma where the life expectancy is less than 57 year, or 22.5 years less than the national average. That means that residents of some communities in Oklahoma face a shorter life expectancy than in the Congo and only months longer than Uganda.

The list continues and Oklahoma fails. From dental care to optometric care to mental health care, an analysis of Oklahoma’s health care delivery shows no bright spots. Plain and simple, people in Oklahoma aren’t healthy and show no signs of becoming healthy.

These and scores of other low ranking categories fall into the category of health care. All indicators point toward a health care delivery system comprised of hospitals, clinics, ambulance services, nursing homes, immunization rates, and many other components that are not adequately delivering services to hundreds of thousands of Oklahomans who are underserved.

The fact that so many of our friends and neighbors are not receiving health care is not due to the state’s hospitals. Oklahoma has quality hospitals that deliver cutting edge medical treatment to their patients. Likewise, Oklahoma’s ambulance services and nursing homes employee staff, including professionals, who are well trained and able to provide quality care.  We have dedicated doctors and nurses.

What is the problem and what is the path toward a healthier state? One idea that has been presented is the expansion of Medicaid for those working Oklahomans who have no health insurance and no current health care coverage. That approach has been soundly rebuffed by Governor Fallin for the past 8 years.

The people of Oklahoma are now looking to a new governor and a new, larger legislative supermajority to have a plan and to put that plan into action. We need to give them that chance. But they must understand that time is a factor. It is a matter of life or death to many Oklahomans.

 

Questions or comments, contact David Perryman at 405-557-7401 or David.Perryman@okhouse.gov.

Economic Development and Health Outcomes

Economic Development and Health Outcomes - October 21, 2018

State Representative David Perryman

According to the Cecil G. Sheps Center for Health Services Research, since 2010, 89 rural hospitals across the country have closed leaving communities without healthcare. The study shows that five of those facilities are in Oklahoma communities like Frederick, Pawnee and Eufaula and mean that in rural Oklahoma there are 204 fewer hospital beds to treat patients who may not have the means to travel to the state’s urban centers for medical care.

That list is only the tip of the iceberg. Most every rural hospital in our state is operating on a shoestring budget. Many are teetering on bankruptcy and several like those in Sayre, Atoka, Antlers, Drumright, Ceiling, Fairfax, Prague and Stigler have either been declared insolvent, been placed in receivership or are currently operating under the supervision of a bankruptcy trustee.

The most recent closure occurred last week in Pauls Valley where 64 more beds were lost and area residents have to be transported to Purcell to the north, Sulphur to the south, Ada to the east or Chickasha to the west, assuming there is a functioning ambulance service available to make the trip.

There are a number of reasons for the current hospital and ambulance financial crisis. Insurance companies intercede with greater frequency and classify many more medical procedures to be outpatient procedures or otherwise substantially shorten hospital stays.

Decreases in the rates paid to hospitals by Medicaid and Medicare also impacts the facility’s bottom line.

Perhaps the most damaging issue faced by hospitals (and ambulance providers) arise out of what is called “Uncompensated Care.” In short, uncompensated care represents those services that are provided to a patient and for which the provider is not paid.

The primary reason that hospitals face the expense of uncompensated care is because a Reagan-era federal law requires that persons who are in need of treatment must be cared for without regard to whether they have insurance and without regard to their ability to pay.

Since the law applies equally across the entire country, one would think that hospital closures would be located consistently from coast to coast. The fact is that according to a study published in the January 2018 edition of the journal, Health Affairs, hospitals located in states that accepted federal dollars to pay Medicaid expenses for low income workers were six times LESS likely to close than in states like Oklahoma where federal funds were refused. Put another way, 90% of the nation’s hospitals that have closed since 2010 were located in states that had refused to expand Medicaid at the time that hospital closed.

The fact is that Mary Fallin is one of only 18 governors who have refused to allow Oklahoma to accept those federal funds. The other 17, like Oklahoma, are primarily in the southern U.S. The 32 states that did accept federal funds for Medicaid expansion have seen the uninsured rate drop by as much as 50%. Cutting the number of patients who cannot afford to pay for medical services by half is big in any state.

Other benefits include financially healthy ambulance services and medical related businesses that can only operate in the presence of a functioning hospital. Likewise, when more citizens are insured, the community enjoys healthier outcomes. But the most exciting part of Medicaid expansion occurs when a community’s economic development director can showcase the community to a potential business prospect and point with pride to a vibrant medical facility that can provide quality health care services to the CEO, his employees and to their families.

