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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.