Mead leaves voters guessing about Medicaid expansion

By Kerry Drake
— September 9, 2014

Gov. Matt Mead spent three years working as hard as he could against the Affordable Care Act (ACA) and Medicaid expansion in Wyoming. It’s only been in the past two months — as his re-election bid draws closer — he’s held out a glimmer of hope the state might work out a deal with the federal government to add thousands of low-income residents to the Medicaid program.

Kerry Drake

Even then, Mead hasn’t been able to actually commit to signing a bill authorizing Medicaid expansion in the event the Legislature passes one, which is far from a certainty. Maybe his strategy is to convince moderates he’s finally taking expansion seriously, while winking at conservatives as if to say, “Do you guys think I’d really support that?”

Most politicians try to give themselves some wiggle room when talking about controversial issues, and Mead may be the champ of them all. When Wyoming desperately needed leadership from its chief executive to bring the needy health care and help keep hospitals from going bankrupt, he threw the working poor and the facilities under the bus while playing irrational, damaging political games.

The Legislature didn’t make the governor negotiate with the feds on a state alternative to Medicaid expansion. In March, it passed a last-minute bill that said he “may” negotiate, which meant he also could decide not to enter into talks. It was his call, and he only recently initiated negotiations that may not even bear fruit. If a compromise is reached, there’s no guarantee the Legislature will pass it or Mead will sign it.

If Mead is re-elected and Wyoming does expand Medicaid, the governor deserves zero credit for what will be a landmark day in the state’s health care system. Given his track record on the subject, someone should make sure he doesn’t sign the bill using disappearing ink.

If I sound a tad irked by Mead’s shameful record on Medicaid expansion to date, it’s possible my reaction is colored by the fact I was once one of the estimated 17,600 Wyoming residents who fall into the Medicaid gap (see The Drake’s Take, Dec. 31, 2013). Our group would have qualified for Medicaid, if Wyoming had accepted the expansion — but it didn’t, so we needed the subsidies and tax credits offered through the ACA, better known as Obamacare.

We couldn’t sign up for Medicaid, which is how we should have received help under the ACA. Yet we weren’t eligible for any Obamacare assistance, either. We could buy insurance through the new federal health exchange, but the astronomical rates made that impossible. My quote for an insurance policy with an $8,000 deductible was $1,300 a month, which is more than I made.

I am extremely fortunate: In May I was able to obtain health insurance from my new employer, ending my time in the Medicaid gap without coverage. But my resolve to see Wyoming’s officials do the right thing for both overwhelming humanitarian and fiscal reasons has been strengthened by the experience.

I entered the legislative session slightly optimistic, then watched while Republican lawmakers callously killed bill after bill last February that would have expanded Medicaid. They offered the specious argument that the program was too expensive and we couldn’t trust the federal government to honor its agreement to pay almost all of the cost.

Legislators did this knowing full well that the state has never questioned accepting federal money for any purpose prior to this one to provide health care to low-income adults without child dependents. They did it knowing the feds would pay 100 percent of the tab for the first three years, and never below 90 percent.

Most astounding of all, lawmakers did it knowing that according to the Wyoming Department of Health’s own estimates, not expanding Medicaid would directly lead to the deaths of 111 Wyoming citizens every year.

Mead knew these facts as well, yet he remained steadfastly opposed to expanding the program, and the majority of his party’s legislators followed his lead.

The positive fiscal impacts weren’t a mystery, either. Wyoming stood to gain about $50 million a year from the expansion, but the officials we put in power seemed downright eager to throw it away. They also knew by not expanding the program, the state would actually have to spend $87 million a year more. That’s a total swing of $137 million that was foolishly flushed by a majority that comprises the most incompetent state legislators in the past 50 years.

Still not outraged? Try this on for size: Wyoming’s hospitals lobbied for expansion, because they were losing a total of more than $200 million a year due to uncompensated care, as the working poor’s only option was to seek expensive treatment in emergency rooms. Municipal officials also spoke in favor of expansion, because they knew how devastating closing a hospital would be to their communities.

It didn’t matter. After the Senate Labor, Health and Social Services Committee heard such testimony, its members adjourned without taking a vote, which killed the bill. Several were smiling as they left the room.

