Progressive Thinking

Sen. Smith writes about the shortage of funding for emergency medical services, and how increasing the shared revenue formula will meet this need to provide life-saving services in the most critical cases.

MADISON - When you call 911, you expect with rock-solid confidence there will be someone to answer the call. You also expect help is on the way. Confidence in the midst of a catastrophe is taken for granted every day.

What many people don’t know is how it all works on the back end. It takes dedicated people and immense resources through shared revenue to local municipalities to get injured and sick individuals to a place they can be treated.

It’s not supposed to matter where you are located. You should expect someone trained in emergency medical services (EMS) to show up when you call.

But increasingly it does matter where you are as more villages and towns struggle to provide emergency services. There are two major reasons for this: lack of personnel and lack of resources and funding.

In most cases, attracting workers to any public service job is a challenge, but recruiting workers into emergency services presents unique challenges. It takes a special kind of person who can respond to the scene of an emergency and calmly apply their training in a high-stress situation.

Emergency responders have varying levels of training. First responder training is considered a bare minimum for emergency responders, but some providers have higher levels of certification. EMS responders have more advanced training and achieve a certification that allows them to deal with more complicated cases, such as spinal injuries. A paramedic has even more training, and can deal with a wide variety of life-threatening situations that require more intensive emergency treatments.

Each of these professions take time and money to learn, and there is a serious shortage of interested people willing to serve in these critical roles. Often in rural areas, emergency responders are volunteers, but even so, training costs money. Education takes time, which means paying workers for their time while training, even if they won’t be full-time professionals such as you will find in cities. Equipment is costly too. An ambulance can cost anywhere from $180,000 to $300,000, and I’m sure you’ll want that ambulance fully equipped if you’re the one calling.

With ever-mounting costs and an acute shortage in trained personnel, some smaller municipalities have turned to cities for help. Towns contract with city services to answer their calls, which cuts down on costs, but outsourcing this job to the city results in longer lag times from when the call comes in to when the ambulance arrives. I have heard of instances where it has taken 20 or 30 minutes or even an hour before an ambulance showed up to some rural calls. Worse than that, I have heard some people tell me that when they called they were told an ambulance was not available.

In many cases, minutes or seconds are crucial to saving a life. If service is not provided in your own town, it can be quite a wait for a response that may be coming from a city 30 miles away. To make matters worse, the closest hospital might be an hour away. In highly time-sensitive cases you may need a helicopter to get there, which is costly in both time and resources.

I’ve heard from countless constituents about their struggles with access to emergency medical services. These problems are the inevitable consequences of underfunding our local units of government for years.

We can provide additional funding through increasing the shared revenue formula. Governor Evers’ 2023-25 state budget includes increasing the amount of shared revenue for local communities, with some earmarked specifically for emergency services.

I’ll be coming to communities around the 31^st Senate District in the coming weeks to talk about the Governor’s budget and how shared revenue funding will help our communities serve residents. Please keep an eye out for when I’ll be in your community. You can see dates on my website as they are scheduled at linktr.ee/sensmith. I look forward to hearing from you.

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The 31^st Senate District includes all of Buffalo, Pepin and Trempealeau counties and portions of Pierce, Dunn, Eau Claire, Jackson and St. Croix counties.

Senator Smith writes about how we can respond to our mental health crisis with services that improve outcomes for patients and support safe and healthy communities.

MADISON - Overcoming the stigma of mental illness has long been our single greatest challenge in meeting health needs. The brain is the busiest and most complicated organ in our bodies and certainly the least understood. There’s no way to fix this problem here in one column, but I want to emphasize the importance of combating the stigma associated with mental health struggles.

The good news is that the healthcare conversation has been increasingly responsive to mental health challenges in our communities. Now when we fill out intake forms at the doctor’s, we are asked questions to give doctors insights into both our physical and mental well-being.

Governor Evers recognized this need when he declared 2023 the Year of Mental Health in this year’s State of the State address. With many shootings occurring weekly around the country attributed to mental health crises, the urgency of addressing mental health struggles is an overwhelming problem.

