Committee to consider two Wyoming Medicaid expansion bills

Wyoming’s debate over whether to expand Medicaid, and how it might be done, reaches a critical point this week.

After years of resisting Medicaid expansion, lawmakers are now left with amending a potentially costly plan or resurrecting the SHARE Plan that the Joint Labor Committee rejected on a 7-7 vote last December.

Supporters of the SHARE Plan say it would bring healthcare to Wyoming’s poorest working adults, create 800 new jobs, curb millions in losses in unpaid medical care at Wyoming hospitals, and inject more than $100 million federal dollars into the state economy annually.

“It makes sense economically from a business standpoint,” Sen. Michael Von Flatern (R-Gillette) said. “It makes sense from the 17,000 people we are going to cover, and for the little hospitals.”

The Senate Labor Committee will consider and amend the alternative plan championed by Sen. Charles Scott (R-Casper) on Wednesday. The essence of Scott’s plan is to use health savings accounts as an incentive for patients to ration their care. The Legislative Service Office projects Scott’s plan would cost $15 million or more in state funds to bring in $134 million in federal Medicaid dollars in 2017. The Joint Labor Committee endorsed the bill in December.

The SHARE Plan, which Gov. Matt Mead asked the Department of Health to draft, wouldn’t require any additional state funds through the year 2020. It is modeled after private insurance, using copays and premiums for able-bodied Medicaid enrollees. SHARE Plan supporters face resistance from those who don’t want a bill competing with Scott’s bill.

Late Monday afternoon Sen. Von Flatern introduced Senate File 129 modeled after the SHARE Plan. Co-sponsors include Sen. Fred Emerich (R-Cheyenne), Sen. Stephan Pappas (R-Cheyenne) and Rep. Sue Wilson (R-Cheyenne).

On Wednesday the SF 129 goes to the Senate Labor Committee, led by Scott, who said he will attempt to amend it to include health savings accounts. Scott said he won’t vote against the SHARE Plan in committee, saying the measure deserves consideration by the Senate as a courtesy to Gov. Mead. If an unamended version of the SHARE Plan reaches the floor, Scott pledges to oppose it.

UPDATE: In a Tuesday morning email Rep. Sue Wilson (R-Cheyenne) said that no separate SHARE Plan bill will be filed in the House. 

The option of throwing out Medicaid expansion altogether remains a possibility. That could happen due to lack of cohesion among supporters, competition among bills, or a conviction on the part of an unknown number of lawmakers to oppose the policy on all fronts.

Sen. Curt Meier (R-LaGrange) is one of 30 senators who will consider the issue if it reaches the floor.

“I’ve got constituents that are on both sides of (the Medicaid expansion issue),” Meier said, “but when I campaigned, I made it very, very clear, exactly how I stood on it, that I was not in favor.”

Two options on the table

On Wednesday the Senate Labor Committee will amend Scott’s Senate File 66- Medicaid expansion-alternative in an attempt to win general support and still meet approval from the federal Center for Medicaid and Medicare Services.

The essence of Scott’s bill is to put Medicaid recipients in the position of rationing their own care using health savings accounts, technically called “Personal Health and Wellness Accounts.” Scott believes the accounts will hold down longer-term costs for the state, but that math hasn’t been done, and some say the premise is unproven.

“There is a lot of debate about the effectiveness of personal health savings accounts,” said Senate Labor Committee member Sen. Bernadine Craft (D-Rock Springs). “Sen. Scott has made it clear that it’s a deal breaker. He will not support anything that doesn’t include it.”

A major sticking point for Scott’s bill is that the state may have to deposit $15 million in the “Personal Health and Wellness Accounts” to get the program running — $2,265 for each of the 17,600 adults projected to enroll. Medicaid will not make the initial deposit into the savings accounts because CMS doesn’t view the accounts as a medical expense.

“The front-loading of the health savings accounts is a state investment,” Senate Labor Committee member Sen. Bill Landen (R-Casper) said. “That causes me great heartburn.”

Scott’s plan also calls for third-party management of the Medicaid program. The Department of Health estimates that arrangement would cost 32 percent more than a state-managed program, based on a comparison with KidCare CHIP, the state’s only existing third-party managed program.

Lawmakers must consider these potential costs — which Scott insists are overstated — knowing that the SHARE Plan as laid out in Senate File 129, is revenue neutral through 2020.

Department of Health Director Tom Forslund calculates the $100 million to $120 million in federal dollars sent to Wyoming annually under the SHARE Plan would create 800 new jobs in the state. It would also allow the state to reduce or eliminate six or more existing state-funded programs for the poor by shifting the care to federal Medicaid dollars. Unlike Scott’s bill, the SHARE Plan won’t require a third-party administrator.

Amendments to Scott’s bill in the Labor Committee this week may focus on reducing the cost to implement the program. The committee may also remove any provisions of the plan that could delay approval by CMS. The committee may also clarify how much of the health savings account balance patients can take with them if they start making too much money to be eligible.

Yet for some members of the Senate, no changes will make Scott’s bill — or any plan to expand Medicaid — palatable. “I don’t think I can support Medicaid expansion,” Sen. Meier said. He isn’t convinced that health savings accounts will work as planned.

“I think they are ineffective because I tried that in my own business,” Meier said. “I used a $2,500 personal wellness account on my employees. It didn’t change their patterns any.”

What’s next?

Scott’s bill is likely to make it out of the Senate Labor Committee this Wednesday. Following that, it will face review by the full Senate.

Von Flatern said he couldn’t predict how the SHARE Plan would fare in committee, but should the measure make it to the floor, he expects a close vote.

“The amendments will be put out there (in committee) and we’ll see how they vote,” he said. “The overall feeling in the Senate is probably against, but I predict one of those 16-14 votes.”

Labor committee members Sen. Landen and Sen. Ray Peterson (R-Cowley) say they plan to introduce a bill to provide direct payment to hospitals to reduce the burden of uncompensated care, which the Wyoming Hospital Association estimates is $200 million annually. Their intent is to help out hospitals in the event that Medicaid expansion does not pass. They haven’t identified a funding source for the proposal.

Marguerite Herman, lobbyist for the League of Women voters and member of the Wyoming Coalition for Medicaid Solutions, said that using Wyoming taxpayer dollars to make up uncompensated care costs won’t address the root of the problem.

“The most expensive door in the health care system is the emergency room door, and to the extent we can take care of needs before then (through preventative care), the better to control health care costs,” Herman said.

UPDATE: By Tuesday morning members of the House had decided not to introduce their own version of the SHARE Plan. That means any Medicaid expansion bill will have to come through the Senate.

Rep. Albert Sommers (R-Pinedale) said he isn’t sure how he would vote on a Medicaid expansion if it passes the Senate and reaches the floor of the House. However, he recognizes that the state already carries the cost of care for those who don’t have insurance.

“I worry about that population of individuals and whether the route we are under now is the most efficient way to care for that population,” Sommers said, “because we are caring for them anyway. It’s just a matter of how you want to care for them.”

UPDATE: This article was Tuesday morning to reflect that the House will not introduce its own SHARE Plan bill.

Resources:

Senate File 129 – Medicaid SHARE plan

Senate File 66 – Medicaid expansion – alternative