Questions or comments, contact David Perryman at 405-557-7401 or David.Perryman@okhouse.gov.

Feeling Pain in Too Many Places

Feeling Pain in Too Many Places - June 3, 2018

State Representative David Perryman

For those of us who didn’t end up pursuing a career in healthcare or any science related occupation for that matter, our high school physics and biology classes serves to provide us with our basic understanding of how the nature works. Words and phrases like “the coefficient of friction,” “photosynthesis,” “catalyst,” and “stimuli” were all given meaning in science class decades ago.

One of the postulates discussed in a class was that human beings can sense pain from only one body part at a time. We did simple experiments like biting our lips or pinching our legs and the theory did appear to have some merit.

Apparently an episode of House M.D. also explored that idea. The concept has been called “Ukhtomsky’s Doctrine of the Dominant” named after a Russian physiologist in the early 1900’s. Strangely, aside from a pre-Bolshevik era Russian and the fictional Dr. Gregory House, there is very little research about the subject.

It could be that the only practical value of the concept is to explain why some patients do not feel the sensation of say, a bone that was broken during an accident, until the pain of say, a laceration received in the same accident is treated and that pain begins to subside.

Feeling pain in more than one place could also be applied to Oklahoma and its current state of affairs. For instance, during the past legislative session it seemed that all eyes were on the education budget. After all, a decade of cuts to Oklahoma public education had totaled 26.9% and the future of our state’s children was being threatened. Parents, students and concerned citizens from across the state stood firmly with teachers who raised awareness about ten years of legislative neglect and as a result, steps were initiated to at least stop the bleeding.

Frustratingly, without a plan, there is no legislative leadership. Putting out fires is no way to plan for the future. As steps are taken to address K-12 educational needs, other areas of neglect rise to the top. Oklahomans must be pro-active in determining what they want the future of the state to look like.

We say that we want businesses to bring good jobs to our state, but without exception those businesses say they want an educated and healthy work force.

While we have historically funded our Career Tech system, we have fallen woefully short in funding our colleges and universities. Our future is not bright when students are dissuaded from higher education by the bleak outlook of a mountain of college debt.

We say that we want all Oklahomans to have access to quality healthcare, but we suppress health outcomes by refusing to address high uninsured rates and uncompensated care. Consequently, hospitals and ambulance services that must provide care without regard to ability to pay are closing or cutting back on services.

Our tax dollars go to Washington but we refuse to consider allowing working Oklahomans whose employers do not provide health insurance to have a path toward wellness. More than 65% of the other states accept federal funds and are experiencing better outcomes and a stronger medical community.

We shake our heads at the violence in our state and don’t even consider that with Medicaid expansion comes health care that provides, among other things, treatment for mental illnesses that are especially critical in uninsured populations.

Our state’s priorities are reflected in how state funds are spent. I want my children and grandchildren to prosper in Oklahoma. That will only happen if we thoughtfully examine our state’s shortcomings and systematically address its needs. The pain of failing to fund education and health care is readily apparent. A good first step is to treat the problem and eliminate the pain for generations to come.  

Questions or comments please call or write, 405-557-7401 or David.Perryman@okhouse.gov.

Seeing the Light

Seeing the Light - January 14, 2018

State Representative David Perryman

In the wee hours of a January 1947 morning, Lilly Williams was driving toward Montgomery, Alabama. Her passengers were her son and his band who a few months earlier had been rejected by the Grand Old Opry. As Lily neared the city, she saw the distant lights of Dannelly Field, the local airport.

Lily attempted to wake up the sleeping band members to report that she had “seen the light.” Her son, Hank, stirred from a deep sleep to hear the phrase, “I saw the light.” Within hours Hank Williams had completed the lyrics and less than 90 days later, recorded for MGM Records, “I Saw The Light,” a gospel song for the ages.

Over the past several weeks, I have been one of about eight legislators (two from each party from each house) who were summoned to meet with a group of Oklahoma City business leaders who also are claiming to have “seen the light.” The gist of their presentation was that Oklahoma cannot sustain an educational system or health care without additional recurring revenue sources.

An epiphany is defined as a “sudden or striking realization.” Any group of Oklahomans whose list of recent epiphanies include the realization that public education in every corner of the state needs adequate funding or that the current devastation of rural health care is the direct result of destructive, politically-driven decisions of state leaders, has either been overly focused on their corporate balance sheet or is so blindly committed to partisan dogma that reality takes a back seat to rhetoric in their world.

As I looked around, I saw men who had fought for years to shift money from public education to private schools, to reduce the tax burden on corporations and high wage earners, to suppress wages, stifle equal pay and block working Oklahomans access to healthcare.

