Rep. Steve Harshman, R-Casper, speaks during the 66th Wyoming Legislature's general session Thursday, March 11, 2021, in the House chamber inside the state Capitol. (Michael Cummo/Wyoming Tribune Eagle/Wyoming News Exchange)

CHEYENNE – The Wyoming Senate Committee on Labor, Health and Social Services voted Wednesday to kill a House-sponsored effort at Medicaid expansion.

The 3-2 vote, which came after more than three hours of public testimony and debate, likely ends this year’s effort to close Wyoming’s “Medicaid gap.” 

Expansion advocates argued that expansion would provided medical coverage for 24,000 uninsured Wyomingites, extended financial support to the state’s ailing hospital system and brought hundreds of millions of dollars in revenue to Wyoming’s cash-strapped state government. 

Wyoming Department of Health numbers support those assertions. According to DOH estimates, House Bill 162 – Medical treatment opportunity act, would have helped enroll anywhere between 13,000 and 38,000 people, lowered health insurance rates for private providers and helped to alleviate the more than $100 million in uncompensated care costs private hospitals eat on an annual basis.

Voluntary Medicaid expansion by the states is a facet of the Affordable Care Act (better known as Obamacare) and has been largely unpopular with Wyoming lawmakers since the ACA’s 2010 passage. Some Republican leaders, however, like former House Speaker Steve Harshman (R-Casper) have had a change of heart, leading expansion advocates to think this year’s outcome might be different.

The bait for Wyoming was also different this year. An increase in the federal match for the program passed as part of the American Rescue Plan, which proponents said would bring $120 million into the state over the next several years. For years, budget hawks in the House and Senate have raised concerns about Wyoming being able to meet its portion of the funding obligations in the future and expressed doubts about the federal government making good on its commitments.

With the upfront incentives from the federal government and assurances from a current Biden administration official that the White House would work with Wyoming to renegotiate its federal match, further sweetening the deal, Harshman told lawmakers he was now willing to support Medicaid expansion after seven consecutive ‘no’ votes on the matter. Harshman had even voted against expansion after then Republican Gov. Matt Mead supported the measure in 2014.

“I told her we’re not going to do this if we can’t increase our [federal match],” Harshman said of that Biden official Wednesday. Harshman did not give the official’s name but said the former West Virginia representative now works for the White House. “She said to put ‘whatever you need into the bill. We’ll work with you.’”

Members of the Senate Committee on Labor, Health and Social Services, however, were less convinced.

Despite passing a similar proposal just 21 days earlier by a vote of 3-2, the Senate Labor Committee killed a House Medicaid expansion proposal Wednesday by another 3-2 vote, with Sen. Troy McKeown (R-Gillette) changing his vote.

Rep. John Romero-Martinez (R-Cheyenne). (Wyoming Legislature)

It was an unsurprising but disappointing conclusion for advocates, who said the House’s vote to pass Medicaid expansion faced slim prospects of being replicated in the Senate. But it also came after weeks of political pressure and outside influence that some observers — including the bill’s sponsor, Rep. John Romero-Martinez (R-Cheyenne) — believed hastened the bill’s demise.

“There was a concerted effort from a corner [to kill the bill],” Martinez said Wednesday.

A long and winding process

Early in the session, the Senate Labor Committee’s vote to advance its own version of Medicaid expansion surprised many. McKeown —who had railed against “socialist healthcare” earlier in the meeting — voted to advance it to the floor, prompting observers to wonder if McKeown’s “aye” had been an accident. McKeown declined to confirm or deny the suspicions.

That bill later died on Senate Majority Leader Ogden Driskill’s (R-Devil’s Tower) desk without a hearing on the floor. The House Revenue Committee, meanwhile, advanced Martinez’s bill to the floor by a 5-3-1 vote.

Running up against a key procedural deadline on March 22, members of the House Freedom Caucus tried to run out the clock by attempting to bring an abortion bill to the floor for debate.

