Senate strips health saving account from Medicaid expansion

The Wyoming Senate stripped a health savings account provision out of the SHARE Plan for Medicaid expansion Friday, bringing it more in line with plans approved by the federal government.

The vote returns the original Senate File 129 – SHARE Plan to the floor. The plan, developed by the Department of Health and endorsed by Gov. Matt Mead, would expand Medicaid coverage to an estimated 17,600 adults. Many of the low-income recipients are able-bodied and working, but don’t have health insurance.

Sen. Charlie Scott (R-Casper) had added the savings account requirement when he amended the bill in the Senate Labor Committee on Wednesday. Requiring health savings accounts would reduce costs, improve patient outcomes, and provide incentives that would ease recipients off the program, he said. The proposal relied on an accounting procedure called “virtual money” to fill the health savings accounts while passing medical expenses to the federal Medicaid program.

Scott’s amendment failed on the floor on a vote of 15 opposed and 13 in favor, as announced by Senate staff. It needed 16 “yes” votes to pass. Senators stood to cast their votes, but did not perform a roll call, which isn’t required for amendments. (See below for the vote as WyoFile observed it.)

Lead sponsor on the original SHARE Plan bill Sen. Michael Von Flatern (R-Gillette) opposed Scott’s amendment.

“This is a great idea in many respects, but I don’t think it is ready,” Von Flatern said of Scott’s amendment. “This would be very complicated for a population that hasn’t dealt with even the slightest amount of paperwork.”

Von Flatern questioned whether the federal government would agree to contribute $50 monthly to individual health savings accounts. The Center for Medicaid and Medicare Services will only cover medical reimbursements.

He also questioned whether CMS would agree to lumping all participants into one benefit level, as proposed by Scott. In other states that have expanded Medicaid, CMS has typically required breaking the population into two income tiers.

On Friday afternoon the Senate passed the Senate Appropriations amendment to make the SF 129 cost-neutral to the state General Fund. The amendment grants the Department of Health Authority to transfer patients from state-funded programs to the expanded Medicaid program.

For example, the department could reduce state funds spent on mental health and substance abuse by transferring low-income patients within that program to Medicaid.

Numerous Senators had questions about the potential effects of the SHARE Plan. Senate President Phil Nicholas (R-Laramie) encouraged the bill’s sponsors to bring amendments to clarify the bill and specify which state-funded programs would be reduced with the patients shifting to Medicaid.

“I support this (cost-neutral) provision, but as the chairman of (the Senate Appropriations Committee), you need to understand where these cuts are going to come from,” Nicholas said to amendment-sponsor Sen. Tony Ross (R-Cheyenne). “If we expand the coverage for a wider net of people and that means reducing programs for others, then we need to own up to it, and identify them in advance.”

The Senate will debate three amendments to the Senate File 129 – SHARE Plan on Monday. One amendment proposed by Sen. Stephan Pappas (R-Cheyenne), would create a reserve account to gather funds generated by reducing state-funded programs. It would then use that money to pay the state’s administrative costs of the SHARE Plan in keeping with the cost-neutral requirement.

Sen. Von Flatern will bring another amendment to create penalties for inappropriate use of the emergency room, and disenroll patients who don’t pay premiums for up to six months. The amendment also carries incentives to complete wellness programs, and penalties for not doing so.

Finally, Sen. Eli Bebout (R-Riverton) will offer an amendment to require recipients to work 32 hours a week. CMS has repeatedly rejected state Medicaid expansion applications that with work requirement.

VOTES*

No on Scott Amendment (15):

Sens. Bruce Burns (R-Big Horn), Eli Bebout (R-Riverton), Leland Christensen (R-Alta), Hank Coe (R-Cody), Fred Emerich (R-Cheyenne), Floyd Esquibel (D-Cheyenne), John Hastert (D-Rock Springs), Larry Hicks (R-Baggs), Gerald Geis (R-Worland), Phil Nicholas (R-Laramie), Stephan Pappas (R-Cheyenne), Chris Rothfuss (D-Laramie), Michael Von Flatern (R-Gillette). Tony Ross (R-Cheyenne), Jeff Wasserburger (R-Gillette)

Yes on Scott amendment (13):

Sens. Jim Anderson (R-Glenrock), James Lee Anderson (R-Casper), Cale Case (R-Lander), Bernadine Craft (D-Rock Springs), Stan Cooper (R-Kemmerer), Dan Dockstader (R-Afton), Wayne Johnson (R-Cheyenne), Dave Kinskey (R-Sheridan), Bill Landen (R-Casper), Ray Peterson (R-Cowley), Curt Meier (R-LaGrange), Drew Perkins (R-Casper), Charlie Scott (R-Casper)

Did not vote:

Sens. Ogden Driskill (R-Devils Tower), and Paul Barnard (R-Evanston)

*As observed from the gallery