Hi everybody welcome to our year end wrap up
with The County Seat I'm your host Chad Booth.
Joining us later in the show will be Lincoln
Shurtz and Adam Trupp from the Utah Assoc. of
Counties. Rather than do a lot of philosophizing
about the great stories of the year or the most
important ones we are just going to recap them
quickly and point towards next year. Let's start
with the most recent, Medicaid Expansion.
through what was entailed in this waiver and
what it said it would cover I was surprised there
were a lot of things that I would not have
anticipated being a coverable Medicaid
expense. How broad is this Dr. Shiozawa?
It's broad in the sense that it is directed to
specific population. When we think of Medicaid
in one circumstance we can say well it's going
to help those people that are poor say a women
who is pregnant or someone who has children
and they can just get general coverage. But
what this waiver does is specifically focus on a
specific population those people in the
homeless situation who have drug and mental
health problems and who have problems with
the justice system. So when they are involved
in that whether it's through the judiciary system
the mental health courts or how they find their
way into that particular category then these
dollars are then focused specific treatments to
help them. Let's say they are like substance
abuse maybe putting the into either outpatient
or inpatient treatment programs. The
residential treatment program I'll just see how
other groups are going to get funding for many
many beds they did not have before to bring
these patients ins they don't go directly from
the jail back onto the street. Or from mental
health courts out into some hotel with an ankle
bracelet but rather into a treatment program
that can give them not only treatment whether
physical or medical assisted treatment
counseling and then also getting them back into
better health and maybe even into a job so
really stabilizing here.
treatment beds and jail beds and making sure
they are expanded or capable facilities with the
jail and I noticed even some kind of elements of
police training. How that fix into the mix does
are they all crucial to make work?
It's going to be hard to have this program
succeed first of all until we know how it is going
to work but without enforcement downtown in
the Rio Grande area to protect not only those
people that are homeless but those citizens
around them and to prevent that vulnerable
population from being preyed upon by the drug
dealers. We are going to have to have more
police and then for those people who really are
drug abusers or violating the law then they have
to to into jail and we have to have under the JRI
for example the Justice Reinvestment Initiative
we have to have funding for that which we did
not get before because we never expanded
Medicaid. And then to get them from there
into residential treatment or outpatient
treatment into programs all three of these
various factors are important. So when you
look at ate judicial system what's it supposed to
accomplish. Well public safety right,
accountability and rehabilitation and if you take
away one of those three aspects you are going
to have a failure in that system and we have to
have that rehabilitation we have been pretty
good with accountability and we are pretty
good with public safety now let's get into the
rehabilitation portion.
So there you have our first topic Medicaid
expansion so to talk about the importance and
relevance of the counties we have Adam Trupp
who is the CEO of the Utah Assoc. of Counties
and their legislative director of affairs Lincoln
Shurtz. All right why was Medicaid expansion
such a big deal this year?
Well it was a long fought effort a very complex
effort of trying to get a state proposal through
the federal government to try and address
specific needs that are identified in our state to
deal with people who have substance abuse
disorders mental health issues who are involved
in the criminal justice system or who are trying
to avoid involvement in the criminal justice
system and by making the expansion possible
that was made and approved by the federal
government we have created the opportunity
for many more people to get the treatment
and medical care that they do need.
And trying to contextualize the politics of all this
right at the same time we are trying to get
expansion through the state of Utah to cover
this JRI population you have the Trump
administration who is trying to pull back the
affordable care act and so navigating those
politics has been not easy for the speaker and
for Representative Dunnigan who did an
amazing job in getting the Trump
administration to approve this waiver which
many thought was going to be accomplishable
with the current political dynamic about ACA.
And yet just a year ago you had an
administration that was very willing and a state
legislature that was going wait and hold on.
And then the administration 18 months ago
who took 18 months and did nothing with the
waiver so pretty interesting times.
Correct and it gave the state of Utah the
opportunity to say this is what we would like to
have in our state and now the administration is
able to say okay show us if it works we will give
your that leeway and let's see if that works and
meets the needs in your state.
Yes, a great win for states' rights if you are of
that ilk.
There you go that is a good way to end the first
segment we will be back and our next question
and topic for importance opioids and lawsuits.