That effort failed when, with the 7 p.m. deadline passed, House Majority Floor Leader Albert Sommers (R-Pinedale) announced he would allow Medicaid expansion to be heard on the floor, where it ultimately passed on third reading by a 32-28 vote.

After the vote, Senate Vice President Larry Hicks told reporters HB 162 would receive a fair hearing if it advanced out of committee. 

The issue, advocates say, was that leadership then assigned Martinez’s bill back to the Senate Labor Committee, which many — including some Senators — believed would kill the bill before it reached the Senate floor. On Tuesday afternoon, Sen. Cale Case (R-Lander) — who shared his own experience from a time when he was uninsured — attempted to overrule the committee assignment with a floor motion to re-assign the bill to his Senate Revenue Committee, which he believed had the votes to advance the measure.

Sen. Cale Case (R-Lander) watches a presentation during a House Transportation, Highways, and Military Affairs Committee meeting March 30, 2021, inside the state Capitol. (Michael Cummo/Wyoming Tribune Eagle/Wyoming News Exchange)

“Did anyone have any doubt what would happen to this bill if referred to Labor committee?” Case asked his colleagues. “We all know it’s not coming out of there.”

Many members of the Senate objected, however, with some expressing reluctance to challenge Senate leadership and upend long-standing norms in the chamber. Case’s attempt failed 8-22, and the bill was sentenced to its presumptive demise the following morning.

What killed the bill?

Pressure on committee members to support the bill was robust.

Cheyenne resident Marcie Kindred baked bread for Senators like Lynn Hutchings (R-Cheyenne), delivering the loaves along with dozens of letters from constituents urging them to vote in favor of the bill. Other advocates urged residents to write to their lawmakers, and held virtual rallies to celebrate incremental victories.

Throughout the week, expansion-supporting lawmakers from the House of Representatives were a regular presence in the Senate chambers. 

Groups like Healthy Wyoming and the Equality State Policy Center rallied more than a dozen individuals from across the state to testify at the 7 a.m. hearing Wednesday, though only about half were heard. 

Even industry groups like the Wyoming Business Alliance, which often opposes government expansion programs, lobbied in support of the bill.

And there was even more pressure behind the scenes, Richard Garrett, the Wyoming State Government Relations Director for the American Heart Association, said in an interview.

“A lot of the pressure you didn’t see,” he said. “I thought it was outreach from constituents and advocates working together to identify those people in the House and, later, in the Senate that would potentially support this idea.”

But pressure against Medicaid expansion was robust as well. 

Cassie Craven, a lobbyist for the libertarian think tank Wyoming Liberty Group, told members that expansion — counter to expert testimony — is “not a fiscally sustainable policy decision.” But she added that the state has no plan to pay for the upfront cost for the plan, that Medicaid is prone to fraud, and that Wyoming could be sued if it ever tries to “yank away someone’s government-funded healthcare” should it regret the program in the future. 

An out-of-state free-market-based organization, the Opportunity Solutions Project, also lobbied against the bill, describing Medicaid expansion failures it said occurred in other states.

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The Wyoming Republican Party — which has actively lobbied against HB-162 — had representatives in the gallery throughout the process of the House’s vote to advance Medicaid expansion. Several lawmakers echoed GOP talking points on the floor, including that expansion has been a “disaster” in Montana. Harshman, who said he spoke with a Montana state representative to learn about his experiences with expansion, said the characterization was untrue. 

McKeown said rural hospitals had been forced to close in Montana as a result of expansion. Representatives for the Wyoming Hospital Association said that was not only untrue, but that hospitals had actually seen revenues increase.

Sen. Troy McKeown, R-Gillette discusses Senate File 80 during the March 3, 2021, Senate Labor, Health and Social Services Committee meeting in the Capitol. (Michael Cummo/Wyoming Tribune Eagle/Wyoming News Exchange)

Rep. Robert Wharff (R-Evanston) said Montana had seen cost overruns. Harshman argued that Montana’s budget stresses from healthcare had actually decreased over time. 