So therefore, it was refreshing to hear men in expensive suits and whose cufflinks cost more than my first car say that they were there to help. It was refreshing to hear them propose a plan that incorporated many of the proposals that the House Democrats had repeatedly put forth in our “Restore Oklahoma” plan.

It was refreshing to watch as their “solutions” displayed recognition that Oklahoma’s cuts to oil and gas Gross Production Tax and income tax cuts for high wage earners had devastated Oklahoma’s ability to educate its children and neglected the needs of health care providers and compromised the ability of state agencies like the Department of Health to perform statutory duties directed by law.

There is much common ground upon which we can build. The group proposed changes to the state’s income tax system and offered a comparatively modest increase in the gross production tax rate in an attempt to stave off a citizens’ initiative petition that will, according to most polls, increase the GPT to 7%. Perhaps the most promising aspect of the meetings is that the House Democrats (82% of whom voted for a similar plan in this year’s first special session) and Step Up Oklahoma seem unified in the belief that if we don’t invest in Oklahoma’s teachers, public employees, healthcare, education, roads and corrections, our entire state economy is left in peril.

While the devil is always in the details, the most serious non-fiscal impediments to the plan’s success is the businessmen’s demand for school voucher expansion, rural school consolidation and privatization of Medicaid.    

In short, it is past time that these businessmen “see the light” and we are ready to work with them to build on common ground and form a budget solution that works for all Oklahomans.

It is interesting to note that when his mother woke Hank Williams to tell him that she had “seen the light,” he was inebriated in the back seat. That incident changed Hank and changed both country and gospel music. Wouldn’t it be magnificent if this group’s epiphany actually changed them and changed Oklahoma.

Thanks for allowing me to serve. If you have any questions or comments, please call or write, 405-557-7401 or David.Perryman@okhouse.gov

For Whom the Bell Tolls

For Whom the Bell Tolls - June 26, 2016

Rep. David Perryman

Some would say that Earnest Hemingway’s 1940 novel deals with the loss of innocence in war. Some would point to the value of human life. Others consider the power of romantic love to bring fulfillment to life even in the direst of circumstances as the book’s main theme.

However, the message that Hemingway may have most wanted to convey is the one reflected in the title he chose for the story. The story centers on an American college instructor whose feeling of brotherhood with an oppressed people was so intense that his fervor led him to Spain to fight Fascism during its civil war.

“For Whom the Bell Tolls” is a phrase taken from a meditation by the 17th Century English poet John Donne that states in substance: No man is an island, complete in oneself. Every man is a piece of the continent, part of the mainland. If a single clod is washed away by the sea, the continent becomes smaller, like it would if a neighbor’s farm or even your own farm were lost. Any man’s death diminishes me, because I am involved in mankind, so, do not send anyone to ask for whom the bell tolls, it tolls for you.”

Earnest Hemingway’s message of community and fulfillment is a message of hope. John Donne’s message of community and awareness is a message of responsibility and vigilance. Both messages transcend the ages.

Oklahoma’s leaders appear to believe that our state is immune from these messages.

Supplemental payments to the aged, blind and disabled were arbitrarily cut by 25% in fiscal year 2016. Child care credits and essential subsidies for child care facilities were eliminated for new enrollees.

The earned income tax credit amounting to $20 per month for most poor working Oklahomans was eliminated. They pay the highest percentage of their wages on state and local taxes and a higher percentage of their wages on food. They are food insecure and often pay 40% or more of their income housing which is not safe nor secure. The poverty of any man diminishes me.

Those same working Oklahomans have little or no access to health care and no ability to get it. They must choose between losing their job or working sick. Their condition worsens until they must go to an emergency room. Hospitals risk closure because they provide care with no hope of being paid. The poor health of any man diminishes me.

Public education funding is lower than 90% of other states. Teachers are leaving the classroom because they cannot afford to house, feed and clothe their own families. Education suffers and poor Oklahomans no longer have quality educational opportunities to better their lives. Uneducated children diminish me.

As these and other critical resources are taken away from our most impoverished neighbors, the condition of a vast number of Oklahomans diminishes you and me and our state.

No man is an island. Oklahoma, the bell tolls for us.

Questions and comments are welcome. David.Perryman@okhouse.gov or 405-557-7401.

Where Do We Go From Here?