Back with The County Seat in just a minute.
Welcome back to The County Seat this is our
yearend review. You know of the things that
caught most attention there are several
problems that are all tied into one base
problem and that is the explosion of opioid
abuse. In all forms. We decided that was one
of our top stories of the year and we are going
to talk about a recent phenomenon of taking on
the drug companies that started this problem.
Yes, it is completely different. The paradigm
has completely changed. You know people
think of drugs they think of the dirty side of
town. What we are seeing is it is not
necessarily the case anymore. It used to be
drugs come in a baggy what about the drugs
that come in a bottle you cannot divorce the
two. We are literally seeing soccer moms,
clergy, business men, and high school kids,
grade school kids getting hooked on opioids,
quietly at home and not talking about it
because they do not want to deal with the
stigma of shame that may come with that
quietly dying at home. Something I have never
seen before. That is how pervasive this is. That
is the difference now we are no longer dealing
with the seedy side of town. We are dealing
with the home.
Commissioner Lee talk to me for a minute
about what Utah County has done as you have
been a headline maker as far as what is
happening with this and I was very surprised
but gratified when I read the headline.
Yes, in looking at this, this is not something that
is behind the scenes as mentioned here. These
are faces that we see we all know them it's in
our neighborhoods it's in our families it's there
all the time and we cannot just duck away from
this. As elected officials we have taken an
sworn oath to protect and defend and that
means to the citizens of our counties as well as
we look at that in a realistic manner we have to
stand up to some of these issues and say here
we are we are going to make a stand on it is not
something we are just going to hide behind and
say maybe some other day. That is a big point.
want to jump to that quickly. They are saying
out there that opioids are safe and effective
that they treat chronic and non-cancer pain.
They also say that the existence of scientific
evidence that opioids are affective for long term
use. It is a narrative that is not correct and as
elected officials and as we are looking at this it
does not just affect the people we have it
within our sheriff's department where we are
looking at the jails we deal with it on a regular
basis. Our Wasatch mental health issues the
drug and alcohol abuse all of the substance that
we are trying to alleviate they are their
constantly. It affects the county on its bottom
line with the budgeting because we have to go
after and deal with these issues. There are in
our emergency rooms we have every day more
than 1000 people treated in the emergency
rooms for misuse of prescription drugs. Not for
the proper use but misuse of prescription drugs.
These need to be addressed we are not
necessarily going out there and saying we want
to have everybody always feel pain all the time
but it's the misuse and then the leading as it
gets into the drug abuses and the drug
overdoses that are a big concern for us and we
have that standing in the county where we are
directly affected by that and we are leading out
and we are saying we need to pursue legal
actions to turn the tide of this or to at least
address it.
Let's take a shot at the opioids and the lawsuit
on first blush this looks like suing opioid
companies seems like I want to blame
somebody but I guess there is a rationale to
this.
There definitely is and again I am not going to
try and go into the proof of all the legal cases
right now but the fact is that there are facts and
there are theories by the counties across the
country that have brought these lawsuits that
are essentially akin to the tobacco lawsuits from
years ago and based on many of the same kinds
of claims and that is a manufacturer of a
product mislead the public and mislead
individual to believe that this was a good thing
to use and that it was not addictive and that
there were not significant health problems that
you would face and as the result of that many
people followed the advice from the makers
and from their doctors and that is how we end
up in a situation we are in now. Now in the
long run does that play out so that counties can
recover money for the costs of service that they
provided as a result of those situations? We do
not know but there is certainly a claim that is
justified so we will see what happens and I am
hopeful that counties will join in to figure out
whether or not they do have an interest in
continuing.
Does that open up a flood gate for individuals to
pursue the same line as some kind of class
action?
I think there is likelihood there will be a class
action lawsuit. The question is jurisdiction. Is
this going to be handled in state court or is this
going to be handled in federal court? And by
Utah counties coming forward and putting
forward claims the hope is it will be handled in
state court vs. a federal class action case. So
that is part of the reason and the logic behind
doing something locally as you can have more
control from the state court process than you
would otherwise have through a federal court
process.
And again this is an issue of local government,
local interests and let's find out what the facts
show. Let's find out as we move forward
whether there is a claim or people are just
trying to find someone to blame.
