CHEYENNE — With new federal incentives being offered to the 12 states that have declined Medicaid expansion over the last decade, a bill to expand coverage in Wyoming to the state's low-income residents was advanced by a legislative committee Monday morning.
Expanding Medicaid to uninsured people whose income is at or below 138 percent of the federal poverty level has been a frequent topic of debate in the Wyoming Legislature in recent years. If authorized by state legislators, Medicaid expansion would cover approximately 24,000 residents in its first two years of implementation, according to estimates from the Wyoming Department of Health released last month.
Under Medicaid expansion, the federal government covers 90 percent of the costs, while states pick up 10 percent of the tab. In Wyoming, that amount totals roughly $20 million in the initial biennium of implementation. In past years, state lawmakers have frequently cited the cost that Wyoming must bear, as well as mistrust in the federal government keeping up its end of the deal, as reason to vote against expansion.
But the landscape has shifted at the federal level, as bill sponsor Sen. Chris Rothfuss, D-Laramie, told his colleagues Monday morning. Under the latest federal stimulus bill in Congress that may be signed into law later this week, the 12 states that have not expanded Medicaid would gain a 5-percent boost to their traditional Medicaid matching program, which is done at a 50-50 split and includes a far wider population than the expansion-eligible one.
A 5 percent increase in federal funds for the state’s general Medicaid population would generate roughly $120 million for the state per biennium, meaning Wyoming would actually gain revenue by expanding Medicaid, Rothfuss said.
“It's a net revenue increase to the general fund of $80 million for us to expand Medicaid for those two years that we wouldn't otherwise and won't otherwise have, while simultaneously providing and covering the health care costs for additional an 24,000 Wyomingites,” Rothfuss told members of the Senate Labor, Health and Social Services Committee.
His bill, Senate File 154, includes a provision that would allow Wyoming to withdraw from the Medicaid expansion program if the federal match fell below 90 percent, or if the match for the broader Medicaid program fell below 55 percent. Rothfuss told his colleagues the state could aim to leverage Congress into keeping the 55 percent match beyond its two-year lifespan under the stimulus bill.
Rothfuss said he was open to other solutions to address health care costs in Wyoming, but added that he has been “met with silence” from his colleagues on other proposals.
“We're taking a principled stand with the lives of 25,000 Wyomingites that don't have the luxury of sitting here today having this chat – folks that are our working poor, the single moms we heard about with two kids that probably have to have two or three jobs, the mentally ill,” said Rothfuss, who is the Senate Minority Floor Leader. "Those are the lives we're playing with, and we've offered them nothing for the last decade.”
Estimates show 76 percent of those who would be covered under Medicaid expansion in Wyoming are single mothers with two children, Wyoming Hospital Association President Eric Boley told the committee.
"We talk a lot about the working poor, and there are a lot of folks out there that are working for low wages that don't qualify (for health insurance), because they don't make enough money to qualify and be able to get any help with the exchange, nor could they afford the premiums, and they would fall in this category where they could have coverage,” Boley told the committee.
The costs of having fewer people with health insurance often show up in other areas of hospitals’ budgets. Josh Hannes, vice president of the Wyoming Hospital Association, said the level of uncompensated care for the state’s hospitals typically costs roughly $100 million each year.
“Every dollar that's spent … covering uncompensated care is money we're not investing in equipment, it's dollars we're not investing in new physicians and providers, it's money we're not investing in updating and maintaining our physical plants, some of which are aging considerably,” Hannes said, adding that no state that has expanded Medicaid has decided later to turn it away.
The proposal, which was also backed by the Wyoming Medical Society and the Wyoming Business Coalition on Health, drew testimony from state residents who could speak first-hand to the need for more accessible health care. Lisa Ridgway, a pediatrician based in Jackson, urged the committee to pass the bill, recounting stories of uninsured residents who pushed off seeking care until their health problems had risen to grave levels.
"I know a family in Jackson who's had to move to a small apartment, then rent out their house to pay the (hospital) bills,” Ridgway said. "I've seen patients in the parking lot at the grocery store here when the moms say they can't afford the emergency room (asking), 'Would I please look at a swollen ankle, a rash or a fever?’ … because if you wait, things tend to get worse.”
Ridgway was among a handful of residents who spoke in favor of Medicaid expansion during the meeting, while no one testified in opposition. Although more recent public opinion polls are lacking, a 2014 survey from the University of Wyoming found that 56 percent of state residents were supportive of expanding Medicaid in the Equality State.
While there was notable support for Rothfuss’s bill during the meeting, a few lawmakers on the committee had hesitations over the proposal. Sen. Troy McKeown, R-Gillette, worried about potential strings attached to expansion.
"Having served in the Army and living overseas, I'm going to tell you, you don't want socialized medicine,” McKeown said. “I saw it, and it’s bad, in my mind … I don’t know how we get the federal government out of the health care business, but that would be my answer, and I don’t know if we can.”
Sen. Anthony Bouchard, R-Cheyenne, argued additional government involvement in Wyoming’s health care system would only make the situation worse.
“I haven’t heard anything that didn’t say we’re just going to move further into the universal health care block, and that is a big red flag for me,” Bouchard said.
Ultimately, Bouchard and his fellow Laramie County lawmaker, Sen. Lynn Hutchings, R-Cheyenne, were the only two committee members to oppose the measure. Despite his criticisms, McKeown joined committee chair Sen. Fred Baldwin, R-Kemmerer, and Sen. Dan Furphy, R-Laramie, in advancing the bill.
With the committee’s approval by a 3-2 vote, the legislation will now head to the Senate floor for further consideration.