Where Do We Go From Here? - June 12, 2016

State Representative David Perryman

We know all about Charles Lindbergh and the pride that he brought to our country as an aviation pioneer. His non-stop 1927 transatlantic flight in the “Spirit of St. Louis” brought him world acclaim. But today, few recall the name of the mechanic who modified the fuel tanks on Lindbergh’s plane and lengthened the wings by more than 10 feet to increase lift.

This young mechanic, Douglas Corrigan, actually pulled the chocks away from the wheels of the Spirit of St. Louis when Lindberg departed San Diego for Roosevelt Field on Long Island, New York, to begin his historic flight to Le Bourget Field in Paris, France.

While Charles Lindbergh went on to become a household name following his New York City ticker tape parade, it is a little known fact that 13 years later, an even larger New York City crowd attended a ticker tape parade for the mechanic whose own remarkable feat caught the imagination of a depressed American public.

Douglas Corrigan, whose nameless, ragtag jalopy of a plane prevented him from obtaining the Bureau of Commerce’s permission for his own transatlantic flight, became known as “Wrong Way Corrigan,” when in July 1938, he filed a flight plan west from Brooklyn, N.Y., to Long Beach, Calif., and promptly flew east to County Dublin, Ireland.

In many ways, Corrigan’s feat was more remarkable than Lindbergh’s. Lindbergh flew the finest plane that money could buy, while Corrigan flew in a patched and soldered plane with NO radio and only a 20-year-old compass. His door was tied shut with baling wire and he sat hunched forward surrounded by so many fuel tanks that he could not see in front of the plane. Many would call that “flying by the seat of his pants.”

Oklahoma’s version of “flying by the seat of its pants” is not doing so well.

Oklahoma policymakers are flying like they cannot see what is in front of them. They slash programs that are the only hope to break cycles of poverty and domestic abuse. They refuse to accept federal funding for mental health treatment and counseling and health coverage to improve the health of uninsured working Oklahomans.

Men and women who want to provide for their families and worry about putting food on the table have no access to health care and risk losing their jobs when they become sick. Consequently, they get so sick that they must use an emergency room because a simple shot or prescription will no longer cure them. That red ink is most of the $560 million in uncompensated care that Oklahoma hospitals suffered in 2014.

Wrong Way Corrigan’s navigational “errors” sent him in the wrong direction but gave America a laugh and raised its spirits. The damaging path that Oklahoma has taken is no laughing matter and puts virtually every vulnerable Oklahoman at risk. Oklahoma voters must demand leaders who will address these issues.

Questions and comments are welcome. David.Perryman@okhouse.gov or 405-557-7401.

Errors and Omissions

Errors and Omissions - June 5, 2016

State Representative David Perryman

It’s hard to believe that it has been forty years since our Nation’s Bicentennial, but it was in 1976 that my Mom crocheted and gave me one of my most cherished items. It is a red, white and blue afghan. She actually made five seemingly identical afghans and gave one to me and one to each of my four siblings.

I say that they were “seemingly identical” because they all had alternating red and white stripes surrounded by a wide blue border containing white stars. However, each afghan contained a small imperfection. Some were missing a row of stiches and some had an extra star. Mine was unique in that among all of the five pointed stars, Mom had somehow managed to crochet a single six pointed star. A Star of David.

I think that the “flaws” in Mom’s artistry were similar to the “flaws” in many Native American crafts and in Persian rugs and in Amish quilts. Imperfection keeps the artist humble and distant from the pride that would result from perfection.

Not so at the Capitol. The legislative session is over and Oklahoma’s citizens have been left in a precarious condition. Many tasks were left undone and few who could have done anything about them are contrite. Humility is a trait not often observed under the dome.

NOTHING was done to address the fact that Oklahoma Drivers Licenses do not meet the security guidelines of Homeland Security. The state continues to bury its head in the sand and hope that the federal government will grant us another extension so that we can fly or enter federal buildings or installations with non-compliant identification documents. Let’s fix this.

NOTHING was done to find a solution to the fact that hundreds of thousands of working Oklahomans are uninsured. Hospitals are drowning in the red ink of uncompensated care because they are required to treat patients regardless of the ability to pay. Those who are opposed to bringing federal tax dollars home to cover the uninsured and rescue health care should propose an alternative for the men and women of Oklahoma who work one or two jobs, neither of which provides insurance coverage and neither of which pays enough for them to purchase insurance. Let’s fix this.

NOTHING was done to eliminate the 2017 automatic trigger that could decrease available revenue further at a time where teachers are paid among the lowest wages in the nation and roads and bridges are crumbling. Let’s fix this.