And now question this epidemic has plagued
the budgets of counties as we provide services
to try and remedy what is going on.
I.E. Medicaid expansion.
Absolutely.
Okay we will take a break and back with The
County Seat with our next topic.
Welcome back to The County Seat we are
continuing our review of the most important
stories of the year perhaps the one that has
gotten the most air time and editorial time the
most coverage time was the declaration of the
Bears Ears National Monument. Now from the
time the year started to the time that it ended
there were many things that have happened
and it's happened in an incredibly short period
of time. Now over our course of conversation is
focused on reduction of monuments but let's
look back and remember what the conflict was
before the monument.
Now that Bears Ears National
Monument is a reality, there are
many questions San Juan County
residents have about what to
expect in the years to come.
While no one knows exactly, there
is a 20 year case study we can
examine: the Grand Staircase
Escalante National Monument.20
years ago, Clare Ramsay was a
Garfield County Commissioner. We
asked him what they promised the
day after the declaration.
Well that everything would remain
the same that we wouldn't lose
any rights or privileges that we
had at that time, of course
everything changed immediately.
The way of life, the culture has
changed, access has changed. The
things that we were building and
the things that we were
preserving have been taken away
or starting to be destroyed
because of the monument.
Four main areas of local
community impact came into play
with the creation of Grand
Staircase: Transportation,
grazing, water, and use of
resources, all have changed.
The roads were a big issue, we
began immediately fighting over
them. In fact, it was from the
pressure from Garfield County
Commissioners that forced
the Monument people to even put
roads into the monument
management plan.
To date Garfield County reports
they have lost nearly 50 percent
of the county road miles within
the monument. For Kane the loss
is worse.
I actually did a count in the
beginning and we have actually
lost 80% of our roads that we
claim as county roads.
For decades people have relied on
resources in the surrounding
hills for things they need.
Those resources are now off
limits as well.
As I remember, there is about two
areas on the Monument where you
can still gather wood. So that
was affected directly and
immediately. There is areas there
that people mined just decorative
rocks, flat rocks for patios and
such and those things were shut
down.
Kane County is no longer allowed
to use gravel from inside the
monument to maintain roads, and
Escalante City had to abandon a
nearby source for clay to line
their landfill.
It was determined no material
could be taken off the monument,
so Escalante had to find another
clay source. It cost Escalante
City a significant amount of
money to haul that clay to
Escalante city.
Perhaps the biggest impact is in
grazing, the one thing that was
specifically promised to remain.
They will tell you that our AUMs
have not been cut, and that is
true, but can we run the same
number of acres of AUMs on our
allotments? No we can't because
of the infestation of pinion
juniper, of weeds.
The physical conditions on the
monument are deteriorating due to
neglect.
Residents in Garfield and Kane
County feel that the promises to
work in conjunction with the
communities failed to materialize
and that the special concessions
listed in the proclamation have
been circumvented. It is their
fear that the same awaits their
neighbors to the east.
From the County Seat, Im Malia
Okay, Bears Ears probably as far as headlines go
that biggest headline grabber of the entire year
here in the State of Utah and in the region as
well. So why does this whole controversy end
up being so important to rural counties?
It's important to rural counties because there
has been a feeling from leadership in those
counties from the citizens in those counties that
they were not heard in the past by the
administration for years and in fact that they
felt that now they were as a result of Interior
Secretary Zinke coming down to the area and
talking to people about Bears Ears and Grand
Staircase that they were now being heard and
they had a voice with their federal government
and with the leadership. I think that is the
biggest reason that it is important to rural
counties. The reality is the change and impact
on the land that is there from the change is not
that significant despite the claims that the land
is being sold or given away to the highest bidder
which is dishonest. The Fact is that what we
still have is protective federal lands with more
access provided. So those two reason I think
are important but the biggest one is the feeling
that people in small communities and
populations are heard by the administration.
Is there really a big philosophical difference of
the protection stance of a monument vs.
multiple use of regular BLM land? Does that
really pay out in day to day life?
Not in day to day life. There is a philosophical
difference like monument status vs. multiple
use status it is much more controlled and more
limited as a monument. But the reality is if you
look at how we are able to access public lands
for multiple uses especially for any resource
extraction there is no question it is still
extremely burdensome still extremely difficult.