Fortunately, Congress took steps to improve access to mental health resources, like implementing the 988 Suicide & Crisis Lifeline, move us in the right direction. If you or someone you know is having suicidal thoughts, you can now call 988. Trained personnel answer this hotline 24/7 and they are there to connect you with life-saving resources.

There is more we can do. By state law, counties are designated with the primary responsibility for the treatment, well-being and care of unserved people with mental illness. If someone is diagnosed with a mental illness and needs treatment but is not covered by private insurance, the county steps in.

Programs administered by our county human services departments are required by statute to provide the community support programs that offer intensive care for adults that might otherwise need institutional care. They also provide emergency mental health services for those in crisis and adult protective services for the elderly and at-risk adults who are survivors of abuse, neglect and exploitation.

Counties are the frontlines for our work to help those struggling with mental health, but the funding for our counties is critical to this end. Counties receive their funding through shared revenue payments to fulfill mental health care responsibilities.

Unfortunately, state financial support for counties has been stagnant while the needs have only grown. For instance, funding for Adult Protective Services has been frozen since its inception in 2006, while counties’ spending on these mandated services has grown. Pepin County reported that their spending on Adult Protective Services has more than doubled from 2010-15 ($22,567) to 2016-20 ($48,043). When state funding doesn’t come through, counties have to deal with the shortfall.

Another challenge has been even finding enough professionals to provide these services. It has become clear that we need more social workers, psychiatrists and other mental health professionals. We have not adequately incentivized graduates in those fields.

The Governor’s budget addresses shortfalls in these fields. These provisions support the employment of trainees in mental health fields, establish mental health training programs for school district staff, and prohibit health insurers from denying coverage for behavioral and mental health performed by qualified mental health trainees.

What we need right now is the political will to pass a budget that gives counties the funding they need to provide mental health services and addresses the provider shortage. These budget provisions are essential to providing care and ensuring we are taking a comprehensive approach to healthcare by addressing all of our healthcare needs.

Mental healthcare is good for our communities. Let’s make sure we fully fund the Governor’s budget so we can provide it.

Republicans have failed to expand BadgerCare, a move that is supported by over 70% of Wisconsinites. This week, Sen. Smith writes about how expanding BadgerCare brings tax dollars home to provide better health outcomes.

MADISON - Since January of 2014, Wisconsin has had the opportunity to receive BadgerCare expansion funds. This is the ninth year Republicans have buried their heads in the sand, rejecting the $1.6 billion from the federal government and leaving 90,000 people without the health care they need.

We all wish this was the ninth anniversary of Wisconsin making the decision to do the right thing, but Republicans have continually rejected numerous bills, budget proposals and special sessions to fully expand BadgerCare.

Thanks to the ACA, the federal government has offered to return our own tax dollars back to Wisconsin if we expand BadgerCare, Wisconsin’s Medicaid program. Unfortunately, we’ve had thirteen years to get the job done and we still haven’t expanded BadgerCare.

According to the Legislative Fiscal Bureau, Wisconsin would have saved over $1 billion in 2021-23 by expanding Medicaid. These savings could’ve been used to lower prescription drug costs, expand mental health services, improve pregnancy outcomes and more. Wisconsin is still being held back by leaders playing politics with people’s healthcare.

If our own tax dollars can be returned right back to us, I suspect most people would consider it a no-brainer to accept. According to a 2022 poll, over 70% of Wisconsinites support BadgerCare expansion. Why should we pay to expand health care access in other states– which is what we’re doing now–before addressing our challenges here at home?

Governor Tony Evers’ 2023-25 budget includes a proposal to expand BadgerCare in Wisconsin. Doing so would expand healthcare coverage to 89,700 more Wisconsinites while also saving our state $1.6 billion due to enhanced federal funds. These savings could be reinvested back into new and existing healthcare programs serving residents across the state.

