Rural

Angels in the Outfield

Angels in the Out Fields - February 3, 2019

State Representative David Perryman

The 1994 film, Angels in the Outfield featured Danny Glover, Tony Danza and Chistopher Lloyd in a family sports fantasy that provided the answer to a young boy’s prayer and along the way engaged the services of a group of angels who helped the California Angels win a pennant and gave him the family that he had so desperately longed for.

I was reminded of that storyline this weekend during a Super Bowl commercial. The ad was for a wireless phone company but it was centered around Major League Football coach Anthony Lynn who had been asked to give a motivational talk to a group of First Responders. As he spoke to the Police Officers, Paramedics and Firefighters who had been gathered, he confessed to them that fourteen years earlier he had nearly died when he was hit by a speeding car as he walked across a street.

Unknown to Coach Lynn, several of the men and women who had responded to his 2005 accident had been assembled in the group to which he was speaking. For the first time since he was injured, he and those who had rendered aid to him were reunited. The emotional coach told the First Responders that he had been told that angels had helped him survive. He surmised through tears that these men and women were indeed those angels.

Across Oklahoma’s 77 counties there are a lot of “out fields.” We call them rural communities and long stretches of highways that at a moment’s notice may need first responders, paramedics and other emergency personnel. The people who need those “angels” are not just the citizens of rural Oklahoma. Visitors to rural Oklahoma hail from all corners of the state and nation as they engage in recreational activities, enjoy nature and attend hundreds of festivals, fairs and other events that represent the true history and heritage of our great state.

While there has been much news coverage about hospitals and emergency rooms closing across the state, the rate of insolvency and closure of Oklahoma’s ambulance services exceeds that of Oklahoma hospitals. More than 50 rural Oklahoma ambulance services shut down between 2003 and 2015 and the rate of closure has not slowed. When an ambulance service closes, that simply means that the territory becomes absorbed in the next closest service. Consequently, distances between ambulance services increase. When Oklahoma ambulance services suffer, so do the people who need them. It is no wonder that life expectancies in some rural communities are as much as 20 years shorter than life expectancies in more urban areas.

A May 11, 2018 Policy Brief by the National Rural Health Association provided the most concise illustration on the challenges facing EMS Services in rural America. 1) The cost per transport is higher in rural areas because the base costs of “maintaining readiness” are sunk costs. 2) With lower volumes there is less of a funding stream to offset costs. 3) Reimbursement rates by Medicare, Medicaid and private insurance are often based on call volume and therefore, in a vicious cycle, studies have shown that over 60% of rural EMS providers rely on volunteers for EMT-Intermediate or EMT-Paramedic staffing and over 70% report having difficulty in recruiting volunteers.

The statistic that is most injurious to rural emergency medical services is the demographic of rural Oklahoma. Oklahoma’s rural population is older, poorer and less healthy than urban Oklahoma. Therefore, when an ambulance call is made in rural Oklahoma, it is less likely that the patient is privately insured or can afford to pay for the services rendered. That “uncompensated care” is often the straw that breaks the back of a rural ambulance service.

There is a solution. If Governor Stitt, in some form or fashion, would accept federal Medicaid funds, $2.3 Million PER DAY would go to Oklahoma hospitals and ambulance services, thus preventing hundreds of Oklahoma EMTs, nurses and medical personnel from losing their jobs. It would not only sustain medical care in rural areas but also roll those dollars many times over through Oklahoma’s economy.

Rural Oklahoma is important to our state and residents and visitors there need “angels” just as urgently as do urban areas.

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

We Don't Need Another Hero

We Don’t Need Another Hero - April 10, 2016

State Representative David Perryman

From just Mad Max in 1979 to the Road Warrior in 1981 and Beyond the Thunderdome four years later, Max Rockatansky, played by Mel Gibson, pursued revenge in a not-too distant future where societal institutions provided no protection from raw selfish ambition.

Some writers consider the original Mad Max as the most influential movie of the past forty years. While the plot opened eyes to how society might exist without social safety nets, it and a number of more recent movies conjure visions of vast areas of wasteland. Some of the wasteland is urban, industrial and rusted; some are rural, arid and unproductive. All are devoid of hope and human compassion.

