Public health nurse Jo Ellen Hockley spends part of each week visiting 10 expectant low-income mothers across Platte County, driving to homes within a 30-mile radius of her office in Wheatland.
Conducted under the umbrella of the Wyoming Department of Health’s Maternal and Child Health Unit, Hockley’s visits aim to reduce infant mortality, premature births and birth defects. The program has seen funding cuts already, and under the budget bill being currently considered in the Legislature it will lose an additional $230,000 a year.
Some lawmakers question the value of relatively small cuts to state services when the state has millions in savings and may continue to put more money away than the state constitution requires.
Others believe hard choices must be made to protect long-term state interests, even if limiting services such as Hockley’s could impact low-income mothers and their unborn children.
On visits, Hockley reviews her clients’ homes for anything that could be hazardous to a child younger than two years old, coaches them on appropriate nutrition and avoiding vices during pregnancy, and encourages them to breastfeed their newborn for at least six months.
“I’m not there to be a judgmental person,” she said. Instead, she’s there to educate new mothers on best medical practices that they might not learn from their own parents or from neighbors. The majority of women the program serves fall in low-income brackets.
“We’re just trying to give them the best start for their pregnancy,” Hockley said.
Hockley was at her office Friday and uncertain what effect budget cuts from the Legislature would have on her work. That morning, House and Senate members of the Joint Appropriation Committee negotiated over differences in how the two chambers had treated the budget.
On Monday, both chambers voted to pass the bill that emerged from those negotiations. It nows goes to the governor for his signature or veto of specific lines in the budget or the budget as a whole.
As it now stands the budget bill will reduce $30 million across state agency budgets and could impose $45 million in cuts to Wyoming’s public schools. The budget bill includes the potential for an additional $17 million in savings, House Appropriations Committee Chairman Bob Nicholas (R, HD-8, Cheyenne) said, though that number won’t be certain until the reductions are finalized. A good portion of those additional savings will come from an amendment requiring the governor to eliminate 90 state positions.
Among the myriad of cuts to agencies in the original budget bill was a 25 percent reduction to maternal and child health, according to Peter Obermueller, executive director of the Wyoming County Commissioners Association.
The House amended the budget bill to replace most of that funding, after first ensuring the money wouldn’t pay for birth control. House Appropriations Committee members spoke against restoring the funding.
A conference committee, which included the same lawmakers who sit on the Joint Appropriations Committee, convened to negotiate a compromise between differing amendments to the budget bill from the House and Senate.
In the process, the House members agreed to a cut of $230,000 a year to the maternal health program. Department of Health spokeswoman Kim Deti said Monday that it is too early to say how the budget would affect specific programs.
Federal funding for the maternal health program has been cut as well, Obermueller said. A federal program called Temporary Assistance for Needy Families that funds most of the maternal health program costs itself has been cut by Congress, he said.
In June, the governor cut state funding of the maternal health program by 18 percent. The Legislature’s original cut would have represented an additional 25 percent over two years, Obermueller said.
Though there is $3.2 million in state and federal funds appropriated for the program, only about $1 million of that gets passed on to the counties to pay for the public health nursing programs. While the cuts could come from somewhere other than the money for counties, Obermueller said the majority of whatever cuts the Legislature makes will come out of the money going to counties.
“It was just one too many cuts in a row,” Obermueller said.
Now counties will have to decide whether they want to provide more of their own funding or reduce the program. County revenues have also slumped as a result of the energy downturn, he noted, making that possibility less likely.
Hockley said she currently has 10 clients. The maternal health program is only half her job as a public health nurse. The rest of her time is focused on communicable disease prevention, adult health and vaccination programs.
There already could be women seeking the maternal health program who aren’t getting served, she said. “I haven’t had to turn anyone away yet, but I’m on the brink of that.”
Previous public health nurses in Wheatland served 17 to 20 women through the program. The change to just 10 was based on staff restructuring, and not budget reductions, but Hockley said it shows that more women would avail themselves of the state’s services if they could. “There’s still more maternal and child health availability needed,” she said.
