So where is that Wyoming health care solution?Guest column by Kerry Drake February 12, 2013
Facts, common sense, what’s good for the people — they all fly out the window when some conservative Wyoming politicians are determined to show how much they distrust the federal government.
It’s happened many times before, but never to the absurd level it did when Gov. Matt Mead and 22 state senators killed Medicaid expansion in Wyoming this session.
No matter how one looks at the issue, they blew it — far worse than most people realize.
On a fiscal level, the state could have saved an estimated $47 million over the next six years, according to a Wyoming Department of Health study. By not committing to a full expansion of Medicaid, Wyoming will have to spend nearly $80 million more than it should have.
That isn’t just fiscal ineptitude, it’s legislative malpractice.
At a time when state agencies are dealing with budget cuts and officials have called for fiscal responsibility, killing the program’s expansion was an insane decision. It was the culmination of a string of blatantly stupid moves to show how much disdain Wyoming has for the feds and the Affordable Care Act, known as Obamacare.
After several years of study, the Wyoming Health Care Commission concluded that expanding Medicaid was the best way to cover all low-income adults and families in the state.
In addition to increasing the number of people with comprehensive health coverage, the move would reduce costs in several health-related areas, including the tab hospitals are stuck with when the poor are treated in emergency rooms and can’t pay their bills.
Like every other recommendation the commission made, the Legislature ignored it. When Obamacare expanded Medicaid, Mead led the charge to fight the new law in the courts. When the U.S. Supreme Court affirmed its constitutionality, the justices said states could decide to opt out of the expansion.
Given that small window of opportunity to make another costly decision, Mead and a strong majority of lawmakers did not waste a moment to jump through it.
“Let’s decide what we want and make the pitch to the federal government,” Mead said in his State of the State address. “In other words, let us try within the law that is upon us to find the best deal, the best fit for Wyoming. To do nothing puts the full brunt of the ACA upon us — everything is dictated by the federal government — without an opportunity to tailor the law to our needs.”
Despite the rhetoric that Wyoming can find a better way than Obamacare, so far the state’s only attempt to design a program of its own was “Healthy Frontiers,” a pilot project designed to help a limited number of the state’s working poor receive health care coverage. But legislators pulled the plug while the program was in its infancy because too few residents signed up. There apparently is no “Wyoming way,” or at least none that anyone cares to identify.
Full Medicaid expansion would allow about 18,000 newly eligible adults into the program, with the feds picking up 100 percent of the initial costs, and no less than 90 percent after three years.
Not good enough, said Mead and the Senate, while offering no alternatives. What if the federal government reneges on its commitment?
That’s never happened in the history of the program, of course. And even if it did, the Medicaid expansion bill sponsored by Sen. John Hastert, D-Green River, allows the state to cancel the expansion any time the feds failed to cover at least 90 percent of the costs.
But why let facts keep us from showing how much our state hates the federal government?
Wyoming can only hope for the day it is led by a chief executive who has the wisdom to put aside such anti-Washington nonsense and do the right thing. A governor like Jan Brewer of Arizona.
Did I just write that? Am I talking about the same Jan Brewer who backed the “your papers, please” law in her state to harass minorities? Who lied about her father dying while fighting Nazis? The one whose claims that drug dealers were decapitating people in the desert were patently false?
I am indeed. While Brewer railed against Obamacare just as much as Mead did after the law was passed, even she knows a great deal when she sees one.
“My concerns about the Affordable Care Act are well-known,” Brewer explained. “But it is the law of the land. With this expansion, Arizona can leverage nearly $8 billion in federal funds over four years, save or protect thousands of quality jobs and protect our critical rural and safety-net hospitals.”
Several other states have dropped their opposition — including Nevada, North Dakota and New Mexico. But not Wyoming.
State legislators delayed studying Medicaid expansion until after the Supreme Court’s ruling, then until after the election, because the act would be repealed by President Mitt Romney. Anyone seen him lately?
Mead said he couldn’t get any answers about the program’s implementation from the U.S. Department of Health and Human Services, but other governors were satisfied by the federal response, or at least feel informed enough to move forward with Medicaid expansion.
Last July, Mead wrote that he has “grave concerns” about the financial impact of expanding Medicaid. Without additional information, he added, the expansion appears to “only add to the unsustainable federal debt while taking away states’ prerogative to make the best decisions for our citizens.”
But in U.S. Health Secretary Kathleen Sebelius’ earlier letter to governors who objected to Medicaid expansion, she stressed that states have the “flexibility to design the benefit package for the individuals covered.”
As for Mead’s fiscal concerns, his state’s own Department of Health issued a report last November that concluded Wyoming will actually save nearly $50 million by using federal funds to expand Medicaid.
Historically, Wyoming has never turned down much of that wicked federal money it has used to build its highway system, public schools, higher education, and enhance the infrastructure of cities and towns. Two years ago it denied the extension of unemployment benefits, but that was just a political statement that punished our jobless residents.
The Wyoming Medical Society and Wyoming Hospital Association (WHA) both supported Hastert’s bill. Dan Perdue, president of the WHA, noted Wyoming hospitals now write off a staggering $200 million per year in uncompensated care, which strains the resources of emergency rooms and increases the costs of those who can afford to pay. Medicaid expansion, he said, could substantially reduce the amount of uncompensated care.
Some uninsured residents are now unemployable due to chronic medical conditions that could be cured, but require tests or procedures that are either too expensive or unavailable where they live. These aren’t people who are trying to game the system to obtain benefits they haven’t earned, but simply residents who need help to become healthy, working citizens.