Vacant storefronts in Oklahoma communities are disturbing to those of us who remember that it was not too long ago when those buildings had businesses in them. No one can point to a single reason why most of the small town retailers went out of business and it dwelling on that or placing blame at this point would serve little purpose.

What we do know is that across rural Oklahoma we have public schools that are frugally educating our children, with higher graduation rates, lower per pupil expenditures and greater success than most urban schools, regardless of type.

What we do know is that to live in rural Oklahoma, citizens must continue to have access to locally controlled schools. They must have quality health care in their communities and adequate fire protection for their homes, businesses, property and lives.

Citizens of rural Oklahoma have many of the same needs as urban areas when it comes to mental health services, law enforcement and water systems.

Just like rural Oklahoma needed electricity last century, it needs broadband today. There are many ways that a society might lose its infrastructure and those institutions that support a healthy and vibrant civilization. Some may be unavoidable, others are not.

In Mad Max Beyond the Thunderdome, Tina Turner sang a song pleading for hope for the future. “Out of the ruins, out from the wreckage/ Can’t make the same mistake this time/ We are the children, the last generation/ We are the ones they left behind/ And I wonder when we are ever gonna change it/ Living under the fear till nothing else remains/ We don’t need another hero/ We don’t need to know the way home/ All we want is life beyond the Thunderdome.

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

Who You Gonna Call?

Who You Gonna Call? - October 25, 2015

State Representative David Perryman

                In the 1984 film, Ghostbusters, Dan Aykroyd introduced the world to the Ecto-1, a 1959 Cadillac “combination car” that was large enough to carry the ghostbusters and their “proton packs.”

                Ecto-1 was called a combination car because it and other like vehicles were long, high-roofed “professional cars” that doubled as hearses and ambulances. In fact, until about 45 years ago, many “ambulances” were operated by local funeral homes in communities where people would joke about the “conflict of interest” posed by an ambulance driving undertaker!

                With the advance of medical science and the recognition that minutes matter when patients are experiencing heart attacks and strokes, communities in all areas of the state focused on ways to couple qualified emergency medical personnel with well-equipped ambulances that would respond to a medical crisis on a moment’s notice.

It soon became apparent that while urban ambulance services readily cash-flowed, ambulance services in areas of sparse populations could not exist solely on ambulance service billings and receipts. Population was not the only problem, higher poverty rates in rural areas meant that a large number of users of rural ambulance services were Medicare and Medicaid patients and many could not pay at all even though the law required the services to be rendered.

In 1976, the citizens of Oklahoma passed State Question 522, by a vote of 54% to 46%, authorizing the creation of Ambulance Districts. The constitutional amendment allowed a community or a group of communities to levy a 3 mill AdValorem tax to help fund an ambulance service. The millage was never intended to provide enough money to equip, man and operate an ambulance service. Instead it was intended to subsidize the ambulance service billing revenues to keep the service in the black.

Today, the cost of operating an ambulance service continues to rise as equipment is more expensive and there is a shortage of trained EMTs. Also detrimental is the phenomenon of “uncompensated care” or that care that is provided to those persons who do not have insurance and are not covered by Medicare or Medicaid.

Rural ambulances are required to care for all patients in their times of crisis and therefore they encounter a few patients who can pay the full rate in cash; a few who are insured and the insurance company has negotiated a relatively low rate; a number of Medicare and Medicaid patients that are not liable for anything above the deeply discounted reimbursement rate set by the federal government; and those who have no insurance and cannot pay any amount.

Rural ambulance services that do not have dedicated sales taxes or other tax revenues to further subsidize the system are closing their ambulance services at an alarming rate. More than 50 rural ambulance services have shut down in the past 12 years, two as recently as this month.

Governor Henry’s 2007 Task Force recommended that the 3 mil cap on levies for ambulance operations be raised. No action has been taken on that or any of the other suggestions made by the task force.

Today, in the absence of help from the state, cash strapped communities that are already subsidizing ambulances are forced to increase sales taxes to keep ambulances rolling.

