Put Medicaid expansion on the special-session docket

More than 30,000 Wyoming workers have lost their jobs since mid-March, many have also lost their health insurance and thanks to the coronavirus pandemic and the minerals industry’s collapse, state government is looking at a $1.5 billion deficit over the next two years.

People are hurting, and so are hospitals. Healthcare facilities operate on thin margins. For two months COVID-19 halted elective surgeries and other non-emergent procedures, decimating hospital incomes. Meanwhile, their already high uncompensated care costs are sure to go through the roof as the newly unemployed and uninsured flood emergency rooms.

If only there were some well-established, proven-to-work-elsewhere program on offer that could insure unemployed residents, bring in revenue for state government and help keep our healthcare system solvent. Oh wait, there is, and I’ve been writing about it here for more years than I care to count.

Medicaid expansion would provide health insurance to thousands of residents, and the program’s reimbursements would prevent hospitals from sinking further into debt due to patients’ inability to pay.

And let’s not forget that the Legislature has flushed nearly $1 billion in federal funds down the drain by rejecting Medicaid expansion since 2013. Yet many self-proclaimed fiscally conservative legislators, including several that I often agree with on other issues, vote against expanding Medicaid year after year. Now they’re flatly refusing to consider expansion during any forthcoming special sessions.

So, my question to them is blunt, but I’m genuinely curious: What on Earth is wrong with you?

I know passing Medicaid expansion is always the biggest longshot of every session. But any lawmaker who doesn’t see that it should be approved now — as a pandemic disrupts the globe and the state is in undeniable fiscal turmoil — is dangerously out of touch with reality.

During the early years of the Legislature’s Medicaid expansion debate, it was obvious Senate and House Republicans were following the marching orders of the national GOP. By voting against the bill, they were denying Barack Obama a victory.

Maybe Wyoming’s GOP legislators didn’t get the memo, but Obama hasn’t been president since January 2017. That was also the year U.S. Senate Republicans failed to repeal “Obamacare,” thanks to the late Sen. John McCain standing on principle and choosing the public good over party politics. It was the last chance they’re likely to have during Donald Trump’s presidency.

Thirty-six states have expanded Medicaid, and more are coming into the fold each year, either by legislative action or voter-led ballot initiatives. Wyoming is in the pack of 14 red states that stubbornly refuse to budge no matter how much money they lose and how much they make their poor constituents suffer.

Still, as has been the pattern of the Medicaid expansion debate for years, the issue inched forward during the interim. The Legislative Management Council voted 7-6 last month to assign a Medicaid expansion proposal with two important strings tied to it to the Joint Revenue Committee for consideration.

House Minority Leader Cathy Connolly (D-Laramie) made the motion, with expansion limited to four years and only if the feds never pay less than 90% of the costs. She reasoned that after four years, legislators could decide whether to continue the expansion experiment.

For Medicaid expansion advocates, it was a hallelujah moment. It’s the first time legislative leadership has given its stamp of approval to the idea. That’s real, tangible progress.

That seventh and deciding council vote is noteworthy because it was cast by House Speaker Steve Harshman (R-Casper), who finally decided he likes, or at least can stomach, Medicaid expansion after years of voting against it.

What changed his mind? Harshman, chairman of the Management Council, identified two major reasons.

“We take care of poor people, poor kids, people with disabilities, but this is an expansion to able-bodied, childless adults, right? That’s what we’re talking about,” he said. “And we might very well have a lot of unemployed, able-bodied, childless adults.”

“We’re going to pay one way or the other,” Harshman added. “They’re either going to go to the emergency room [at the] Wyoming Medical Center or somebody else.”

After that historic victory, the path forward seemed clear. The Joint Revenue Committee sponsored a bill earlier this year to authorize the governor and Department of Health to negotiate with the feds for a Wyoming expansion program. The committee had the chance to approve the council’s revised bill at its May 26-27 virtual meeting online, which would have cleared the way for consideration during the special session on COVID-19-related issues that begins June 29.

Connolly, also a member of the revenue panel, pushed for exactly that agenda. She not only got no takers during last week’s meeting, but opponents lashed out at the notion of even revisiting the issue.

Rep. Dan Laursen (R-Powell) reminded everyone that the Medicaid expansion authorization bill was defeated in the House by a 2-to-1 margin in February. 

Yes, but that was before coronavirus laid waste to the state’s already shaky economy. How can any legislator look a constituent in the eye who has lost his or her job and health insurance through no fault of their own and yank their lifeline to healthcare away?

Senate Vice President Ogden Driskill (R-Devils Tower) said if he hadn’t been absent for the Revenue Committee’s vote during last year’s interim to sponsor the 2020 bill, it would have failed. Touche.

“I frankly don’t give a damn what the Management Council says we should be doing,” said Sen. Bo Biteman (R-Ranchester). I think he will after the state GOP leadership hears that comment.

Biteman last week called Medicaid expansion “a horse we’ve beaten to death many times.” He also said the public doesn’t want it, which simply isn’t true. In 2016, the last time a poll looked at the issue, the University of Wyoming’s Center for Energy Economics and Public Policy found that a majority supports Medicaid expansion.

Biteman claimed Wyoming can’t afford expansion, even though it’s estimated the Centers for Medicare and Medicaid will pay $135 million per biennium and Wyoming’s share will only be $18 million.

At that rate of return on its investment, Wyoming can’t afford not to expand Medicaid.

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But there was no appetite on the Revenue Committee to take more than a cursory look at the council’s proposal, much less a vote. Co-chairmen Sen. Cale Case (R-Lander) and Rep. Dan Zwonitzer (R-Cheyenne) instead decided the committee will study expansion again and perhaps vote on sponsoring a bill for the 2021 general session.

That’s six months too late to help people and hospitals who need immediate assistance. I agree with Biteman about one point: If Management Council members want this bill, they should sponsor it themselves at the next special session.

Harshman’s conversion might be enough to make a difference in the House, where it would only need a simple majority to pass. But there’s a narrow window for his backing to matter, since his term as speaker is about to expire. His likely successor, House Majority Floor Leader Eric Barlow (R-Gillette) has been a consistent no vote on expansion.

All three Senate GOP leaders — Senate President Drew Perkins of Casper, Majority Floor Leader Dan Dockstader of Afton and Driskill — also oppose the idea. That makes getting the bill through the upper chamber the Mount Everest of legislative challenges. It would take a veritable avalanche of letters, emails, voicemails and in-person lobbying (with proper social distancing) to pull it off.

So, I’ll ask myself the same question I posed to opponents: What on Earth is wrong with me?

Well, you may say I’m a dreamer. But on this issue, I know I’m not the only one.