O’Gara: How many legislators actually grasp Medicaid expansion?

by Geoff O’Gara, Wyoming PBS (published with permission)
— February 19, 2014

Geoff O’Gara, Wyoming PBS
Geoff O’Gara, Wyoming PBS

Serious legislation is a complicated surgery to remove or implant or suture up some damaged part of the enormous body of law that is our state’s DNA. When you sit in the gallery in Cheyenne – as few citizens do for any length of time – and listen to the twisting arguments over what government might do to deliver health care to Wyoming citizens, you have to wonder how many of the dozens of legislators on the floor actually grasp it.

This is cruel to say. But the debate over expanding Wyoming Medicaid to serve another 17,680 citizens – with the federal government footing the bill – is a journey through a labyrinth. There are detailed studies and reports by consultants and the state Health Department. There have been several bills. There is the carcass of a failed attempt a few years ago to provide expanded health care “the Wyoming way,” called Healthy Frontiers, to pick over. Several bills have failed already in 2014, with details as gnarly as a lightning-struck juniper. A last-ditch effort to give the Medicaid expansion a sunset-limited tryout, by Sen. Chris Rothfuss (D-Laramie) and Rep. Matt Greene (R-Laramie), is stuck in the Senate Labor Committee, chaired by Sen. Charlie Scott (R-Casper), who has written his own book on how to fix health care. Scott doesn’t like Rothfuss’ bill, or most other bills written by others, and he especially doesn’t like the Affordable Care Act, which he resolutely calls “Obamacare.”

It’s one of the big stories of the legislature, but in the flurry of silly and serious stuff that rains down on this short legislative session, it’s difficult to follow. Medicaid expansion has become a cat and mouse game, which is what often happens with serious legislation: difficult legislation, difficult to track.

Scott’s committee met today and listened to some passionate testimony – people begging for a Medicaid safety net – and some cold fiscal logic – hospitals administrators asking for the expansion so they could stop absorbing the costs of uninsured sick people coming to their emergency rooms. But Scott did not call for a vote on the bill, and could not say when that would happen.

Rothfuss made his pitch. His bill is booby-trapped so that if the feds fail to fund as promised – a fear expressed by Gov. Matt Mead and Scott – the program blows up and goes away. It puts the Department of Health immediately to work negotiating a Wyoming-style program, which is allowed under the ACA, so “we are at the table, in … with some novel ideas as well” (including aspects of Scott’s failed Healthy Frontiers program). According to a Wyoming Department of Health analysis, the Medicaid expansion would save the state $47 million, and the infusion of federal money over the next decade would top $700 million, according to Rothfuss.

Scott’s committee heard testimony Wednesday, but he did not call for a vote. Nor could he say when that would happen. Senate watchers say the committee is stacked 3-2 against the bill. Scott had a bunch of amendments that afternoon to the appropriations bill, such as grants for rural health care, and they all failed. Rothfuss had his own amendment, another circuitous route to jumpstarting Medicaid expansion, but he withdrew it at the last moment. Cat and mouse – perhaps he’s waiting for the committee to act before he tries this last desperate route. “It’ll be back,” he said. (There will be a third reading of the budget bill – a last chance.)

This has proven a troublesome issue for both the governor and the legislature. All will say they want better health care for more state citizens. But there is a political paralysis in Cheyenne when it comes to working with the federal government – even if it costs the state millions.

It’s looking like they will duck it, but we’ll see. Tough issues like this are just too hard in a short session, and it’s too easy to pass – on health care, that includes not just Rothfuss’ pilot Medicaid expansion, but also Scott’s rather complex bill responding to “Obamacare,” which is already dead. From where I sit – pretty much alone in the gallery above the Senate during the health care amendments debate on the budget bill – it appears that only a handful of legislators actually get what’s going on. And among the citizens who elected them, I fear the number may be even smaller.

— Please visit Wyoming PBS Capitol Outlook for further coverage of the Wyoming Legislature by Geoff O’Gara. O’Gara is a longtime Wyoming journalist. He was a Wyoming Public Television producer and host of the influential Capitol Outlook and Wyoming Chronicle programs. He is the author of What You See in Clear Water: Indians, Whites, and a Battle Over Water in the American West (2002) and A Long Road Home, Journeys Through America’s Present in Search of America’s Past (1989) and several other books.

Geoffrey O'Gara

Geoffrey O’Gara is a writer and documentary producer based in Lander, Wyoming. He works for The Content Lab, LLC and serves on WyoFile's board of directors. His column, Weed Draw, is named for a remote...

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  1. rbd,
    It was that “stroke of a pen”, signing the AHCA, that created the 17,000 additional Medicaid enrollees. Why was the eligibility level raised to 133% (effectively 138%) of the poverty level? To wit, it was a political maneuver, the American Insurance industry and the Obama Administration realized that if these “‘17,000” (using the WY figure) were allowed into the exchange they would have to be fully subsidized. Better to shift the burden to the states by providing reimbursement in the first years as an inducement. In the ensuing years the states have much more of the financial burden.

  2. The Rothfuss bill certainly makes sense and takes away some of the fiscal concerns about the Fed’s not meeting their commitments.
    But, I can understand the Legislature’s unwillingness to buy into the fiscal unknown called Obamacare – who knows what the cost sharing will be come 2020 and beyond. Nobody seems to want to talk about that.

    As I have said before, this Medicaid gap problem could be solved “with a phone call and stroke of a pen” as the Obama administration has done numerous times before with the ACA and various other legislative issues. Instead, just like the Legislature, the administration is playing politics. How about somebody calling the President out on the carpet and asking him to use his phone and pen? Instead, he leaves 17,000 residents twisting in the wind.

  3. Yes indeed! Senator Scott really needs to retire. I feel your pain Geoff. Why is it they’re OK with taking huge sums of money from the Feds for almost everything, but refuse to take money to help Wyomingites live a healthy productive life? At the request of the people who know best, the hospitals, and Governor’s own commitees, to boot? Let’s not forget it will also lower the premiums for the rest of us too. But why not just do it because its the right moral direction to legislate?