There is a solution. If Governor Fallin would accept federal Medicaid funds, $2.3 Million PER DAY would go to Oklahoma hospitals and ambulances and prevent hundreds of Oklahoma EMTs, nurses and medical personnel from losing their jobs. It would not only sustain medical care in rural areas but also roll those dollars many times over through Oklahoma’s depressed economy.

Without your ambulance service, it doesn’t matter who you’re gonna call. It matters how far they have to drive to get there.

Medicine for What Ails You

Medicine for What Ails You - September 6, 2015

State Representative David Perryman

According to John Gunnell’s Standard Guide to 1950’s American Cars, “It was 1957 and more than ever before the hit songs of the year reflected the American culture’s swing towards being young at heart. Among the leaders on the charts were ‘Young Love,’ ‘Wake Up Little Susie,’ and ‘That’ll Be the Day.’” The space race had just begun and “launching” became the “in” term for getting things underway.

It was the age of the ’57 Chevy and the Ford Thunderbird and both sported tubeless tires for the first time. Years would elapse before automotive safety got more serious than Ford’s “Lifeguard Door Latches.”

More than five decades later, safety features like side curtain airbags, lane departure warnings and pre-collision automatic braking are becoming standard equipment.

Seventy years ago, most rural counties had no hospitals. If they did, it was usually affiliated with a doctor’s practice. In 1946, during the Truman administration, a bipartisan effort involving a GOP Senator and a Democratic Senator sought to bring good quality medical care to rural America.

Beginning in the late 1940’s and for 20 to 30 years, the Hill-Burton Act, provided grants and loans for the construction of hospitals, primarily in underserved states like Oklahoma, thus creating the backbone of today’s rural medical care.

Unfortunately, while medical science has advanced, rural hospital infrastructure has not always kept pace.

We would never place the rigorous demands on 58 year old cars that we do on 58 year old hospitals, but day in and day out across rural Oklahoma we expect our hospitals to be there the instant that we need them.

For a multitude of reasons, hospitals in rural Oklahoma are under financial siege. They are required to treat many people regardless of the ability to pay. For years, they have not had sufficient cash flow to reinvest to upgrade infrastructure. More than half of Oklahoma’s rural hospitals have operated at a loss since 2009. At least seven have filed bankruptcy since 2011 and a dozen or more have less than ten days cash on hand to operate.

It has been said that a recession is when your neighbor loses his job and a depression is when you lose yours. The same goes for the risk of losing one’s hospital. Not only is basic medical care lost, but patients needing emergency care are pushed beyond the critical first 30 minutes into that time period when death or irreversible adverse medical conditions are more likely.

Beyond that, hospitals are often the first or second largest employer in a community. When a hospital closes, so does the supporting medical industry. Jobs are eliminated, restaurants, hotels and retail establishments fail and the community is much less likely to be able to attract new industry or commerce.

While there are a number of issues that are placing rural hospitals at risk, we as Oklahomans must focus on the ones that we can do something about to get our hospitals off life support.

First, support the governing body of your local hospital. Ask them what you can do as a member of your community to make sure that your hospital becomes more fiscally sound.

Second, support local and county funding sources to make up for the loss of funds that the state will be appropriating toward programs that help fund your local hospital’s services.

Third, tell legislators and the governor that the situation is critical and that Oklahoma is losing $2 Million per day because of partisan rhetoric. Rural hospitals exist because of bipartisan cooperation. It is time to either stop talking about modifying Insure Oklahoma and do something about it or begin accepting federal dollars to provide Medicaid to low income working Oklahomans.

No matter where you live or travel in Oklahoma, closed hospitals put you and your loved ones at risk.

David may be reached at 405-557-7401 or David.Perryman@okhouse.gov.

REAPing What is Sown

REAPing What is Sown for the Common Good - August 10, 2014

State Representative David Perryman

American folk heroes do not come around every day.  The legend of Johnny Appleseed is a favorite and holds special meaning for many of us. Fortunately, for rural America, there is much truth to the stories of the industry of John Chapman, the pioneer nurseryman.