NOTHING was done to roll back the 2016 income tax cut. Oklahoma income tax cuts have taken over $1 billion out of Oklahoma’s budget over the past decade. Corporate tax breaks, credits and incentives have cost the state nearly $2 billion during that same time. We all want young parents to have jobs but it is extremely difficult on them when child care subsidies and the earned income credit are cut just to protect tax credits for corporations. Let’s fix this.

The errors and imperfections in Mom’s afghans and throws did not detract from our ability to use them to keep us warm. The same cannot be said of the omissions of this legislative session. They harm citizens for years to come.

Questions and comments are welcome. David.Perryman@okhouse.gov or 405-557-7401.

Let's Make a Deal

Let’s Make a Deal - May 8, 2016

State Representative David Perryman

“Tell them what they’ve won, Jay,” was the way Monte Hall awarded game show prizes on the Long running game show, Let’s Make a Deal as contestants chose from Door Number One, Door Number Two or Door Number Three.

In less than three weeks, the 2016 legislative session must come to an end and it isn’t pretty. West Texas Intermediate crude is hovering around $42 per barrel and as a result of tax cuts, Oklahoma’s oil and gas gross production tax receipts are even lower than they were in 2001 when the price of oil was less than $27. Today, even if the price of a barrel of oil approached $50, the total gross production tax on that barrel would remain less than $1.

Projections for the Fiscal Year BEGINNING on July 1, 2016, are even more dire. Even though the legislature is dealing with an anticipated $1.3 billion budget gap and legislators MUST approve a budget before the end of this month, as of May 1, there had been no bills presented on the floor of the House of Representatives to address next year’s budget crisis.

One “solution” proposed by the Governor and her Finance Director is to borrow several hundred million dollars to supplement the budget covering ODOT payroll, materials and overhead and then paying the loan out of appropriations over the next several years.

Another of the Governor’s “solutions” is to raise additional tax revenue by “modernizing” our tax code through the elimination of certain sales tax exemptions and increasing the list of goods and services that are subject to sales taxes.

While those “solutions” are crafted for next year’s budget, they will do nothing for the current health care catastrophe facing Oklahoma RIGHT NOW with ambulance services folding, hospitals closing, mental health patients left untreated and 9 out of 10 nursing homes teetering on the edge of shutting their doors.

Which brings us to Doors Numbered One, Two and Three. Behind those doors in no particular order are possibly the only three ways to address Oklahoma’s health care disaster.

One door involves a plan for tens of thousands of working Oklahomans whose employers do not provide health insurance and who cannot afford private coverage on their salary of up to 133% of the poverty level. They would become eligible for SoonerCare Medicaid coverage and thereby decrease the millions of dollars that Oklahoma hospitals annually write off as bad debt of citizens who have no access to health care except the local emergency room.

One door involves a plan to boot more than 170,000 disabled, pregnant women and children from SoonerCare rolls over the next 3 years and require them to secure federally subsidized health insurance through the federal health care exchange.

One door leaves the disabled and pregnant women and children on SoonerCare but accepts federal funding for the expansion of Insure Oklahoma for those tens of thousands of working Oklahomans whose employers do not provide health insurance and cannot afford private coverage on their salary of up to 133% of the poverty level.

One plan is called Medicaid Expansion, one is called Medicaid Rebalancing, and one Expands Insure Oklahoma. All of these plans provide much needed mental health services, will improve health outcomes and will allow hospitals and ambulance services to recover fees for those they treat.

The funding for each of these plans will require an increase in the state’s tobacco tax and consequently will require a 75% vote from both the House and the Senate. There are many arguments on why we should not increase the tobacco tax. A tax increase will place a financial hardship on smokers across the state and will likely cause cigarette smuggling.

However, Oklahoma’s partisan obstinance and dogmatic pursuit of tax cuts has left us with no other options on the table. One thing is clear, health care must be saved and refusing to select a door will be catastrophic and will mean that as many as 4 out of 5 hospitals will not deliver babies and that more than a dozen hospitals will close within one year and that 9 out of 10 nursing homes will be forced to shut down. “Tell them what they’ve won, Jay.”

Questions and comments are welcome. David.Perryman@okhouse.gov or 405-557-7401.

The Fallacy of Logic

The Fallacy of Logic - March 29, 2015

State Representative David Perryman

The verdict is definitely in. Numbers do not lie. Accepting federal funds may cause diabetes according to the 23% increase in persons with diabetes in those states that have accepted federal health care dollars for employees living below or near the poverty level. We’ll discuss that logic below.

