I gazed into my Wyoming legislative crystal ball after setting it for Jan. 12, 2027, when the next session begins. I couldn’t believe what I saw.
Opinion
A miniature Sen. Charlie Scott, R-Casper, was jogging from desk to desk, playfully getting high-fives from almost everyone in the chamber. In the gallery former senators I hadn’t seen in years were locked arm-in-arm, singing a terribly off-key version of “For He’s a Jolly Good Fellow.”
“What would they be celebrating?” I wondered.
Then someone wheeled in a cake. I squinted to read the tiny message in bright red frosting: “Charlie Was Right About Medicaid Expansion.”
“Oh no you don’t,” I said. “I knew this day would come, Sen. Scott, and I’m not going to let you get away with it!”
Please forgive the above silliness. It was my rather childish way to try to trick you, dear reader, into spending at least a few minutes thinking about Medicaid expansion.
You’ll see a lot of headlines soon about a subject few Wyomingites seem to have much interest in anymore. But when you learn about billions of dollars in Medicaid cuts in other states, you should know what to expect here.
A bit of foreshadowing: What you’re about to read will be comforting, if your top concern is keeping state costs down. But you may be surprised about where that leads.
Do you remember the summer of 2025, when President Donald Trump and his “One Big Beautiful Bill” promised to cut $880 billion from Medicaid over the next decade? The huge number didn’t even seem real, because no one offered an explanation about who would be affected.
Well, we’re finding out that the answer is different depending on many factors, but one that looms large is whether a state expanded Medicaid. Wyoming is one of 10 that did not.
The state of Washington, an expansion state, recently ran the numbers to get a head start on Jan. 1, when the cuts start to kick in.
The news in Washington isn’t good, according to the Seattle Times, which reported that hospitals will lose nearly $6 billion over the next seven years because of federal Medicaid cuts.
Much of that expected loss is due to hospitals absorbing “uncompensated care,” when patients can’t afford to pay hospital bills. U.S. Sen. Maria Cantwell, D-Wash., said the losses “will likely lead to clinic closures, longer ER wait times and other challenges for patients.”
There could be up to 200,000 Medicaid recipients in Washington who no longer qualify if they don’t meet the federal work requirements that take effect Jan. 1.
That $880 billion in Medicaid cuts has been revised to $625 billion. Still, it’s estimated that 7.5 million people will lose their benefits over the next 10 years.
But what about Wyoming? To find out the expected impact here, I asked Eric Boley, president of the Wyoming Hospital Association.
“Medicaid cuts will affect each state differently,” Boley said. “We’re not an expansion state. Some of the huge cuts that they’re seeing in the disenrollment come from changes in the federal match that’s taking place.”
Because the Wyoming Legislature didn’t expand Medicaid, Wyoming still splits the cost 50-50 with the federal government. In states that did expand the program to more people, the feds picked up all costs for three years and 90% after that.
Now, after a Republican president and Congress united to pass a huge tax cut for the wealthy and help pay for it by taking health insurance from low-income people, expansion states must pay 10% more of program expenses each year until they get back to the 50-50 match.
“We won’t see that,” Boley said. “But some of the expansion states are really going to see decreases in their funding as it ratchets down to a lower matching rate.”
The other way states will spend more for Medicaid is from state-directed plans, which allow them to make additional payments to healthcare providers under managed care programs. But Wyoming doesn’t have a state-directed plan, Boley said, so it doesn’t lose any money there, either.
Some states will have to spend more to make sure people on Medicaid are complying with new federal work requirements that begin Jan. 1.
But Wyoming joins Alabama, Florida, Kansas, Mississippi and Texas as the non-expansion states that don’t have to meet those work requirements.
While other states are looking at huge cuts, Wyoming and South Dakota — because of their low population and number of Medicaid recipients — may actually receive an increase in federal payments. RAND Health says the pair will benefit substantially percentage-wise from the Rural Health Transformation Program from the One Big Beautiful Bill “and see little to no impact from other provisions.”
So why did the fantasy version of me looking into my crystal ball get so ticked off at the thought of Scott — by far the most vocal anti-Medicaid expansion legislator — taking a victory lap? Doesn’t this show that the Legislature was right to reject Medicaid expansion year after year?
No, it only seems good if you look at the issue from this point forward. To view the big picture we must go back to 2012, when the U.S. Supreme Court ruled that the Affordable Care Act’s mandate that all states expand Medicaid was unconstitutional.
The court allowed states to voluntarily expand the program, which 40 did because it was so obviously beneficial to their respective economies and the low-income workers who desperately needed health insurance.
In the 14 years since, Wyoming flushed an estimated $1.6 billion in federal Medicaid funds down the drain. How is that not the most boneheaded move in the state’s history?
In addition, approving Medicaid expansion would have led to adding more medical providers and related jobs and businesses, plus giving about 20,000 low-income Wyomingites — our families, friends and neighbors — health insurance.
Any workforce is more efficient if it’s healthy. But a majority of Wyoming legislators acted like anyone receiving Medicaid was a leech who didn’t want to work, despite the fact 20% of low-income Americans are helped by Medicaid.
Some Republicans, particularly in later years, did want to expand Medicaid. But a majority opposed it, even though they kept saying they wanted a “Wyoming solution” to healthcare problems. Did it occur to them that $1.6 billion since 2012 might have helped them find one?
Scott’s chief concern about Medicaid expansion was that the feds could stop paying 90% of the cost, and they did, but only after 14 years and at the direction of the senator’s own party.
Year after year I watched Democrats and some Republicans implore GOP leaders to expand the program, if only for a year or two, to help people get off welfare and become healthier by getting regular care from a doctor, and not wait to go to the emergency room when their conditions became worse and more expensive.
I’ve read quite a bit about how expansion states will cope with the drastic increases they’ll be paying for Medicaid. Most involve three unacceptable options: raise taxes, cut education, and reduce benefits for at-home and community-based health programs, mental health and patients with disabilities.
If Republicans want to celebrate the biggest federal Medicaid cut in history, go ahead. But don’t expect anyone to believe that you did it to be fiscally responsible or whatever BS you try to sell voters on Nov. 3.
