Natives trust feds more than Republicans on Medicaid expansion

By Ron Feemster

January 24, 2013

CHEYENNE—With three dozen people crowded into the Senate committee room and spilling out down the third floor hallway of the Capitol building, Allison Sage, head of the Northern Arapahoe Health Service, chose his few words carefully when he stood to address the Medicaid expansion bill.

“If we don’t have more access to Medicaid on the Wind River reservation, we will end up using the emergency rooms more,” Sage told the five members of the Senate panel on Wednesday, Jan. 23. “We want to be more on the primary care side.”

Sage was one of about 20 people arguing for the bill in front of the five Senators who had to decide whether the bill moved to the Senate floor. In addition to the bill’s sponsor, Sen. John Hastert (D-Green River), representatives of Wyoming’s physicians, nurses, hospitals and primary care clinics pointed out advantages to giving more low-income people health coverage.

The bill would cover some 18,000 of Wyoming’s poorest residents who are not currently eligible for Medicaid and save the state nearly $50 million between 2014 and 2020, according to a Department of Health report issued in late November. Not covering this newly eligible population would cost the state more than $70 million over the same period, mostly because state health programs currently draining the general fund could not be moved onto the federal Medicaid budget.

“We have a lot of men and single parents who don’t have health care,” Sage said in an interview later in the day. “This is an important bill for us.”

Under current law, only poor people who are children, pregnant, aged or disabled or very low-income caregivers of others are eligible for Medicaid. The Affordable Health Care Act, also known as Obamacare, gives states the option to broaden Medicaid eligibility to anyone who earns less than 138 percent of the federal poverty line. Adults who work at low-wage jobs make up a large portion of the uninsured population that would qualify for healthcare nationwide and in Wyoming under Medicaid expansion.

After the committee listened to a parade of speakers who spoke up for the law—and heard nobody from the audience arguing against it—they voted to move it out of committee and to the Senate floor. But they did so without the usual “do-pass recommendation” given to almost all bills that make it through committee. After the do-pass motion failed 4-1, the committee chairman Charles Scott (R-Casper) solicited a motion for a do-not-pass recommendation, which freshman Senator Jim L.D. Anderson (R-Casper) made. That motion passed 4-1, with Sen. Bernadine Craft (D-Rock Springs) casting the minority vote on both motions.

The Senate majority leader must decide when and if the bill gets full debate on the floor, Scott said.  In general, bills with a do-pass recommendation are heard first.

“It’s a very big bill,” Scott said. “I do not believe it should pass, but I think we want to give it a chance to move out of committee. I’ve seen bills pass with a do-not-pass recommendation.” Scott gave no specifics, but said such a bill passed in the late ‘80s or early ‘90s.

The primary argument against the bill was the committee’s general distrust of the federal government. Scott and Anderson both expressed doubts that the federal government will keep its promises to pay the bills associated with the Affordable Care Act.

Most disturbing for Sage was the way Anderson expressed those doubts. The freshman senator compared the situation of states trusting in funds for Medicaid expansion to that of Native tribes who made treaties with the federal government in the 19^th century.

“Those treaties said ‘as long as the grass shall grow,’” Anderson said. But he pointed out that the feds changed the rules on the treaties then and moved tribes off of land where gold was discovered. The government could change the rules on Medicaid funding in the same way now, he said.

“I wondered if he would have said that if I were not in the room,” Sage said. “I wanted to get smarty with them, but the bill is too important.”

By almost any measure, Native Americans tend to trust the current administration in Washington more than most people in Wyoming. As lawmakers worked through most of President Obama’s inauguration festivities on Jan. 21, a group of singers and dancers from the Wind River Indian Reservation became the only representatives of Wyoming to march in the parade in Washington, D.C. Reservation precincts voted overwhelmingly for the president in 2008 and 2012.

“I don’t think we have that kind of trust problem,” Sage said about the federal government. “The only guys we have to worry about are the Republicans.”