Healthcare provider costs actually went down as well following expansion in Montana, Harshman said, despite Wyoming Republican Party claims that such costs had gone up. 

“The talk about Montana wanting to get out [of the Medicaid program] is inconsistent with our conversations with our partners in Montana,” Josh Hannes of the Wyoming Hospital Association, said.

But the pressure on lawmakers was immense. In the hearing, committee chairman Sen. Fred Baldwin (R-Kemmerer) said he’d received more than 200 form-letter emails opposing Medicaid expansion. Martinez also said numerous lawmakers from the party’s right wing had been seen attempting to influence their Senate colleagues’ votes throughout the week — taking them to lunch and otherwise lobbying them privately.

“I’m not going to engage in a media war,” he added. “I didn’t do it in my campaign and I’m not doing it now. But [me telling you this] is the grenade to all the people who are told they don’t matter, including myself.”

Nate Martin, director for expansion-supporting group Better Wyoming, spoke to that pressure even more directly, telling lawmakers “I understand that there were some powerful people who were upset about that decision [to advance Medicaid out of committee]. But I promise you, for every person that was upset about it, there were many more who are grateful.” 

Martinez — a conservative Republican who has sponsored anti-abortion bills but has broken with the party on healthcare and labor issues — says he understands the anti-expansion pressure exists, but won’t buckle to it.

 “This is war,” he said, “and I will not relent. I am hopeful the Senate will work a solution, and I’m willing to work with them on that.”

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  1. Medicaid expansion isn’t the answer. Giving people little incentive to work better paying jobs just so they can keep Medicaid helps no one. Being dependent on Government programs helps no one. How about incentives to get people employed in better jobs that offer health insurance instead ?
    Thanks to Obamacare, I can no longer afford the bloated costs of health insurance but ill be damned if I’d except Medicad. I just make damn sure I take really good care of my health and save my money. Luckily I’ve been blessed with great health.

    1. Actually, what “helps no one” is telling poor people to just ‘stop being poor’.

      Expanding Medicaid on the other hand, would directly help thousands of people by giving them access to healthcare.

      Additionally, the legislature’s 10 years of inaction on this issue has not only failed to solve any healthcare-related problem in this state, it has actually allowed the existing problems to worsen.

  2. The US has the highest maternal death rate and death rate of children ages 1 to 5 of any industrialized nation even higher among low income. House bill 161 comes before the health committee in the Wyoming senate saying in effect that all pregnancies should result in birth whether or not the mother has the resources or the capability to care for a child.
    HB 162 Medicaid Expansion that could provide health care for many of the mothers and children was killed in the same committee.
    Bottom line, the two faces of the three members who voted for HB 161 and against HB 162 saying there should be births but it is of no concern about those mothers and children who die for lack of available health care

  3. Well, well, who would have though it? Hundreds of thousands of dollars from the state budget to hire a lobbyist to cajole other statesthrough lies and strong-arm tactics to protect a dying coal industry, but not one dollar to protect the health of the most needy of state residents! Way to go Wyoming! Why nor just put a “For Sale to Most Right-Wing Bidder” on every road into the state and sell into the legislature? Anyone remember the scene in “Blazing Saddles with Mel Brooks as governor? Feel familiar?

  4. WY legislators need education.
    The people of Wyoming suffer because ideology based on misinformation and a stubborn reluctance to learn leave us all behind.
    Its one thing to be independent thinkers and another to be fools.

  5. I guess we get the legislation we deserve. As long as the citizens of Wyoming are stupid enough to elect a bunch of right wing knuckle dragging Neanderthals, we should not be surprised that they vote like a bunch of right wing knuckle dragging Neanderthals. It is pretty sad that so many in Wyoming care so little for those less fortunate than themselves, especially when helping costs the state nothing.

  6. Maybe it was pointless to lobby or provide any public comment when our state’s three or four big money donors were telling alt-right legislators how to vote? Do average citizens even have a say in this debate?