Meanwhile, with millions of working Americans unable to afford insurance, it has become apparent that the rising cost of health care had an alarmingly negative effect on the health of America’s poor. At the same time, hospitals across the country faced the real possibility of closing because they had to write off massive amounts of bad debt because so many people who they did treat were unable to pay.

Nowhere were those situations more drastic than the Sooner State where no one was eligible for Medicaid if they held a job. Any job. To address the situation, the federal government proposed that states could receive federal funds in return for tweaking their Medicaid eligibility requirements so that working men or women whose jobs do not provide health insurance could sign up for Medicaid, so long as they did not earn more than $16,244 per year.

Medicaid would be available for couples if their combined wages did not exceed $21,000 or if a couple had a child, $22,000.  The non-profit non-partisan Urban Institute says that there are about 149,000 working Oklahomans whose jobs do not provide insurance, but do not make enough money to purchase insurance. The proposal was that federal funds would pay 100 percent of the cost for the first three years and a minimum of 90 percent of the cost thereafter.

Over the past five years, 31 states have either changed their Medicaid rules or are in the process of changing their Medicaid rules so that these uninsured men and women who live in or very close to poverty would have health coverage. Oklahoma has refused to accept federal dollars for this program.

According to an editorial this week in the Journal Record, the effect on the business communities in those states that have accepted this money has been extremely positive. There have been significant drops in uninsured emergency room visits and uncompensated care has been reduced by $5 billion dollars.  That is $5 billion dollars more in their economies. Also, there has been a decrease in bad debt and a drop in the number of consumer bankruptcies is anticipated.

According to the Oklahoma Hospital Association, hospitals in our state provided more than $577 million in uncompensated care in 2013. About half of that amount or nearly $300 million is uncollectable “bad debt” causing medical costs to rise for everyone as these shortfalls are shifted to patients who pay out of pocket, insurance companies and self-insured businesses.

If Governor Fallin would sign on the 31 Republican and Democratic governors who have given the acceptance of federal funds a thorough and serious non-partisan look, she would see that allowing the working poor to be insured will provide the state with average annual net savings of $45 million over ten years simply by using federal funds to pay costs that are currently paid for with state dollars. $450 million is way too much money to leave on the table.

Those federal funds could be spent on medical care right here in Oklahoma and boost payrolls, replace some of the red ink on the balance sheets of community health centers and rural hospitals with black, provide a major economic boost in all sectors and help individual businesses have healthier employees.

Now getting back to that 23% increase in diabetics as reported by Quest Diagnostics. Thank goodness that those newly diagnosed diabetics live in states other than Oklahoma where they will now be receiving treatment and medicine so that they can enjoy healthier and longer lives.

Unfortunately, the 23% or more in Oklahoma will remain undiagnosed, untreated and unhealthy so long as our state follows its current course. The message Oklahoma’s working poor receive: “Get out of bed. Go to work. Being sick is no excuse. Besides, we don’t have enough doctors for you to see mine. In your next life, get a job that has insurance.”

Thank you for allowing me to serve as State Representative.  If you have questions or comments about this issue or any other matter, please contact me at David.Perryman@okhouse.gov or 800-522-8502.

Cruise Controls Just Regulate Speed, They Don't Steer

Cruise Controls Just Regulate Speed, They Don’t Steer - December 14, 2014

State Representative David Perryman

A scene from the 2013 movie, Anchorman 2 places “legendary” newsman, Ron Burgundy and his “has been” news staff in an RV traveling cross country in search of themselves. Will Ferrell, who plays Burgundy sets the RV in “cruise control” and joins his friends in the back of the vehicle to reminisce about better times.

After seemingly miles of straight roadway, one of Burgundy’s buddies has a flash of lucidity and inquires as to the identity of the driver. When told that the cruise control was on, the buddy responds that “cruise controls just regulate speed, they don’t steer.”  Unfortunately, the instant the group realizes the danger of abdicating the steering wheel, the drifting RV leaves the roadway, rolls several times and ends up destroyed and laying on its side.

The magic of cinema, enabled the passengers to emerge with only minor scrapes and bruises.  However, because of Oklahoma’s version of an unattended cruise control, the “passengers” living and working in this great State are not faring as well.

Oklahoma’s “automatic” income tax cut that is triggered by “estimates” and not actual receipts does not take into consideration existing expenses, future expenses, unbridled tax credit liabilities or any one of a score of other factors that could plunge Oklahoma’s budget deeply in the red.  That is but one example of setting the cruise control and then going to the back of the bus.

Likewise, “off the top” earmarks bind the budget and leave the legislature with no ability to have a voice in deciding how to spend 60 cents of each dollar of state revenue.

