Believe it or not, Medicaid expansion might happen here

While waiting to hear a panel discussion about Medicaid expansion in Cheyenne last Thursday, I marveled at how far Wyoming has come on the long-debated issue.

We’ve gone from just talking about it in 2013 — the first year the Legislature rejected it — to still just talking about it. What a leap! Who says we’re not a progressive state?

Pardon my sarcasm, but it’s born out of frustration. The case to expand the health insurance program for low-income residents has been strong from the start. But now, the positive experiences in almost all of the 36 states that decided to expand make the case overwhelming.

Yet long-time expansion proponents like myself still find ourselves having to explain to lawmakers the obvious benefits to the state. Expansion will help the working poor, provide a much-needed revenue source for Wyoming, improve hospitals’ bottom lines and boost our overall economy.

I suppose I should be grateful that the discussion suddenly has a higher profile as we head into the budget session. There are some good signs, especially the Joint Revenue Committee’s 8-5 vote to sponsor the latest expansion bill.

Events like last week’s panel (featuring three proponents, three opponents and one in the middle) sponsored by the Wyoming Liberty Group — a group long opposed to the proposal — give the public opportunities to better understand the issue.

I’m admittedly jaded from so many defeats, but not everyone is. The most promising development I’ve seen in years is the formation of Healthy Wyoming, a new coalition in favor of expansion. It has an excellent roster, including the Wyoming Medical Society, the state hospital association, AARP Wyoming, the Wyoming Primary Care Association, Equality State Policy Center and state chapters of the American Heart Association and the American Cancer Society Cancer Action Network.

I hope the coalition can move the needle. As Medical Society President Dr. David Wheeler, a Casper neurologist, said in a coalition announcement last week, “Medicaid expansion would extend coverage to thousands of uninsured people in our state. Studies and experience show that having insurance improves the health of people and communities.”

During the Liberty Group’s health care policy panel, proponents constructed a robust argument in favor. Rep. Dave Zwonitzer (R-Cheyenne), who chairs the House Revenue Committee, said in states that have expanded Medicaid, almost all show health care costs remaining steady or slightly decreasing.

That’s important for Wyoming, since health insurance premiums in this sparsely populated state are the second highest in the nation and increasing every year.

If Medicaid expansion were rolled out, the Department of Health estimates 19,000 low-income Wyomingites could enroll during the first biennium. The state’s cost would be $18 million, compared to $135 million in federal funds from the Centers for Medicare and Medicaid. By rejecting expansion, our taxpayer money is currently flowing to other states to fund their programs.

Right now, individuals who could be covered under Medicaid expansion often end up in expensive emergency rooms visits when they get sick because they can’t afford to regularly see a doctor for preventative care. The Wyoming Hospital Association estimates its members rack up $120 million every year in uncompensated care, which is partially recouped by charging residents who have private insurance more for services. That, in turn, drives up premiums.

Reducing the number of uninsured people could lower health insurance premiums on the Health Marketplace by as much as 15%, Josh Hannes of the Wyoming Hospital Association said.

The bill shouldn’t be a heavy lift. It doesn’t automatically expand Medicaid; it authorizes the governor to negotiate with the federal government on a waiver to create a state plan. The Legislature would then decide whether to approve the resulting deal.

“I’ve been in the Legislature for 16 years, and I’m at the point where I’ve got to say: ‘Wyoming, we’re out of options,’” Zwonitzer said. He noted insurance companies in other states have had the ability to sell policies in Wyoming for the past decade, but none have opted to enter the market here.

Rural areas have higher proportions of people who can’t afford healthcare and don’t have access to mental health services, Zwonitzer said

“If we can get a low-income population in our state access to better care, which I think will save us tens of millions of dollars later on, I believe we should pass Medicaid expansion at this point,” the legislator said.

Another panelist, Rep. Sue Wilson (R-Cheyenne), said she is on the fence about the bill. This is despite the fact that she sponsored a similar measure six years ago.

While she said Medicaid expansion would obviously benefit people who don’t have insurance, Wilson won’t vote for the Revenue Committee’s bill “unless I can see a clear new revenue stream.”

Sen. Bo Biteman (R-Ranchester) also cited cost restraints as a reason for his staunch opposition. “We don’t have that money,” he said. “We’re scrambling, scratching, clawing, looking under the mattress for quarters. We’re not in any position to grow state government at all; we need to be cutting our government.”

But far from supposedly crashing the economy, Medicaid expansion would be a much-needed investment in the healthcare system. Rejecting it is penny-wise and pound-foolish. I urge lawmakers worried about the expenditure to examine what has unfolded in Montana, an expansion state.

An independent study found it has introduced more than $600 million annually into that state’s economy, generating 6,000 new jobs and $350 million in personal income. “Savings created by the expansion … along with state revenue generated by this increased economic activity more than offset the cost to the state,” the study concluded.

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It’s easy to get bogged down in economic figures. While important, it shouldn’t solely drive the debate. I waited 90 minutes for the WLG panelists to arrive at the subject of how addition to the expanded Medicaid rolls would benefit an actual low-income person without health insurance.

Jan Cartwright, executive director of the Wyoming Primary Care Association, provided this missing piece in her closing comments.

Cartwright said she talked to a worker who signs up people for the Health Marketplace, which subsidizes insurance policies under the Affordable Care Act. The employee’s first interaction was with a woman who depends on oxygen to live.

The physically disabled woman had been trying to get on Social Security disability but was turned down. She works, but not enough hours to meet the income threshold to qualify for the federal health insurance premium tax credit.

“She was extremely upset because she was having trouble affording her oxygen,” Cartwright recalled. “She started crying and said, ‘What am I supposed to do, die?’”

I want to see a panel comprised of people with stories like this. People who can hopefully change the minds of legislators who think Wyoming should continue to put this vulnerable portion of the populace in a situation where they must ask that question.

There’s nothing more powerful than hearing from Wyoming residents whose lives could be improved, perhaps even saved, by these policy changes.

Cartwright had a final point to make after listening to Biteman expound about the state’s inability to afford expansion.

Legislators, she said, are often willing to spend the state’s finances giving tax credits to industries to grow businesses. In fact, while dismissing Medicaid expansion, Biteman wants to give the coal industry a tax break to help save jobs. This would cut state revenues and leave lawmakers less money to spend.

Why doesn’t the same principle apply to expanding Medicaid?

“The state is willing to gamble money to make money,” Cartwright concluded.

Medicaid expansion, on the other hand, isn’t a gamble. The Legislature doesn’t need to roll the dice. All it needs to do is use common sense and find the compassion in its big ol’ Wyoming heart to finally do the right thing.