Chapman was born in Massachusetts just a couple of years before the signing of our Declaration of Independence.  After a somewhat nomadic couple of decades, at age 31, John Chapman began working at a nursery in rural Pennsylvania and gathered the skills that allowed him to do his part in fulfilling a vision for the future. What he learned was the art of planting seeds and nurturing seedlings…apple seedlings to be exact.

Elementary school and the literary license of Walt Disney films, has led us to believe that Johnny Appleseed wandered aimlessly through the countryside tossing apple seed hither and fro with abandon.  Factually however, Chapman planted sizeable apple nurseries caring for them to a point, training others to do so in his absence and returning periodically to monitor progress and remedy any problems.

Instead of simply sowing apple seed, John Chapman systematically fostered agri-business in rural America and apprenticed rural residents to help fulfill that goal. As a result, apples were produced and the residents of cities, towns and villages through the upper Eastern states were able to consume the fruit of his labors.  In turn, rural residents were financially able to purchase staples, supplies and goods in those cities, towns and villages.

Likewise, today, a robust RURAL Oklahoma lifestyle and economy is necessary for a robust Oklahoma economy.  In our mobile society, substantial sales tax revenues generated in Oklahoma City, Tulsa and other larger communities can be traced to unincorporated areas and communities with fewer than 7,000 citizens.

The quality of life in those rural areas requires the same types of infrastructure that is constructed and maintained by sales tax dollars in more populated areas.  With rural incomes being spent in cities on food, clothing, supplies and yes, even OKC Thunder basketball games, rural residents subsidize the infrastructure of larger communities and actually shift those funds from the rural communities in which they live.

The recognition that rural Oklahoma subsidizes cities and towns is why I was frustrated by an August 7, 2014 editorial in The Oklahoman.  The editors portrayed funds going to rural communities as “an ever-increasing drain on state finances.” The program targeted is called the Rural Economic Action Program (REAP) which was first appropriated in 1997.

In an effort to provide a funding source that will partially make up for the sales tax “leakage” that flows to cities and other urban areas, the legislature appropriates a tiny fraction of the budget to the REAP program to help rural areas with otherwise unfundable infrastructure needs.  In 2014, the REAP appropriation was about 15/100 of one percent of the legislatively directed appropriations.

With this appropriation, rural fire departments are able to acquire equipment, small towns and rural water districts are able to repair water and sewer lines and install fire hydrants and communities are able to bring sewer lagoons into compliance and resurface roads.  These funds allow deferred maintenance to be performed on rural libraries and other structures.  All of these purposes allow rural residents and businesses to continue to exist in small communities and unincorporated areas across Oklahoma.

The editorial acknowledged that REAP projects may have merit, but should be the responsibility of local governments and not state taxpayers.  What the Oklahoman’s urban leaning editorial board failed to see was that for every dollar spent by rural residents like you and I in the urban areas, four pennies go into the state revenue funds and four or five more pennies go to the urban communities to fund similar urban needs while similar rural needs go lacking, but for funds provided by REAP grants.

According to the analysis of the paper’s editors, for “every dollar spent on REAP is a dollar taken from another need.”  That may be, but that same argument can be used against corporate tax credits, tax cuts and a myriad of urban projects that are slipped into the budget.

REAP funds are administered across rural Oklahoma in a highly competitive and open grant process that is fair and transparent.  Unfortunately, the 2013 appropriation was 20% below the average and in 2014 it was decreased another $700,000 to around 75% of the program’s lifetime average appropriation.

John Chapman saw the wisdom in a vibrant and productive rural America.  The REAP program has consistently helped rural Oklahoma meet the needs of its residents and businesses.  Generations of Americans reaped the benefit of Johnny Appleseed’s vision.  In Oklahoma, REAP exists to benefit ALL Oklahomans.

Thank you for allowing me to serve as a State Representative.  If there is 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 hearing from you soon.

Libraries, Fire Departments, etc.

Last Thursday, December 27, was the deadline for submitting substantive language on the bills that are to be introduced in January for the First Regular Session of the 54th Oklahoma Legislature.  Last week I discussed two education bills that I have been working on and this week I would like to discuss four bills that will provide enabling legislation to allow rural communities, municipalities, school districts and counties to address needs in their particular jurisdictions.