Add to that the fact that of the $17.19 billion budget in FY 2013, $6.647 billion or 39% was federal funding with strings attached for specific purposes.

For FY 2014, collections by the Oklahoma Tax Commission totaled $8.45 billion and of that only 63.3% went into the general fund.  That is a drop from the FY 1995 percentage of 78% of Oklahoma Tax Commission receipts. In other words, having succumbed to lobbyists demands, the legislators are spending about 20% more time in the back of the bus rather than wrestling with hard budget issues.

Earmarking funds as “off the top” and dealing with federal funds as well as appropriated funds allow persons with an agenda to twist the numbers anyway they want.  For instance, who do you believe about whether education is over funded or underfunded or making it just fine?

Here are two facts:  Number One, the largest share of state spending from all sources goes to health and social services (37 percent) and education (24 percent) and Number Two, Just over half of the $6.7 billion dollars appropriated by the legislature in FY 2011 (less than half the states total spending) went to education and about one-fourth funded health and social services.

The bottom line is that Oklahoma’s teachers and state employees are underpaid with many below or near the federal poverty level.  Tough decisions must be made with regard to revenue and expenditures. Cruise control is not the answer and according to comedian Ron White, auto-pilot will not do much more than get us to the scene of the crash about 30 minutes before the ambulances arrive.  Unless we step up soon, we probably won’t need the paramedics.

Thank you for allowing me to serve as State Representative.  If you have questions or comments about this issue or any other matter, please contact me at David.Perryman@okhouse.gov or 405-557-7401.

What Would Will Say About That?

What Would Will Say About That?…For the Common Good - October 13, 2013

State Representative David Perryman

The homespun humor and wisdom of Oklahoma native Will Rogers has fascinated America for nearly a century.  His unique insight, accurate analysis and fearless delivery “plain-talked” himself into the hearts of millions.  When the California Legislature formed the California Bar Association to regulate the conduct of lawyers in the Golden State, Rogers said, “Personally I don't think you can make a lawyer honest by an act of the Legislature. You've got to work on his conscience. And his lack of conscience is what makes him a lawyer.”

In his no nonsense way, Will was quoted as saying, “What this country needs is dirtier fingernails and cleaner minds.”  Will Rogers, in the oft quoted words of Finley Peter Dunne, regularly and routinely, “comforted the afflicted and afflicted the comfortable.” In speeches and syndicated articles, our State’s favorite son, spoke on a multitude of subjects, hashed no words and always smiled as he conveyed a truth that was sometimes hard to swallow.  Although William Adair Penn Roger’s 134th Birthday will take place in a just a few days, his remarks are timeless, having uncanny application to current events.

This great American icon spoke of congressional gridlock and used terms like the “little guy,” the “big guy” and “the Normal Majority.” He poked fun at Democrats and Republicans and everyone in between.  His audience appreciated the clarity by which he spoke. 

Two of his particularly relevant quotes from the 1930’s were, “Doctors should make enough out of those who are able to pay to be able to work for the poor for free. One thing that a poor person should never be expected to pay for is medical attention and not from an organized charity but from our best doctors. Your doctor bill should be paid like your income tax, according to what you have” and “There is nothing that keeps poor people poor as much as paying doctor bills.”

Oh what a prophet…In 2009 Bloomberg Business reported that a Harvard University study found that 62% of all personal bankruptcies were medical related and 50% of all residential foreclosures are the direct result of health care costs incurred by the family that lives there. In the U.S. someone files for bankruptcy every 30 seconds in the aftermath of a serious health problem. And poor people are not the only ones affected.  This is an issue that touches each one of us. 

Health care providers who are only able to collect a fraction of their billings because of a patient’s bankruptcy or simple inability to pay, must either increase billing rates or decrease overhead. Decreasing overhead means employee layoffs or a lower quality of medical care.  Increasing billing rates will result in additional bankruptcies.  This pervasive vicious circle illustrates clearly why outgoing Chairman of the Federal Reserve, Ben Bernanke, says that “unless we resolve the health care issue, the economic issues we are grappling with today will be unresolved and will only grow in complexity and in depth.”

Most hospitals in Oklahoma, particularly rural hospitals, are writing off millions of dollars in bad debt.  It isn’t like patients do not want to pay, but the age old practice of using produce and eggs to satisfy a medical bill no longer pays the electric bill, allows the hospital to meet payroll or make payments on advanced medical equipment needed in today’s medical science.  In 2009, American families paid an average of $1,100 more in health insurance premiums every year to help cover the cost of medical care for the 47 million Americans who had no insurance.