Some conservative legislators who faced primary challenges from the extreme right no doubt jumped on the anti-D.C. bandwagon with more vigor than normal. They can keep their promise to do everything possible to push back Obamacare, but still agree to expand Medicaid next year when faced with no other alternative.
But there’s nothing to guarantee that the same generous funding provisions the federal government offered states this year will return when the Legislature meets again in 2014. Moreover, if lawmakers are still unwilling to expand Medicaid then, it will be Wyoming’s working poor who suffer from acute health problems who will be shut out from coverage for yet another year.
Sen. John Schiffer, one of four Republican senators who supported expansion, couldn’t convince most of his colleagues to join him. But he had an excellent argument.
“Nobody has come up with a better system,” he said. “You can call it antiquated. You can call it expensive. You can call it whatever you want. It’s better than anything out there, because there aren’t any proposals out there.”
The Legislature has appropriated $100,00 for a study of Wyoming’s Medicaid program, with the goal to see if there are more cost-effective ways to use state and federal money to provide health care coverage for more people.
Yes, let’s keep searching for that elusive Wyoming solution to our health care problems.
Unfortunately, while the governor and lawmakers study the issue to death, it’s real people who are suffering and even dying because those in charge stubbornly refuse to accept a federal answer that may actually work.
Click here to read WyoFile’s complete coverage of the Medicaid expansion debate.
— Kerry Drake has 37 years of journalism experience at Wyoming’s two largest daily newspapers. He lives in Casper.
Guest columns are the signed perspective of the author, and do not necessarily reflect the views of WyoFile’s staff, board of directors or its supporters. WyoFile welcomes guest columns and op-ed pieces from all points of view. If you’d like to write a guest column for WyoFile, please contact Guy Padgett at email@example.com or Dustin Bleizeffer at firstname.lastname@example.org.
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Politics,, how sad is that. I had believed Wyoming was above this, but having seen what is going on in Washington, I shouldn’t be surprised. I do not know what the Republican Party has become, but it is not the one I grew up with and I will no longer support them, it is about what is right, not what is “Right”!
People don’t matter,, it’s just politics. Since the election of our first black President, the Republicans have done everything in their power to discredit him and obstructed anything and everything to move this nation forward. In this state, almost 1 in 4 people voted for him in this last election, his Second win and still, nothing from the Right, even their own ideas, if supported by President Obama, are null and void. Our own Senator McConnell, err,, I mean Barrasso, our Texas Representative is one of the worst and I am guessing that The Gov. is his “pocket pal”, wake up people, straight party-line voting does not work any more, vote for the best person for the job!!
P.S. No one can know who you vote for, so feel free to vote Blue,,,, if best qualified, and do your homework!
Nice one Kerry, good point!
Excellent story, Kerry. Balanced, but with a point. As I watch Wyoming from afar, and bear witness to my “progressive” adopted state of Wisconsin turn into Wyoming, I miss the Cowboy state even more, as weird as that may seem. When we moved here over 20 years ago Wisconsin had all kinds of political, cultural, and social things going for it, but doesn’t any more. Now that the Badger state seems hell bent on joining the anti-Fed, cut-off-your-nose-to-spite-your-face, flat earth society, I might as well start thinking about returning to Wyoming! Keep up the good work.
Great article, Kerry. I wish I could remember the book I read about the failings of our health system and how we compare with the world. We are certainly not the best in any category. But this is Wyoming and we have to maintain our conservative image and then when the Affordable Care Act came along, we redoubled the effort. Too bad. Thank you, Tom
Ouch, that shot in the foot really hurts! But we certainly showed them!
To be consistent with his anti federal government view, wouldn’t the governor and the legislature have to turn down all Federal subsidies? I mean, if the federal government runs out of money wouldn’t Wyoming get stuck with those bills too? Good article, Kerry.
Just to clarify, while Jan Brewer may have been incorrect in saying there were people beheaded in AZ desert, it was happening across our border in Mexico so definitely close enough to make the border issue very important in AZ. She was correct in the beheadings, just incorrect in the actual area. Sad to hear Wy is not doing well with the Obamacare but such is the case when a 2000 page bill gets passed by people who don’t read the whole thing or see the loopholes the insurance companies do 🙁
Thanks, Kerry. Best overview I’ve read on the Wyoming Healthcare fiasco. When folks outside Wyoming look at Wyoming they sometimes think we’re irrelevant in the big picture – perhaps they are correct.
In a normal year, fears that the federal government would fail to come through on promised funding would be regarded as wild speculation, an empty threat.
But this is not a normal year.
By a bipartisan vote, Congress created a sequestration gun to the head, filled with such horrible cuts for budgets dear to Republicans and Democrats alike, that the conventional wisdom was that it would force Congress to compromise and enact both cuts and higher taxes to deal with the deficit.
Conventional wisdom was wrong.
The Tea Party wing of the Republican Party actively wants massive budget cuts to rip through defense, health, education, homeland security, etc — not like a scalpel, but a chainsaw! Thanks to gerrymandering, most sitting Republicans have zero fear of general election challenges from the left, but are terrified of primary challenges from the extreme right. Come March, we will see savage, across-the-board cuts in federal budgets because the concept of “compromise” and “tax increases” are absolutely forbidden in the extreme right. Consequently, we’re going to have another deep recession, soaring unemployment and not a dime spent or raised to address the critical challenges of the day. Everything will be sacrificed in the name of reducing the deficit — despite abundant evidence in Europe that austerity makes things worse rather than better.
SPOT. ON! Great article Kerry!