Heavily regulated the fear mongering out there
that this was all of the sudden going to become
private land for development is just a fallacy
just to gin up the opposition vs. recognizing still
public land still highly regulated and still going
to be there for the public use.
But isn't it going to improve like grazing
problems and restrictions and some
transportation issues that will have an impact
right?
Certainly I think it will I think that is the hope
for many people that live in those rural
communities no question about it. That would
be a positive on many levels. On the flip side of
that the fact that there was monument
protection did not mean that the federal
government was putting a lot more time and
money and staff in making sure the land was
properly taken care of it simply meant it had a
different designation and peoples uses were
limited more that is not going to change the
lack of staffing change does not change no
matter what the status is.
Great, very good we will be on to our final topic
right after this commercial break.
Welcome back to The County Seat. We have
been going through the half hour looking at the
most important issues of the year and we are
going to take a look at the last one which we
already know is going to be an issue again this
year. Its medical marijuana this has gone
through a lot of iterations and has been a
dialogue that probably has no end in Utah until
we come to a final sentiment of how to deal
with it lets check this out.
The marijuana plant is made up of over 100
individual components called Cannabinoids.
The primary ones are Cannabidiols {CBD} and
Tetrahydrocannabinols or {THC} [This is the one
that has psychotropic qualities.
According to the National Institute of Health,
the human body also produces and uses its own
cannabinoid chemicals.
Currently there is medical interest in THC and
CBD. THC has proven to increase appetite and
reduce nausea. The FDA-approved THC-based
medications are used for these purposes. THC
may also decrease pain, inflammation, and
muscle control problems. But it does have
potentially harmful side effects
CBD is a cannabinoid that does not affect the
mind or behavior. But preliminary research
indicates that it may be useful in reducing pain
and inflammation, controlling epileptic seizures,
and possibly even treating mental illness and
addictions.
Other areas that show promise are in
attacking certain cancer and tumors including
brain tumors, combating autoimmune
diseases, multiple sclerosis and Alzheimer's
disease.
We have come quite a distance on medical
marijuana it's been discussed every year for
years and what is changing how year ended up
different this year and the year before on this
issue.
I think you have to look at public sentiment as
the main driver of why things have changed. In
Utah I do not know if I would thought 5 years
ago that it would be polling at 60-70% approval
rating in terms of medical marijuana and that is
where things are at today. So when you see
public sentiment change you have seen literally
every surrounding state adopt either
recreational or medical marijuana I think the
dynamics around the entire issue have begun
the change. The citizens' initiative that is going
to likely make its way to the ballot certainly
changes the dynamics of the discussion it will
be fascinating to see how the legislature
responds to that recognizing you got this
initiative hanging out there that is polling at
70% public is going to vote for it unless they do
something. How much preemption can the
state legislature do to really keep control of this
issue, vs how much is going to be done by
initiative will be the issue du jour for much of
the legislature.
Do you think the legislature will be as motivated
by this as they were by count my vote? They
are going to be motivated what is also
interesting is that you have Senator Shiozawa
who the leader of much of this conversation
about how do we handle this how do we handle
it in a scientific and medically appropriate way
has now resigned from the legislature to take a
position with HHS. Health and Human services
federally so with his absence who is going to fill
the vacuum in terms of the policy discussion.
Senator Mark Madsen is no longer in the
legislature so a lot of space to fill.
I guess Senator Vickers is all that is left.
Senator Vickers who is a pharmacist by trade is
there and certainly has a perspective on this
issue as a licensed pharmacist in the state and
like I said there is a lot of space to fill in terms of
politics it will be fascinating to watch this one
play out during the session.
You think people really understand what the
initiative is about or do you think it is just
popular sentiment?
Heavens no, it's largely based on the Madsen
bill what was that 2 or 3 years ago. I would
argue that very few people have actually read
the initiative to see what it contains.
Well okay that is the top four stories and
gentlemen thank you for joining us and Happy
New Year to you.
You too.
Will you come back in a couple of weeks and
talk about the legislature?
We will look a little more tired but we will be
back after the legislature concludes.
Absolutely.
Thank you so much and thank you for joining us
happy new year everybody and we will see you
next year on The County Seat.
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