Supporters make budget case for Medicaid expansion

The first hint of whether Wyoming lawmakers will reverse themselves on Medicaid expansion could happen this week when the Joint Appropriations Committee is expected to wrap up budget recommendations.

Groups and individuals for and against expansion spent part of the Martin Luther King holiday on Monday appealing to lawmakers on the committee.

“Behind all the numbers are real flesh-and-blood people who are suffering for lack of health care,” said Deacon Mike Leman of the Cheyenne Diocese. “When people don’t have health care their health problems don’t go away … They wait until the pain becomes unbearable and they call 9-1-1.”

Others, including the libertarian think tank Wyoming Liberty Group, continued to warn lawmakers that expanding Medicaid may cost the state more if the federal government doesn’t make good on its promise to cover a majority of the cost. And cost could be the deciding factor for Medicaid expansion in Wyoming — particularly this year.

In rejecting Medicaid expansion year after year, Wyoming lawmakers haven’t been swayed by data suggesting the economic benefits to the state. But the economic argument may be a little more compelling this year as the Legislature prepares to deal with a significant budget shortfall, expansion proponents say.

“Everybody is talking about our economy right now and that has changed the tone of the conversation and caused everybody to go back and look at the numbers,” Equality State Policy Center executive director Bri Jones said in an interview.

Wyoming is among 19 states that have not expanded Medicaid coverage under the Affordable Care Act. Without the expansion, some residents fall into what is known as the Medicaid “gap” — childless, working adults earning between 100 percent and 138 percent of the poverty rate don’t currently qualify for Medicaid or healthcare premium subsidies. And the estimated number of people who fall into the gap just grew by 14 percent.

Tom Forslund, Wyoming Department of Health director, told lawmakers on Monday the estimate has increased from 17,600 to 20,000. The higher the number of enrollees — should the state expand Medicaid coverage — the more federal dollars would flow to hospitals and providers as more people seek health care. Expanding Medicaid would infuse $263 million into the state’s economy over the next two years, Forslund said.

“Essentially, people who are on [a] Medicaid program will have their healthcare needs met, and those providers will be paid,” with federal dollars, he said.

That money would come at a critical time for individual providers and hospitals alike, according to health officials. The amount of uncompensated care among hospitals is expected to rise beyond the estimated annual $110 million over the past several years, according to Wyoming Hospital Association president Eric Boley. He said expanding Medicaid may cover 10 percent of those losses.

“We could manage their [Medicaid gap clients’] chronic illnesses much better, which in the long term will save a lot of money,” Boley said.

Members of the committee spent more than an hour questioning health director Forslund about how expanding Medicaid would work, and how much it might cost or save the state. Forslund, as he has testified for several years, told lawmakers he believes expansion would save the state money. His boss, Gov. Matt Mead (R), reversed himself on expansion late in 2014, and this year he wrote Medicaid expansion into his budget proposal.

Jones, of the Equality State Policy Center, said she thinks that was a strategically thought out move.

“I think the governor was very smart to put it in his budget to show just how many programs [costs] would be reduced by closing this coverage gap — reducing the amount of uncovered care, and just the myriad ways it affects the bottom line.”