Medicaid expansion opponents should pay the price

(Opinion) — Watching state legislators debate Medicaid expansion during the budget session was like seeing a driver head full-speed toward a cliff and refuse to hit the brakes.

The fully anticipated plunge adds to the financial pressures faced by many Wyoming hospitals and played a role in Wyoming Medical Center laying off 58 employees in Casper last week.

During the past four years literally everyone who testified before the Joint Labor, Health and Social Services Committee told the panel what would happen if lawmakers did not expand Medicaid. If they had listened, state government wouldn’t have kissed off more than $260 million in federal funds that would have greatly cushioned the impact of hospital budget woes during this economic nosedive.

But a majority of Republicans on the committee, led by co-chairman Sen. Charlie Scott (R-Casper) foolishly ignored the warnings from business, industry, labor, hospital, church and social service representatives. They also said no to GOP Gov. Matt Mead, a Medicaid expansion convert who finally saw the light and told lawmakers they must approve the program — not only to get federal funds, but to provide health insurance to nearly 20,000 working poor residents.

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The Senate killed the only Medicaid expansion bill this year with only seven Republicans joining four Democrats to support the measure, while 19 GOP members voted no. The House didn’t even take up the issue, but there were even more expansion opponents in that chamber.

The Legislature’s failure to expand Medicaid was a monumentally stupid decision that has negatively affected all Wyoming residents. The dozens of Wyoming Medical Center employees laid-off and others in the state who will follow them to the unemployment line don’t deserve their fate. But the lawmakers who perpetrated this health-care emergency should be removed from office.

Personally, I’d like to see them tarred-and-feathered and booted out of Wyoming, but in our civilized society the way to properly punish these reckless fools is at the ballot box. This is such a serious issue that no one who opposed Medicaid expansion should be voted back into office.

The state legislative leaders of the anti-expansion movement had one goal: Deny President Barack Obama any type of victory in the landmark health-care reform he championed. Even though the Affordable Care Act has enabled 20 million Americans to finally obtain health insurance and prevented the industry from not insuring anyone due to pre-existing health conditions, Charlie Scott & Company have been hell-bent on its destruction by any means necessary.

These Republicans did it under the guise of not trusting the federal government to keep its promise to pay at least 90 percent of the cost for Medicaid expansion. Thousands of Wyomingites bought that excuse during the last election, but the GOP’s action showed this claim to be a bald-faced lie. Even when an amendment was added that would have automatically withdrawn Wyoming from the program if federal support ever dropped below 90 percent, opponents kept up their charade.

Last week I spoke with Wyoming Hospital Association president Eric Boley, who was and still is one of the main proponents of Medicaid expansion. He thinks the Legislature must address the issue again in 2017, but that will clearly only happen if those who stubbornly drove us off the cliff don’t return. If they are rewarded for their asinine behavior by being re-elected, they will see it as evidence the public wants them to double-down on their decision.

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Boley said Medicaid expansion wouldn’t have fixed all of Wyoming Medical Center’s financial problems, but it would have brought in about $2.5 million annually to the facility, which would have made any layoffs much less severe. In addition to the 58 out-of-work medical employees, the hospital’s administration also decided it will not fill 57 other positions that are now vacant.

Boley said the hospital was trying to cut about $10 million from its budget before the layoffs, and hoped to do much of it by finding efficiencies. Wyoming Medical Center has experienced several budgetary hits through no fault of its own, including the loss of its sole community provider status due to competition from other hospitals that set up shop in Casper.

Medicare used to provide about $6 million a year to Wyoming Medical Center because as the only hospital in town it was mandated to treat everyone who sought aid regardless of their ability to pay. The feds have determined the new Mountain View and Summit Hospitals’ market shares mean Wyoming Medical Center is no longer considered the sole provider, even though it is still the community’s “safety net” hospital. It has to take all uninsured and underinsured patients. To add insult to injury, the hospital had to repay Medicare nearly $16 million.

“While Summit and Mountain View are taking the highly insured — the people who can pay their bills — WMC is forced to take all comers,” Boley explained. “So they’ve seen a huge shift in their patient mix and it’s had a real effect on their bottom line.”

Meanwhile, patients who can pay have seen their insurance premiums go up to pick up the slack.

Because taxes are collected a year in arrears, Boley said he expects the downturn in Wyoming’s economy to really start hitting hospitals hard in 2017. What happened at Wyoming Medical Center could be repeated at other hospitals across the state.

“Our state’s been lucky, while the rest have struggled over the past several years,” the WHA president said. “Wyoming always seems to lag behind, but they did predict [lower mineral prices and tax revenues] and you could see this coming. … It’s a real drastic downturn and I think it’s going to take several years for us to rebound from it.”

Several factors contributed to Wyoming Medical Center’s fiscal woes,  but the lack of Medicaid expansion, it can be argued, is the primary driver. Just look at the numbers, which were readily available to lawmakers before the budget session.

Colorado passed expansion in 2013, the first year it was available under the ACA. All of its hospitals, including their small critical-access hospitals, are operating in the black.

“The critical-access hospitals have an operating margin of about 8 percent, and it’s obvious [Medicaid expansion] has worked,” Boley said. “The other thing we’ve seen in states that expanded Medicaid is they’re seeing a 63 percent reduction in the amount of uncompensated care that’s being written off annually, as opposed to those that didn’t expand, which are seeing 3- to 4 percent increases.”

Boley noted the Wyoming Department of Health was recently directed to cut about $117 million from its budget. “With federal matching funds, the true number is about $200 million,” he added. “The across-the-board cuts are going to cripple hospitals and affect providers and physicians. Medicaid expansion would have really plugged a hole in the budget and at least kept the Department of Health whole and given us [$260 million in] General Fund money that could have been re-purposed to other programs throughout the state.”

Boley said he feels terrible about Wyoming Medical Center employees who lost their jobs and the difficulties the hospital is facing. “But hopefully it will be a wake-up call to the Legislature that this is real and it’s hitting our state right now,” he said.

I’m not as hopeful as Boley is that state lawmakers will answer a wake-up call. In my home county, Natrona, voters who want to send a message that what legislators did to hurt Wyoming Medical Center is wholly unacceptable won’t have to do much research to find out who should pay the price at the polls. The entire county delegation consists of eight representatives and four senators, all incumbent Republicans who opposed Medicaid expansion. The eight who are seeking re-election shouldn’t need to book any hotel rooms in Cheyenne next January.

They drove all of us off a cliff, and we shouldn’t be the only ones who crash.

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