To the officials who ignored our combined pleas for help, we were obviously a joke. But guess what? The Republican governors who catered to the Tea Party crowd aren’t laughing about Medicaid expansion anymore, particularly the ones who are trailing badly in the polls. Most of them are either running for cover or trying to sign up.

A recent Los Angeles Times article reported the respected Robert Wood Johnson Foundation estimates the 24 expansion holdout states (including Wyoming) will lose a combined $600 billion through 2022.

The foundation also calculated that for every dollar a state spends on Medicaid expansion, it receives $13.41 in federal spending. How could Wyoming officials be allowed to intentionally pass that up, no matter how much some residents distrust the federal government?

Meanwhile, Tenet Healthcare reports that in the five states the corporation operates that have approved expansion, its hospitals are seeing more than a 50 percent decline in uncompensated care.

The states that have expanded Medicaid are happy to spend the millions in tax dollars Wyoming decided it didn’t want. As Democratic gubernatorial candidate Pete Gosar recently noted, the amount we’ve lost is already up to $70 million. It will climb much higher if the Legislature and whomever is elected governor fail to approve Medicaid expansion in January.

Gosar would sign the bill; I have absolutely no faith Mead would do the same. If he would, why doesn’t he just say so? Voters have a right to know his plans.

These next two months would be a good time to ask the governor why he spurned Medicaid expansion for so long, and only now decided it was even worth bothering to toy with voters over the issue. I don’t know how he’s faring in the polls at this point, but maybe he’s read his own numbers and decided that hey, maybe there really is a fast, rising tide of resentment out there.

I still have enough faith in voters to believe that when riled, they can make elected leaders pay dearly for squandering millions of dollars, ignoring their constituents’ best interests and continually making boneheaded decisions. Being this callous isn’t a crime, but maybe it should be.

— Veteran Wyoming journalist Kerry Drake is a contributor to WyoHistory.org. He also moderates the WyPols blog.

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Kerry Drake

Veteran Wyoming journalist Kerry Drake has covered Wyoming for more than four decades, previously as a reporter and editor for the Wyoming Tribune-Eagle and Casper Star-Tribune. He lives in Cheyenne and...

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  1. I think my focus on the issue is quite clear – very clear when you have the facts.

    1. I fully understand what Medicaid expansion is supposed to cover. It is interesting to see the number of individuals now eligible has increased by 5,000 since the ACA was enacted

    2. According to Medicaid.gov: The Affordable Care Act actually refers to two separate pieces of legislation — the Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152) — that, together expand Medicaid coverage to millions of low-income Americans and makes numerous improvements to both Medicaid and the Children’s Health Insurance Program (CHIP). How is the ACA not related to Medicaid expansion?
    3. The Federal Gov’t is notorious for changing the rules midstream. There is a simple fix for the Medicaid gap – the President just needs to issue another Executive Order and all of those in the in gap can receive insurance. The President chooses not to because their is no political gain in issuing the order. The President promised lower health care and insurance costs – yet we have higher costs. The President promised people could keep their existing plans……..
    4. The issue is quite clear, quite clear when you take out the emotion and focus on the facts and the real issue(s).

  2. 1. Medicaid expansion is for low-income adults without dependent children. It is for people who are working but earning less than $15,000 a year. It turns out 22,000 people in Wyoming fit into that “gap population.” (Including anyone at minimum wage)
    2. Medicaid expansion is not ACA. You should know that by now.
    The reasons Wyoming has to let childless poor adults apply for Medicaid would be: we want them to have health insurance; we want them to be healthy enough to keep a job; we want hospitals and providers to get paid; we want millions of healthcare dollars to be spent in every county in the state; we want to save General Fund money now being spent on programs that would be covered by Medicaid.
    3. Any expansion of Medicaid eligibility to include low-income adults without children can include an “escape clause” to cancel if the feds ever pay less than 90 percent of the cost.
    4. You seem to have trouble focusing on the issue.

  3. Kerry Drake has a job and now can provide his own health care. That is a good start.
    The left continues to complain about Governor Mead not implementing Medicaid, yet President Obama continues to issue Executive Orders to fix the ACA at every turn. Why not issue another one? You will probably get less pushback getting Obama to issue the magic Executive Order.
    My second unanswered question is the cost of the unknown – the ACA after the government subsidies fad away and the State is stuck funding the boondoggle – after Obama finishes bankrupting coal and whatever other energy sources the State of Wyoming is providing.