  7. How is it possible that elected representatives can do something like this that costs the state millions of dollars every year and that seriously impacts the health of 12,000 to 35,000 Wyoming residents and still get re-elected? We have been through this so many times, and it is always the same: people from all walks of life support Medicaid expansion because it would provide health care to people who don’t have it now, because it would bring badly needed revenue to the state and to rural hospitals, and because it would reduce the overall cost of medical care in Wyoming. Those people come out in large numbers to press for Medicaid expansion. Then a few people from out of state with associations with conservative billionaire funded national organizations come in with half true or untrue stories of failure. Without even checking most of their stories, our elected officials grasp at the excuse to continue harming the people of Wyoming, knowing that voters will likely not hold them accountable. Wyoming people are committed to ignorance of facts and total disdain for the population by elected officials. Why do we expect so little for ourselves?

    1. If Wyoming expands their medicaid program and the federal funds are no longer avaliable in, say 8 years, how does the state pay for this? Would this benefit our seniors?

      PS. My healthcare cost including premiums and deductible didn’t quadruple until Obomacare.

  8. The Legislature has taken on the role of “death panel” with their continuing choice not to accept Medicaid dollars. If there are 25,000 uninsured Wyomingites who would receive medical care with Medicaid expansion, then there are a number of those persons who will die because they couldn’t afford to visit a doctor before their illness became lethal.

    The Wyoming Legislature continues to make decisions to cull the herd of Wyoming’s citizens. It is a real, not metaphorical DEATH PANEL, deciding to let our poorer friends and family die rather than accept federal dollars.

  9. As is so often the case, a greater understanding of what drives votes can be had by following the money. Many of those casting recorded no votes on Medicaid Expansion receive substantial contributions from contributors who oppose expansion.. Scrolling through these links reveals several familiar names.
    https://www.followthemoney.org/entity-details?eid=10143887&default=contributor
    https://www.followthemoney.org/entity-details?eid=8437503&default=contributor
    For me and within this context, its also worth contemplating the message of Exodus 23:8

  10. I am bitterly disappointed that my senator was one of the votes that prohibited any real debate on this bill.
    For some of the 18-30,000 Wyoming citizens it is a matter of life or death. To say it is o.k. and will be back
    is little comfort for those who have no insurance and no where to turn. This is not the way a real public
    servant would vote.

  11. In any other state, constituents would have understood the failure to advance Medicaid as incredibly ignorant and unamerican. In Wyoming, just short sided incompetence as usual in the Legislature.

  12. Helenair.com dated 08 Jan 2019 states Montana state health obligations increased with Medicaid expansion. Rep Harshman can claim costs went down but budget data is easy to check and he is wrong. The current federal match makes expansion attractive but the key question becomes are we stuck when the federal match drops. Medicaid expansion should not be rushed at the end of the session without clear knowledge of the important details.

    1. Damon jensen: Unfortunately there is no way to check your source as archives appear to be unavailable on the website you referenced.

      But this source:

      https://mthcf.org/wp-content/uploads/2018/06/Manatt-MedEx_FINAL_6.1.18.pdf

      indicates that Montana’s budget has fared very well due to Medicaid Expansion – savings were in the tens of $millions/yr.

      And this source:

      https://mthcf.org/2019/01/blog-economic-impact-of-medicaid-expansion/

      indicates that Medicaid expansion was and is enormously beneficial for Montana’s people.

      So while it may be true that Montana’s “obligations increased” as a result of Medicaid expansion, it appears that these increased obligations were more than offset by federal financial payments and higher productivity (through better health) and standard of living for Montana’s people.

      This doesn’t have to be complicated.

      I wish the GOP would quit making it so.

  13. Nobody in opposition presented any cogent, fact-based, folly-free argument.

    That Wyoming Republicans think that they are by some miracle more insightful and forward-thinking than the lived experiences of 39 other states is pure delusion.

    Also, where was the Governor on this? Invisible.