SHERIDAN — Sheridan advocates for Medicaid expansion in Wyoming are used to disappointment.
The topic has come up frequently in the state Legislature since a provision in 2010’s Affordable Care Act first called for expansion of Medicaid eligibility. But for every step forward, there have been multiple steps back.
Former Gov. Matt Mead spent many years exploring options for expansion of coverage and regularly included it in his budget proposals, but he continually faced pushback from the Legislature. That pushback continued after the election of Gov. Mark Gordon.
In 2019, a bill calling for a study of the effects of Medicaid expansion by 2021 passed with strong support in the Senate and narrowly failed in the House.
Later that year, lawmakers on the Joint Interim Revenue Committee voted in favor of a Medicaid expansion bill, and the bill died in committee on the first day of the 2020 legislative session.
Local advocates said it is not surprising, in light of this history, that two attempts to expand Medicaid failed this legislative session.
Rather than focusing on the failures, advocates are celebrating small victories including the passage of one bill through the House and several longtime legislators who voiced their support for expansion for the first time.
“Getting Medicaid expansion passed in the House was historic,” said Dayton resident and expansion advocate Julia Willis. “We have legislators that are really starting to listen to the people of Wyoming. One of our representatives, Mark Kinner, told us he had always voted against Medicaid in the past, and there are others like him who are listening to the human impact it has on us and also seeing the positive economic impact this will have on our state when they pass Medicaid.”
“The bill got further than it ever had before, which shows continued building momentum,” said Danielle Arnoux, Sheridan County Democratic Party president. “…It shows that our Legislature can do the right thing, even if there weren’t enough strong voices to finish the job.”
Legislators considered two Medicaid expansion bills this session.
House Bill 162 — sponsored by Rep. John Romero-Martinez, R-Cheyenne — passed the House on a 32-28 vote before being killed in the Senate’s Labor, Health and Social Services Committee on a 2-3 vote.
Senate File 154 — sponsored by Sen. Chris Rothfuss, D-Laramie — was not introduced on the Senate floor before the deadline for consideration.
The bills, like previous proposals, would have expanded Medicaid to currently uninsured people whose income is at or below 138 percent of the federal poverty level.
Medicaid expansion would have covered approximately 24,000 residents in its first two years of implementation, according to estimates from the Wyoming Department of Health.
Advocates like Arnoux and Willis have long argued expansion provides valuable care to thousands of Wyoming residents who have already been funding the program through their federal taxes over the past decade.
“Medicaid isn’t only the right thing to do, but the legislators who’ve said no are damaging our whole state by refusing the funds we have already paid for with our taxes,” Willis said.
Currently, Wyoming is one of 12 states that have not passed Medicaid expansion legislation.
Historically, Medicaid Expansion has been a tough sell for many Republican legislators, who have expressed a philosophical opposition to bills advancing “socialized medicine” and cited the cost of expansion as a reason to vote against it.
Under Medicaid expansion, the federal government covers 90 percent of the costs, while states cover the remaining 10 percent. In Wyoming, that 10 percent equals roughly $20 million in the first two years of implementation. Lawmakers have expressed concern the state share could increase after two years if the federal government refuses to uphold its end of the bargain.
Financial concerns were the primary ones voiced during the Senate Labor Committee meeting where HB162 was killed.
“This program, I don’t believe, is even close to sustainable,” Sen. Troy McKeown, R-Gillette, said during the committee meeting. “And at the end of two years, the federal government will do what it does best. It will yank the carpet out from under us and leave us with a $200 million program at a time when we can’t take care of our elderly as it is.”
“We’re not just trying to run into it — we’re sprinting into debt,” Sen. Lynn Hutchings, R-Cheyenne said.
Both Rep. Mark Jennings, R-Sheridan, and Rep. Cyrus Western, R-Big Horn, cited financial concerns as the primary reason they voted against Medicaid expansion when it was considered by the House.
“It started as a savings deal, but… (it would) become very untenable, especially as we have more budget problems,” Jennings said.
Western said that, while the bill contained an “escape clause” that allowed the state to exit Medicaid expansion if it became financially untenable, he was concerned it wouldn’t be that easy in practice.
“I appreciate how the bill was written that you could pull out and withdraw if the federal government does,” Western said. “That sounds fair to me, but let’s walk through this. Let’s say it passed and two, three or four years down the road, the federal government pulls out. That means we have to go on the record of removing health care from a bunch of these people. So it says we can withdraw, but in reality, it is a much stickier and more complicated process than some people said it was.”
But mixed in with those against expansion were Republican legislators who, for the first time this year, changed their vote on Medicaid expansion. One of those was local Rep. Mark Kinner, R-Sheridan.
“Although I am one of the ones who has been resisting this, I have really given this some thought, and I think it’s time,” Kinner said during the first reading of House Bill 162. “I recently visited and had heart-to-heart conversations with several friends in my area who would certainly benefit from this.”
House Speaker Steve Harshman, R-Casper, voted for expansion for the first time after seven previous no votes.
“I’ve always prided myself as (being) the most pro-life speaker in the history of Wyoming,” Harshman told the Senate Labor Committee before its consideration of HB162. “These are lives too.”
Some legislators may have been partially motivated by some new financial benefits of Medicaid expansion. The latest federal stimulus bill signed into law by President Joseph Biden last month allows states that have not expanded Medicaid to gain a 5-percent boost to their traditional Medicaid matching program, which would generate roughly $120 million in new revenue for the state every two years.
Freshman Rep. Barry Crago, R-Buffalo, said the financial incentive is what motivated him to support Medicaid expansion.
“That change in 5 percent saved tens of millions of dollars,” Crago said. “...I voted on it based on the dollars and cents.”
The voices of the 32 representatives who supported the legislation are heartening to Willis and Arnoux. In a decade-long battle, the small victories make all the difference for those supporting expansion.
“Everyone who is in this battle is pretty emotional about the bill dying, but we are feeling really hopeful, too, because we have made a ton of progress in these past months,” Arnoux said. “We have activated many of our neighbors across the state to take action with us. We’ve flipped some critical leaders in the Legislature, who are now championing Medicaid expansion, and moved the bill through the house for the first time ever. We will not stop.”
Despite the bills’ failure this session, both Arnoux and Willis said they are redoubling their efforts to provide health care coverage to Wyoming citizens.
“We want to take the message to the people that our legislators are playing political games with people’s lives, “Arnoux said of the Democratic Party’s plans to promote Medicaid expansion. “We plan to knock on doors, make calls and try to get the message out that if access and the cost of health care is important to you, you need to be contacting your legislators and telling them to pass Medicaid expansion.”
“For me, as a regular person who became disabled and needs Medicaid, this isn’t a change in tactics,” Willis said. “We will keep reaching out and calling on our representatives to represent us until they do.”