How Policymakers’ Personal Stories Inspire Their State Service: A Conversation with Wyoming State Senator Fred Baldwin

In this Q&A, Milbank Memorial Fund National Director of Population Health and Health Equity Morgan McDonald, MD, talks with Fred Baldwin, a Republican state senator from Wyoming and a 2022-23 Milbank Fellow, about his background and how it has influenced and inspired his public service. Mr. Baldwin, a physician assistant and volunteer firefighter, discusses how some of his views on health policy have been formed, and why he values working with people with varied perspectives. Please see a companion interview with Fatmata Williams, director of medical administration at the Connecticut Department of Social Services Division of Health Services.

What is your origin story and how has it influenced public service?

I came into public service in an unusual position. My mother-in-law, who held a seat in the legislature, was retiring and said, “Hey, do you want to run for my seat?” That was 10 years ago. But I’ve always performed some kind of public service. I’m a firefighter by trade in one of my past lives. I also work in medicine. I started out as an EMT through the fire service and became a paramedic nurse. Now I’m a physician assistant. In addition to my legislative duties, I still do medical work and I’m a volunteer fire chief.

There are so many different lines of service that you’re committed to. Where did that start?

I wanted to be a firefighter when I was a little kid. I started by jumping out of helicopters into forest fires. Then working as an EMT, I really enjoyed helping out other people. So, I kind of inched my way into public service as a legislator. And it’s just grown on me. I love everything I do.

I think my parents influenced my desire to help other people. They didn’t push me into it, but they sort of nudged me. I have a grandfather who was in public service. He served in the Wyoming House of Representatives. He died before I was born. I was not aware of his service until quite recently. But when I was first [sitting] in the House of Representatives, immediately over my right shoulder was his picture.

It sounds like service itself feeds you joy, which is great to hear. How do you approach work working with people from different backgrounds?

I consider myself a sponge. When I work with people from different backgrounds, different origin stories, they’ve all got something to teach me that I can use to better myself and the lives of those around me. Every time I associate with somebody new, that benefits me.

What was it like growing up in Wyoming?

You have to be tough. Interstate 80, or any given road for that matter, is closed half the winter. Here at my house, we couldn’t go anywhere for days at a time this last winter. You have to be able to take care of yourselves if the power goes out, if the gas goes off. You learn to be self-sufficient. In Wyoming, you’re a little bit more independent and more resistant to the federal government, or anybody, telling you what to do. I can go out and wander the open spaces for days and not see another person. I know all my neighbors, I know where I can and can’t go, and I don’t like people telling me what to do.

The other side of that independence is that people don’t like to admit that they need help. It creates a dual-edged sword. People need help, and they’re creating problems for themselves and their family, but they don’t want to go ask anybody for help, because that’s sending a message that you’re not strong.

Can you think of a time when being able to share where you come from and seeing where others are coming from has been helpful?

I think that is so important in the legislature. We come into a committee meeting, and a lot of opinions are already formed. A lot of votes are already decided before we even hear testimony. I think that’s the wrong approach. I think the right approach is to be that sponge. You may not agree with all the people who are testifying, but if you don’t learn from those people, then you’re not treating the subject fairly. It’s important in the legislative world to be open, to absorb ideas, to learn new things. It may not always be in the committee meeting, right? It may be in my medical office one day when a patient comes in and gives me their opinions. It’s important to learn everything you can in every given moment. Otherwise, you can’t help your constituents in the best way you can.

I wish that we could get more people involved in policymaking, and not just in the legislature but in other government leadership positions. I wish we could draw more people in, so we have more points of view. I’m chairman of the Labor Health Committee, and about nine members are brand new. They tend to bring into the committee the ideas of the platform that got them elected. It’s hard to move them away from that platform and realize there’s other items that we have to consider and accomplish. 

Have your strategies and goals pertaining to advancing health in Wyoming changed over time?

Tremendously. When I first came into the legislature, we were talking about Medicaid expansion for the first time. The Wyoming legislature was very hostile toward Medicaid expansion as it remains today. My votes on that issue have changed, quite frankly, as I understand the subject better, as I get better feel for Medicare and Medicaid. We don’t live in a vacuum. We have to help each other. And that’s not necessarily just within the state of Wyoming, that’s working with other states and the evil federal government [laughs].

My views have changed in part from being exposed to people who need health insurance like young ranching families who are just getting started. Ranching is not a terribly lucrative profession, and these young couples can’t afford insurance. As opposed to saying, “If you get sick, hope you do okay,” I now have a softer view on having some sort of affordable care available.

Not a week goes by that somebody doesn’t come to me and share why they can’t obtain insurance, or why they can’t afford a kidney transplant, or access mental health care. In Wyoming, we have fewer than 600,000 people in the entire state. But the availability of medical providers, especially mental health providers, is very low. We have people that are remote — out in frontier Wyoming — who can’t obtain any mental health care. Families can’t function because one family member is in that difficult situation. I share those stories all the time.

It sounds like those stories are part of your origin story too, in a sense, because they’ve shaped how you view the world and become a source of inspiration and accountability. Any final thoughts?

Whatever your origin is, don’t hide it. You need to be proud of it. It’s part of you. It’s your strength.