If the Affordable Care Act is not the answer to the health care crisis, then it is imperative that an alternative solution be proposed.  It does not matter to Americans whether the leadership for that solution is Democratic or Republican, but shutting down the federal government without putting a solution to the health care crisis on the table is irresponsible.  What would Will Rogers say about that?  He already did. On July 28, 1935, only 18 days before he and Wiley Post perished in the plane crash in Alaska, Will said, “There is nothing as easy as denouncing..... It don't take much to say that something is wrong, but it does take some eyesight to see what will put it right.”

I appreciate the opportunity to serve you as your State Representative.  If there is ever anything that I can do to assist you, please call me at 405-557-7401 or eMail me at David.Perryman@okhouse.gov

I look forward to seeing you soon.

Seldom Heard Discouraging Words

Seldom Heard Discouraging Words…For the Common Good? - July 28, 2013

State Representative David Perryman

I have always wondered what Otorhinolaryngologists did in their spare time in the 1870’s.  I bet you have too.  Well wonder no more…just hum along with me a familiar little tune based on a poem originally called “My Western Home.”

Having staked a claim in Kansas under the federal government’s Homestead Act, Dr. Brewster Martin Higley, VI, an ear, nose and throat doctor who was attempting to escape an unhappy past built his cabin near Beaver Creek and was overwhelmed by the beautiful blue skies, the endless prairie and abundant source of game. 

Dr. Higley, who had been twice a widower arrived in Smith County, Kansas in 1871 and secured a homestead location that was aesthetically similar to the natural terrain of much of the plains states, including Oklahoma.

Oh, give me a home, Where the buffalo roam, And the deer and the antelope play. Where never is heard a discouraging word, And the sky is not clouded all day.

Dr. Higley’s words are similar to the song, but not identical.  Readily memorized, the lyrics quickly spread across the country.  Cowboys, Settlers and others heading into the frontier made the song the unofficial anthem of the American West.  But it did not stop there.

 The song has been performed in numerous movies since the turn of the century. Not only countless westerns, but also the Chipmunks and an episode of the TV show Cheers. In 1932, President Franklin Roosevelt called it his favorite song and it was declared the state song of Kansas in 1947. 

Today at the end of each University of Kansas home football game, the band plays an arrangement of “Home on the Range.”

Ideally, the natural beauty and bounty of Oklahoma, like the area around Dr. Higley’s cabin should eliminate any thought of discouraging words. Unfortunately, all is not bliss in the land of buffalo and beautiful sunsets.

In Dr. Higley’s time, all the way up to the last 3 or 4 decades, medical care was affordable by just about anybody who needed a doctor; even an ear, nose and throat specialist like Dr. Brewster Martin Higley, VI. 

Things have changed. In 1986 at the request of President Ronald Reagan, Congress passed the Emergency Medical Treatment and Active Labor Act. The law requires hospitals to treat patients in need of emergency care regardless of their ability to pay, citizenship or even legal status.

Consequently, three things happened in rapid succession.  Patients who could not pay their doctors went to the emergency room instead; hospital charges skyrocketed; and medical bills quickly became the number one cause of personal bankruptcy.

Compounding our problem is Oklahoma’s chronic health condition where about 1 in 3 adults are obese, 1 in 4 smoke and 1 in 5 are uninsured.

Oklahomans have indicated that they do not want to participate in the Affordable Care Act.  Unfortunately, no one in the Sooner State is proposing an alternative.  Playing politics with the lives and healthcare of working Oklahomans is not good policy.  The hard truth is that in about 5 months, the Medicaid reimbursement rate for the 1 in 6 Oklahomans who are currently enrolled in that federal program will be cut back.

Oklahoma’s hospitals are bracing for the cuts.  Particularly hard hit will be rural hospitals.  Layoffs will be necessary and jobs will be lost, like they were in Bartlesville this summer.  We do not have jobs to spare. We cannot continue to bury our head in the sand.

We must have a plan.  It is imperative that we work in a bipartisan to keep our rural hospitals from being harmed.  They are imperative to the quality of life in our rural communities.  If we refuse the proposal that is on the table, we must advance an alternative plan that will protect our citizens and our hospitals.  Silence is deadly.

By the way, Dr. Higley eventually found the paradise featured in his song.  His “final” home on the range was the beautiful Fairview Cemetery in Shawnee, Oklahoma.

I appreciate the opportunity to serve in the Oklahoma House of Representatives.  I look forward to hearing from you at David.Perryman@okhouse.gov or 405-557-7401.