Wyo medical students’ laudable fight for Medicaid expansion

Larissa Siirila of Worland is so committed to providing access to quality healthcare for her future patients, she’s willing to fight for it.

Siirila, a first-year medical student at the University of Wyoming, was one of 15 students who traveled to Cheyenne recently to show their support for Medicaid expansion.

The Legislature has overwhelmingly and repeatedly rejected expanding the government health insurance program since 2013. The issue will be debated by lawmakers at least one more time at the beginning of February’s budget session.

That’s because, in a surprising turn of events, the Joint Revenue Committee advanced a Medicaid expansion bill by an 8-5 vote recently. The vote followed two hours of testimony from people who mostly favored the measure.

Siirila’s story was compelling. She explained that after her father lost his job at 62, the health insurance that covered his family disappeared, too.

Extending coverage through COBRA was unaffordable, and private health insurance plans were either too expensive or had such high deductibles they weren’t worth it. Three years ago, Siirila was able to buy her own insurance from the Affordable Care Act’s Health Marketplace.

“It allowed me to get desperately needed primary care and mental health services,” the student told legislators. “I was headed down a trajectory where I would no longer be able to take care of myself. Being able to access healthcare changed all of that for me. Today I’m living my dream, attending medical school and making future plans to work in the state as a family physician.”

Each academic year, up to 20 Wyoming students are accepted in the WWAMI Medical School at the University of Washington, which has clinical sites in Washington, Wyoming, Alaska, Montana and Idaho.

Students spend the first two years of the four-year program in Laramie, then transfer to other sites to complete their training. If they choose to provide healthcare in Wyoming, the cost of their medical education is free. They can start their practices without being saddled by huge student debts.

Conner Morton of Casper worked as an emergency medical technician with the Mills Fire Department before becoming a WWAMI student two years ago.

Morton said the medical, nursing and pharmacy students who belong to UW’s “Health Equity Circle” believe Medicaid expansion is essential to the state. He said many have already seen patients struggle with medical bills, like a woman who couldn’t afford to pay $60 for both an antibiotic and a medically necessary inhaler.

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Patients shouldn’t have to choose between life-saving medicines, Morton said. They will eventually end up in the emergency room, and without Medicaid expansion, he noted, “We’ll all pay for that medical care.”

He’s right. Medicaid expansion would provide health insurance to between 19,000 and 27,000 low-income Wyoming residents who could qualify for the program, according to the Department of Health. Many are stuck in the so-called “Medicaid gap” and don’t qualify for government assistance.

Without Medicaid, the patients cannot afford to see a doctor and receive preventive care to keep them out of the ER. Wyoming hospitals provide more than $100 million annually in uncompensated care, jeopardizing the future of some rural facilities. Such charity care is made up by charging more for patients who can afford to pay. Meanwhile, private health insurance premiums increase.

Why, you might wonder, has Wyoming thumbed its nose at expanding Medicaid for so long? I blame it on short-sighted and/or uncaring state lawmakers who have been willing to throw away hundreds of millions of dollars while punishing poor people.

Because of its choice, Wyoming has lost at least $840 million in the past seven years. These are funds that the state’s residents have already paid in federal taxes. The money goes instead to the 36 states that have chosen to expand Medicaid.

The federal government picks up 90% of the total expansion cost. Wyoming’s estimated share is $18 million, which would largely be offset by savings from other social service programs that will see reduced usage.

Medicaid expansion opponents have claimed the feds can’t be counted on to keep funding the program at the same guaranteed rate. Rep. Tim Hallinan (R-Gillette), a retired physician, recycled the argument again at the Cheyenne meeting.

“I think the 50% that the state pays for the current Medicaid population is likely to be applied to these Medicaid expansion people in the future,” he said. “I believe that is an expense the state cannot afford.”

Utah, Idaho and Nebraska all passed ballot initiatives to expand Medicaid last year, after the governors and legislators in those red states refused to do so. Rep. Pat Sweeney (R-Casper) told the committee that the same thing could happen in Wyoming, and then lawmakers would “get it shoved down our throats in ways we don’t want for our state.”

“It’s coming whether we like it or not,” Sweeney said.

The UW medical students certainly hope it is. One of their instructors, Dr. Tracy Haas, underlined why Medicaid expansion is so important.

“This is not an issue of politics, but one of economics and responsibility,” she said. “These students will choose to live and work in a place that cares about patients’ access to medical care and will get them the treatment and medication that is needed most.”

Hallinan said he didn’t want to disappoint the students, but he voted against the bill. “I had [patients] who couldn’t pay, and I saw them and took care of them,” he told them, adding that charities also pitched in. “I hope that you would be willing to do the same in the future.”

Haas said her students have worked at free clinics and raised funds for patients who need medicine and treatment they can’t afford. But she stressed that relying on the good nature of doctors to provide care at little or no cost isn’t a sustainable system “when any of us could be brought to our knees by a catastrophic diagnosis at any point.”

“Patient access to health care should not depend on families’ ability to sell their homes, cash out their retirement or fund raise in the church basement,” the doctor said. “This is a long-term economic issue that will affect all of us for years to come.”

Sweeney, a GOP moderate, said he has opposed Medicaid expansion in past sessions but supports it now. One of the reasons he cited was the UW students’ testimony, who represent the future of medical care in Wyoming.

From my perspective, the students were instrumental in convincing legislators to pass the bill. Patient care is their chief concern, and Wyoming is lucky to have them. While Medicaid expansion advocates still have a tough road ahead in lobbying the entire 90-member Legislature, on this day their efforts were fruitful.

“We’re constantly looking for ways to expand our economy and find new sources of revenue to replace failing old ones,” Siirila said. “I’m here to tell you that the very solution you’re looking for might come from someone who is too sick right now to enact it.”

Affordable healthcare — which everyone deserves — wasn’t available to the future physician for several years. Her point is well taken: People like her will benefit through expansion of federal and state programs like Medicaid.

It makes no moral or fiscal sense for Wyoming legislators to keep saying no.