The House and Senate budget bills introduced this week exclude Medicaid expansion, one of Gov. Matt Mead’s signature budget items, and rely instead on a patchwork of health care measures.
Medicaid expansion proponents failed to get the program back into the budget Monday, after the Joint Appropriations Committee stripped it from the Department of Health account in January. Mead estimated that expanding Medicaid would save the Department of Health $10 million while the status quo would cost another $23 million — a total win for Wyoming of $33 million.
Several studies have estimated that expanding Medicaid would be a net positive to Wyoming health care patients, providers and the overall economy by even more than that — hundreds of millions of dollars.
Some Medicaid expansion advocates say they expect the health-care measure will be offered in a budget amendment. But members in the House and the Senate see little chance Medicaid expansion will pass in any form this year.
Instead, attention has shifted to Senate File 86, and several other patchwork measures to help health care providers and an estimated 20,000 Wyoming residents who are left in the so-called “Medicaid gap.”
“There is no grand plan to take care of the folks who are left in the gap between currently eligible for Medicaid and eligible to be on the exchange and can’t afford insurance — there is nothing,” Rep. Eric Barlow (R-Gillette) said. “Now, we’re doing smaller things around it,” the Joint Labor, Health and Social Services Committee member said.
Scott proposes expansion alternative
SF 86 “Medical Assistance Program Design” calls for a $20,000, 2-year study and is sponsored by longtime Affordable Care Act critic Sen. Charlie Scott (R-Casper). The bill calls for “a medical assistance program for people who cannot afford adequate health care” while also prohibiting Medicaid expansion, the co-chairman of the Joint Labor, Health and Social Services Committee said .
Despite that prohibition, Sen. Scott described the bill as a cost-controlled state version of Medicaid expansion. “This is a compromise solution where we can put sideboards on Medicaid expansion,” Scott told WyoFile. “It’s clear to me as I count the votes that the pure expansion does not have, and has not had in this Legislature, the support to pass it. So we’re saying, OK, what can we do that could potentially build that support so that it could pass?”
SF 86 includes a work requirement and other built-in welfare reforms.
“Medicaid expansion that’s proposed right now is pure Obamacare — make as many people dependent on the government as possible,” Scott said. “And this, we’re looking for a way off it.”
Marguerite Herman of the Wyoming League of Women Voters, which supports Medicaid expansion, said SF 86 is an attempt to provide political cover for those who oppose expansion, just as with other failed expansion alternatives.
Gov. Mead had offered his own Medicaid expansion alternative, the SHARE Plan developed by the Wyoming Department of Health, in 2014. It earned some support among expansion advocates as an alternative to full Medicaid expansion. But Scott successfully added an amendment to the SHARE plan that other lawmakers thought complicated the fiscal workings, eventually leading to the demise of the SHARE Plan proposal in the 2015 legislative session.
Apart from SF 86, lawmakers proposed about 17 bills that attempt to bring relief to health care patients and providers, in lieu of Medicaid expansion.
Among the bills that are still alive is HB 57 “Upper Payment Limit Program-Private Hospitals,” which would qualify hospitals for higher federal reimbursement for Medicaid patients. SF 49 “Direct Primary Care-Insurance Exemption” would provide so-called concierge health care, or primary care services for a low monthly subscription rate. SF 104 “Volunteer Health Care” would allow doctors, nurses and midwives — everybody in the medical profession — to donate their services without liability insurance.
“These are small pieces in a very big puzzle that over time help fill in some of these access gaps,” Rep. Barlow said. “It doesn’t fix insurance, or help people afford their premium payments or deductibles. It doesn’t do any of those things in a direct way.”
Barlow said he would have liked to have seen Medicaid expansion brought to the Legislature in a stand-alone bill, rather than in Gov. Mead’s budget.
Joint Labor and Health Committee co-chairwoman Rep. Elaine Harvey (R-Lovell) said she believes Medicaid expansion is unattainable for Wyoming because of fear that the federal government won’t make good on its commitment to help fund it. Meantime, the state has provided minor relief for hospitals with high uncompensated care costs, supported rural healthcare clinics and nursing home care, she said.
“Without Medicaid expansion, we’ve got to do something,” Harvey said. “It’s important to continue to look for ways to help our citizens.”