On the House floor, those in favor of restoring the program’s money acknowledged the need to make cuts but argued that maternal health is an essential program.
“This is one of those cuts where folks from throughout the counties have come forward and said ‘whoa,’” Rep. Tyler Lindholm (R, HD-1, Sundance) said. “It’s time to back up.”
Rep. Albert Sommers (R, HD-20, Pinedale), who serves on the Joint Appropriations Committee, spoke against restoring the funding. In doing so he outlined the JAC’s thinking as it applies to many of the cuts they’ve imposed on state agencies.
The state faces a structural deficit, he said. “As hard as it is to make these cuts, this is what we have to do — we have to buckle down and do the work,” he said.
However, not all are seeing the same structural deficit as the JAC.
Governor and JAC see two different situations
Gov. Matt Mead has said the Legislature’s cuts aren’t needed after he cut $250 million in June and the Legislature cut $84 million in the 2016 budget session. He believes citizens haven’t felt the full impact of that round of cuts, and that more cuts could hurt access to state services.
The governor and the Joint Appropriations Committee view balancing the budget differently, House Appropriations Chairman Bob Nicholas said. When the governor draws his budget, he relies on two revenue sources Nicholas said he would like to see eliminated. The first is capital gains — earnings off the state’s investments in the stock market.
At the beginning of the legislative session, the governor presents his recommended budget to the JAC. The committee then decides how closely they’ll follow his recommendations.
Gov. Mead’s budget lists money from capital gains as available in the general fund, education accounts and the rainy day fund.
Those capital gains aren’t technically in the state’s coffers yet. Since the beginning of the fiscal year on July 1, the state’s investments have already accumulated far more than what the governor used in writing his budget. The money won’t be available until the end of the fiscal year in June, but it would take a sharp downturn in the stock market to erase those gains.
But Nicholas said those capital gains are vulnerable. “If the stock market takes a turn, we could easily lose all the current gains,” he wrote in an email response to questions.
The Legislature has never used capital gains when writing the budget, he said, and when there are gains they try to use them for one time expenditures. Nicholas said the State Capitol construction project, large water projects and other construction projects around the state — including on community college and UW campuses — have used capital gains.
In fiscal year 2016, the state did lose money on its investments, a rare occurrence, Patrick Fleming, Chief Investment Officer at the State Treasurer’s Office, said.
Feed the state’s trust fund, or fund state services
The more significant difference in how Mead and members of the JAC see the budget is over the use of mineral severance taxes. Mead wants to use more of that money to pay for state services. The JAC, Nicholas said, wants to keep growing one of the state’s largest financial assets — the $7 billion Permanent Mineral Trust Fund.
Wyoming’s Constitution demands that a 1.5 percent mineral severance tax feed into that fund. In 2005, the Legislature decided to divert additional severance revenues into the PMTF to accelerate the fund’s growth. Funds placed in the PMTF are inviolate and unavailable.
Before 2005, that money went to the General Fund, which pays for state services.
During the 2016 legislative budget session, as the state’s mineral revenues plummeted and money for state services ran short, the Legislature voted to end the diversion to the PMTF and put that money instead into a holding account where it could be used to help with budgeting. It came to more than $168 million in extra money for the state to spend.
However, the JAC would like to resume the diversion to the PMTF, Nicholas said.
Other members of the House hope to use the severance tax revenue to help shore up education funding. The House Education Committee’s omnibus education bill, currently awaiting consideration in the Senate, would spend the money on schools for four fiscal years, from fiscal year 2019 to 2022.
Mead wants the severance tax revenues to be deposited in the General Fund for use by state agencies, as it was before 2005.
“We have made substantial reductions in programs and personnel, and the cuts are only now being felt in Wyoming communities,” Mead spokesman David Bush wrote in an email. “The statutory one-percent amount [the severance tax revenue diversion] should return to its historic use as General Fund.”