Medicaid ensures that Wisconsin residents have access to preventive and lifesaving healthcare. Current Medicaid programs–including IRIS, Family Care and SeniorCare–are available to help individuals living in poverty, people with disabilities and those who may be ineligible for Medicare. Medicaid provides prescription drug subsidies through SeniorCare. Medicaid helps cover screenings and treatment for breast and cervical cancer for women under the age of sixty-five. BadgerCare expansion would help more Wisconsinites by increasing reimbursements and building greater capacity of existing Medicaid programs.

We have an opportunity right in front of us to cover more Wisconsinites while also saving our state money. This would seem like an easy decision, right? After all, this is about bringing back our federal tax dollars to Wisconsin.

Many politicians seem to believe healthcare is a privilege – as if the quality of care you receive should depend on how wealthy you are. Whether you believe healthcare is a right or a privilege, our federal tax dollars are still being sent to other states to pay for their programs when it should be coming back here.

Wisconsin is one of only ten states that have refused to expand Medicaid. Last month, North Carolina Governor Roy Cooper signed a bipartisan bill expanding Medicaid coverage, leaving Wisconsin in an ever-dwindling minority of states who have not expanded coverage for their citizens yet. We’re still paying for other states to expand Medicaid without taking care of residents here in Wisconsin.

We need Medicaid because of our current healthcare system that far too often prioritizes profit over public health. With a broken healthcare system driven by insurance companies and big pharmaceutical corporations, the most humane thing we can do as a society is ensure that all Americans have access to affordable, high-quality health care. BadgerCare expansion ensures we’re being smart by returning our dollars to lower the cost of Medicaid programs overall.

We can get this done, right here in Wisconsin. We’ve had this discussion time and time again. It’s time to listen to our constituents and do the right thing by expanding BadgerCare.

Sen. Smith promotes public participation in the Legislature’s Joint Finance Committee budget listening sessions. Join them next Tuesday, April 11, at the W.R. Davies Center at UW-Eau Claire from 10:00am to 5:00pm to share your thoughts on the 2023-25 state budget!

MADISON - It’s not fun, but we all have to budget. We budget our time and our resources because we have a limited amount – of hours in the day, of energy, of money. Every day, each one of us makes decisions on how we allocate our time and resources, and while it’s not always a zero-sum game, sometimes we have to make tough choices.

So budgeting is not a foreign idea to any of us. Planning something as large as a state budget may seem daunting, but the same principles apply. We have a limited amount of money and many priorities to keep in mind. We start by estimating as closely as possible the revenue our state can expect over a two-year period. Then we allocate funding to the areas of spending we know we will need to address.

Wouldn’t it be nice if everyone agreed on priorities, and it were as simple as filling out a spreadsheet, moving the funds we need into each column? Unfortunately, the reality is much more complicated than that.

Every odd-numbered year, the legislature and the governor (in theory) work together to draft a new budget for our state. Since we in the Legislature are elected to serve you, the people of Wisconsin, it is only right that you have the opportunity to have a say in which areas you feel are most in need of state funding.

It's common for legislative committees to hold public hearings on bills before those bills are sent to the full body for a vote. Public hearings are where legislators gather more information and hear the thoughts and ideas of those people most affected by the policies on the table. Public input is vital, and the voices of our constituents is so valuable in making legislation better.

For my part, I get out every week in my red truck for my “Stop and Talks,” my mobile office hours throughout the communities in Senate District 31. I encourage anyone and everyone to stop and talk with me. I’ll be posting the dates and times on my Facebook and Twitter, and would love to have the chance to catch up with you the next time I’m in your community.

It’s somewhat rarer to have the opportunity to have your voice heard by a larger body of legislators, representing districts all across the state. Because the budget is the largest and most impactful bill that legislators vote on, representatives of the Legislature’s Joint Finance Committee (or JFC) go on the road to hold public hearings on the proposals being considered.

This year, the JFC has scheduled four such listening schedules, one of them right here in western Wisconsin. They’ll be coming to Eau Claire next Tuesday, April 11^th at UW-Eau Claire’s W.R. Davies Center.

