Wyoming lawmakers are set to distribute $85 million in federal pandemic relief for capital-improvement projects, and Tracy Brosius - the CEO of HealthWorks, a safety-net health center in Cheyenne - is getting in line.

While everyone wants to be finished with COVID, she said COVID is not finished with us. And as winter months creep closer, she said she does not want to see clinicians treating patients in parking lots in the snow again this year because of lack of space.

"So I just really think an investment in capital construction at this point in time," said Brosius, "would really be able to help us with the dignity of both my providers and our patients."

Brosius - who is also the incoming executive director of the Wyoming Primary Care Association - called the American Rescue Plan Act money a once-in-a-generation opportunity to access capital for Wyoming's federally qualified health centers that serve some 50,000 residents each year regardless of their ability to pay.

Senate File 0066, passed in the last session, tasks the State Loan and Investment Board - which includes Gov. Mark Gordon - to decide who will receive funding.

Brosius said the need for counseling and other behavioral health services exploded during the pandemic. She noted that expanding facilities will be critical for addressing COVID's long-term ripple effects on mental health.

"We have five clinicians at this point," said Brosius, "but physically we do not have enough space to hire another staff member, because we just don't have a space to put them. So therefore we can't expand our services and treat more patients."

Wyoming's health centers contribute $71 billion a year in economic impact, but Brosius said they face unique challenges raising large sums required for construction projects.

She said she believes health centers are a good fit for federal funds because they predominately serve the state's most vulnerable populations.

"In many cases in Census tracts where people have low income levels and/or difficulties seeking care," said Brosius. "So this funding would allow us to build and access capital that most of our clinics are not able to generate for themselves."

As National Glaucoma Awareness Month comes to a close, one Nevada ophthalmologist wants to remind people to get their eyes and vision checked.

Dr. Janet Lee, an ophthalmologist with Shepherd Eye Center, said glaucoma is a group of eye diseases that affect the optic nerve and can be thought of as a cable that connects a person's eye to the brain. Damage to the optic nerve can result in partial vision loss or total blindness.

Lee said there are more than 3-million Americans in the U.S. with glaucoma, and once damage to the optic nerve has been done it cannot be reversed.

"Studies have shown that decreasing the pressure in your eyes can slow down the progression of glaucoma. Fortunately, we have many effective ways to reduce the eye pressure," Lee said.

Catching it early is key, she said, and added the pressure can be reduced, ultimately slowing the progression of glaucoma, through eye drops, laser treatment or surgery.

She said regular eyes exams and prevention are key in detecting glaucoma, which has been found to impact African American, Hispanic and Asian populations at higher rates.

Lee said glaucoma is a silent disease, and while there is no cure for most forms of glaucoma, many patients, once diagnosed, can be treated successfully. Lee said as the disease progresses, blind spots develop in one's vision and the change is so gradual that a person may not even notice a change until the glaucoma reaches an advanced stage.

"Primary opening-angle glaucoma is the most common type of glaucoma." she said. "There are no warning signs or obvious symptoms in the early stages. In fact, half the people with glaucoma don't know they have it."

Lee added it is also important to be aware of acute-angle closure glaucoma, which is a less common type of the disease but is responsible for a sudden rise in eye pressure. Symptoms include headache, nausea, vomiting and pain in the eye or brow area.

It is not a pandemic yet, but eye doctors worry the constant use of digital devices could eventually result in long-term health problems for many Texans.

Problems can include age-related macular degeneration, disrupted sleep cycles, and digital eyestrain.

Dr. Jacob Moore, president of the Texas Ophthalmological Association, said it can start with dry eyes after spending hours on digital screens.

"Probably the number one reason people have dry-eye-related symptoms when they use the computer a lot, is because is when we're actively reading, we blink less," Moore explained. "Just the fact that we're working and that our minds are active, we blink less."

He pointed out the average American logs 13 hours a day watching screens, up from between seven and 10 hours per day before the COVID-19 pandemic began.

Dr. Scott Edmonds, chief eye care officer for UnitedHealthcare Vision, said eye specialists became concerned during the pandemic about the dangers of blue light emitted by digital devices, especially because people needed them for school and work, more than ever before.

"Kids were learning remotely, using screens and laptops and cellphones; workers had moved away from the office, working from home," Edmonds recounted. "We know that the millennial generation, in addition to school and work and social media, they also play a lot of games, which emit very high levels of blue light."

In addition to dry eyes, or eyes that feel scratchy or burning, people who log excessive screen time often notice the print goes in and out of focus and complain of headaches or brain fog.

Jacobs offered tips for anyone trying to protect their eye health.

"I would recommend that people wear sunglasses when they're outside. They should wear safety glasses when they're hammering a nail or doing anything that has a risk of eye injury. People need to stay away from smoke, and secondhand smoke."

Eye specialists also recommend those who use digital screens a lot follow the 20-20-20 rule: Take a 20-second break and look at something at least 20 feet away, every 20 minutes.

A bill that would expand Medicaid coverage for some 19,000 Wyoming workers who earn too much to qualify for standard Medicaid, but can't afford private insurance, is making its way through the state Legislature.

Ana Marchese - director for the group Healthy Wyoming - said expansion would bring millions of federal tax dollars back to the state, and would largely help women working at jobs that pay low wages and offer no health benefits, including restaurant, construction, agriculture and retail.

"In Wyoming, more than half of those covered by Medicaid expansion would be low-income women," said Marchese. "Wyoming has one of the highest uninsured rates for women of childbearing age. This has big consequences for the health of mothers and infants."

Wyoming is one of just 11 states that have not expanded Medicaid coverage. The most recent American Cancer Society poll found that nearly two-thirds of Wyoming voters across the political spectrum support expansion, including 66% of Republicans.

Critics have long warned about the potential costs, and some lawmakers are leery of entering into a deal with the federal government.

House Bill 80 cleared the Joint Revenue Interim committee, but has not yet been scheduled for a hearing.

Expansion has been a lifeline for rural hospitals, according to a Families USA report, lowering the likelihood of closure by 62% - largely by reducing losses when people without insurance can't pay.

Wyoming hospitals spend $120 million a year in uncompensated care.

Marchese pointed to hospitals in Kemmerer and Rawlins that recently closed labor and delivery services due to financial struggles.

"After Montana expanded Medicaid, uncompensated care went from $143 million to $89 million in 2019," said Marchese. "And that's a big deal, that keeps hospitals open."

Marchese said expanding coverage will also boost Wyoming's economy.

People with insurance tend to be healthier, more productive workers with fewer sick days. Insurance also gives workers access to less costly preventive care.

"When people lack coverage they often seek treatment at the emergency room, which comes with a hefty price tag," said Marchese. "Having health insurance, and being able to take care of your own physical and mental health, has a positive impact on your ability to work."