Both Nicholas and Mead have said the reduction in state revenues is not going away anytime soon. But that informs their views of the severance tax diversion differently. Nicholas said it needs to be diverted back into the Permanent Mineral Trust Fund, to protect the PMTF from inflation. Many years, the constitutionally designated 1.5 percent tax alone isn’t enough “inflation proof” the PMTF, he said.
State Treasurer Mark Gordon has also called for the Legislature to direct more of the PMTF’s investment earnings back into the fund itself.
Without including the money diverted in 2016, the JAC sees a budget deficit of over $100 million. Thus the need for cuts.
“If we want to live within our means, and appropriate only what we bring in, we must reduce expenditures if we want to continue to inflation proof the PMTF,” Nicholas wrote.
Returning money to the PMTF when the state is facing reduced revenues would be a mistake, said House Minority Floor Leader Cathy Connolly (D, HD-13, Laramie). “That’s real money that we have available,” she said. “When we don’t put additional money in savings… that doesn’t mean we’re in a structural deficit.”
Connolly was on the House Appropriations Committee from 2015 to 2016. She thinks the Republican majority has redefined the budget discussion to be centered around a structural deficit that needs to be addressed by cuts. Meanwhile, they’re ignoring the potential consequences of the cuts being made.
“I am concerned with the willy nilly cutting of state employees,” she said.
The budget currently proposed would draw $106 million from the rainy day fund, Rep. Lloyd Larsen (R, HD-54, Lander) a member of the appropriations committee, said.
Small government principles help drive cuts
Rep. Marti Halverson said she believes the governor is concerned about the cuts because the Legislature is finally starting to trim the number of state employees, as opposed to just cutting vacant positions. The state has far more public employees than other similar sized states, she said, an indication of inflated government.
“Now we’re getting close to cutting flesh and bone,” she said, which has caused Gov. Mead to react protectively.
Halverson voted to restore funding to the maternal health program. She prefers to make cuts to “buildings, institutions and bureaucracies,” over services like public health, she said.
However, some lawmakers on the House floor argued the program was an example of taxpayer funded overreach.
His heart ached to vote against the amendment, Rep. Scott Clem (R, HD-31, Gillette) said. But he would do it because he did not want to draw the money to pay for it out of the rainy day fund and he was unsure if it was a necessary role for the state.
“Is this really a function of government?” he asked. Low-income mothers may be a vulnerable population, he said, but the public health nurse program discourages neighbors, friends, or church members who could do the job for free.
“Do we discourage community involvement and say ‘well no you know what, the government will take care of it, they’ll send a nurse to your house?’” he asked.
Hockley disagreed with that assessment. She said public health nurses provide low-income mothers with evidence-based expertise in health that a neighbor can’t.
“I think that’s a really big common myth, that we can just ask our neighbors or hit the Google button,” she said.
As an example, she cited a common dangerous myth that if a baby is sleeping all night the mother should let it. As a nurse, Hockley said, she knows that babies shouldn’t go much longer than two to three hours between breast feeding.
“That can be a direct impact on a baby’s health and wellbeing because somebody told [the mother] to let it sleep,” she said.
Another of her jobs is encouraging expectant mothers to give up vices that could hurt their child’s development. Though she says most mothers are aware they should give up tobacco and alcohol during pregnancy, not all are easily able to do it. Hockley refers them to state programs that can help them quit tobacco or drinking.
Poor health practices during pregnancy can lead to increases in infant mortality, birth defects and premature births. Those problems don’t come without a cost to the state, Hockley said. Particularly since many of the mothers she deals with may be on Medicaid or other state funded health programs.
During debate, Rep. Landon Brown (R, HD-9, Cheyenne) said around 30 percent of preterm births come from Medicaid recipients.
The $230,000 cut will not kill the maternal and child health program, just further damage it. Several times during debate on the House floor lawmakers said even the full $400,000 cut originally proposed equated to only $14,000 per Wyoming county.
Others pointed out that at the county level, even $14,000 would make a difference.
“That’s a lot of gas money going out and seeing moms that live way out from town,” Lindholm said.