The public hearing will go from 10:00am to 5:00pm. Anyone who wants to testify will be asked to fill out a form to be added to the queue. The earlier you are added to the queue, the sooner your name will be called to testify, so it’s good to arrive early.

Generally each person gets two minutes to share their comments to the Joint Finance Committee, or five minutes for groups of three or more. Having printed comments of your testimony for each of the 16 members in encouraged. If you need accessibility accommodations, call the Legislative Fiscal Bureau at (608) 266-3847.

If you can’t make it to the hearing, you can also submit your testimony online at https://legis.wisconsin.gov/topics/budgetcomments or by emailing your testimony to This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Tuesday, April 11 is your opportunity to make your voice heard. Whatever your priorities, it’s so important that the members of this committee hear from you. These hearings are democracy in action, and no one can tell your story but you.

I’ll see you there!

Senator Smith writes about the balance of power in the Wisconsin Legislature, where Republicans have had thirty years to change the status quo but have refused to do so.

MADISON - The English language has many words loaned from Latin, and the phrase “status quo” is one of the most recognizable. “Status quo" is Latin for “existing state,” and in our modern use, status quo is the existing state of affairs, especially regarding social or political issues.

If the rules are tilted in your favor or you hold power, you definitely have a vested interest in maintaining the status quo. After all, change threatens the existing state of affairs. Our political systems often pit those advocating for change against those who fear change will result in their being less well-off. In that way, the idea of the status quo defines our political environment as well.

The solution is never simple. But I would like everyone to consider how we get stuck in the mud and so little is accomplished. Somehow the people in power are able to convince voters to keep them there.

Here in Wisconsin it is downright puzzling to look back over the last 30 years. It’s typical for a sitting president to lose members of Congress of their same party in the middle of their term, known as the “midterm elections.” Rightly or wrongly, voters attribute the changes that occurred in the last two years as mostly the president’s doing, and often opt to create a “balance” by voting for the opposite party for Congress.

The midterm change sentiment often trickles down the ballot to state elections. Let’s look at Bill Clinton’s first midterm as an example. In 1994 Newt Gingrich riled voters up with what he called the “Contract with America” (the details of which we are still waiting to hear). By painting Clinton and his policies as the “status quo,” Republicans won majorities up and down the ballot across the country. These congressional and state legislative majorities retained power for decades.

Wisconsin is a good example of this national trend. Starting with the 1995 legislative session the Republican Party has held the majority in our state Assembly nearly continuously. Last year’s election did not change that, and Republicans have gerrymandered their way into two more years of power. With the current session majority decided, that makes 28 out of 30 years of Republican legislative majorities in the state Assembly. Though the Senate majority changed hands on occasion during that same 30-year period, power has not flipped in either house since 2011 – status quo in Wisconsin.

Many people say, “That’s why we need term limits.” But studies show term limits exacerbate the influence of the status quo, as new legislators rely increasingly on information from special interests and lobbyists. I won’t dive into all the reasons term limits don’t work in a democratic republic, but one reason is that those who hold the power (the status quo) are the same ones that would have to change the rules to limit their time in power.

Meanwhile voters ask why we can’t – or won’t – come to agreement on anything. Almost every meeting with constituents in my office reminds me that we have so much opportunity to make lives better. When visitors to my office mention that they have visited other offices “across the aisle,” I wonder how my colleagues believe that doing the same thing over and over again will result in different outcomes.

The next time you hear a politician complain about the current state of affairs or tell you we need change, ask them what they’ve done to effect positive change lately. When those expressing frustration with the status quo are the ones maintaining it, their words ring hollow. Such politicians are only parroting their constituents’ concerns, giving lip service to change while maintaining the status qu0.

The Wisconsin legislature can act to meet the needs of our people. We could accept Medicaid expansion as 40 other states have already. We could follow the lead of over 70% of our citizens and legalize medical marijuana. In my experience, these policies are overwhelmingly popular with Wisconsinites. But we don’t have a legislature that works for the needs of those we serve. We have a legislature that serves the status quo.