How the Wyoming Senate killed Medicaid expansion, again

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.

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.

“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.

Support independent reporting — donate to WyoFile today

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.

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.”