One-word change was a bombshell for the poor

— March 4, 2014

With a one-word change, everything else around that word came crashing down.

“Shall” became “may,” and suddenly any hope that first word had provided supporters of Medicaid expansion in Wyoming was gone. It was as dramatic as if a minister asked a woman if she wanted to become a man’s bride and everyone smiled and knew what she was going to say, but instead her mouth formed the word “no,” and when she said it aloud, the wedding party was over.

Everyone left, taking their presents with them. There would be no kiss, no more photos and no first dance.

No honeymoon, either.

After two weeks of toying with us, legislators opposed to Medicaid expansion finally decided to crush the hopes of 17,600 low-income people who can’t sign up for Medicaid or qualify for Obamacare subsidies because our representatives and senators and governor essential said; No, we won’t allow the federal government to help you see a doctor no matter how sick you are, even if it doesn’t cost us any money.

They said no, even though expanding Medicaid would save us $43 million in the first year alone because the poor caught in the Medicaid gap won’t have to go to expensive emergency rooms to get treated anymore, and won’t need costly help from a slew of other government assistance programs.

They said no to expanding Medicaid even though our own state studies found that with better health care for the poor, Wyoming would save 111 lives every year. It also means the state will have to spend $80 million instead of pocketing $43 million. Our policymakers effectively said; Well, you’re all going to die sometime anyway, aren’t you?

Legislators never even bothered to take a vote this year on the traditional Medicaid expansion that 25 other states have approved since the Affordable Care Act made it possible for them to offer the program to low-income, childless adults. Both the House and Senate killed four alternative expansion proposals during the budget session, each weaker than the one before it.

A Democratic state senator from Laramie, Chris Rothfuss, attempted to make Medicaid expansion at least a possibility next year. He took everything out of the previous bills Republicans found objectionable, and said here are all the tools you need to craft any kind of plan you want – just give these poor people some hope. The Senate said no, we can’t do that. What if the feds change their minds and won’t pay for it?

Rothfuss said the state would create a health care savings account, and deposit the $80 million Wyoming would save in the first two years, and Republicans can decide how to use it. The expansion would be phased-in, and if the payment promise ever changes, the program would instantly be over. If the state wanted to continue the expansion, at several steps along the way its leaders could decide to opt in – but if they didn’t, it was automatically over.

The Senate still said no. So a Republican representative, Eric Barlow of Gillette, tried the same thing in the House, on the last day a budget bill amendment could be considered, and the House finally said “OK.”

“It’s a start” was the reaction of the 25-organization Wyoming Coalition for Medicaid Solutions, which tirelessly lobbied for expansion in some form. Medicaid can’t happen in 2014, but the Rothfuss-Barlow amendment directed Gov. Matt Mead, along with the Department of Health director and the state’s insurance commissioner, to negotiate a waiver for a Wyoming demonstration project.

Would senators on the conference committee get their way and kill the House amendment to the budget bill? That was the worry of expansion supporters, but it turns out the Senate didn’t even have to expend that much energy. They let the amendment – actually, now a footnote – stay in the bill. Last Thursday, the second day of talks, Senate Vice President Eli Bebout (R-Riverton) said the Legislature really has no business telling the governor what to do, and he made a motion to change the footnote from the governor “shall” negotiate to the governor “may” negotiate.

One word was changed, but that’s all it took. The House conferees rolled over and voted with the Senate – that is, all of the senators but John Hastert, a Democrat from Green River, who did the right thing and voted no.

He’s a good man, that John Hastert. The night before, he flatly told the other conferees the amendment they were debating was the weakest possible move the Legislature could make this year. So he offered his own amendment, which changed it to “Lemonade expansion.” Why? Because it directed the governor to “pretend” to negotiate a Medicaid waiver.

They should have just passed that one. Hastert’s joke had the sharp edge of truth. A day later, when Bebout’s real amendment won approval, it became clear the Republicans were only providing themselves cover on the most controversial issue of the session. “Don’t look at us,” GOP lawmakers can now say, though not with a straight face. “We signed our names to this. We had banned talks with the feds, but we gave the governor our permission to negotiate.”

Yes, they did. Instead of ordering Mead to do it, they gave a man who has fought Medicaid expansion tooth and nail for the past two years the option of leading Wyoming’s team.

How do you think he’ll do, Eli?

Obviously, the governor is not really going to do a damn thing. He might write a few memos to his staff, maybe send a letter to the feds, and his office can submit a report to the Legislature in November – which is required in the footnote – that says sorry, it just didn’t work out this time. Maybe next year.

The list of 17,600 people now in the Medicaid coverage gap will expand – minus the deaths of some unfortunates who won’t get the medical help they need in time – as the chasm between rich and poor gets even wider in Wyoming. As the list grows, the number of people supporting their cause needs to expand, too. People need to write and call the governor, and every time they see him in public, he should be asked when he’s going to start the Medicaid talks. Remind Mead the feds’ door is open, so it’s up to him.

The other thing people need to do is start kicking lawmakers who oppose Medicaid expansion out of their comfy seats, starting with the GOP primary in August and continuing in the November general election.

Every legislative candidate should be asked if he or she will vote to expand Medicaid. If they’ve already voted against it, ask them why, and if they’ve changed their minds. And if they are still proud of their votes – the ones that have condemned some of their most vulnerable constituents to poor health, continued poverty and even death – please ask them the $43 million question: “What do you have against poor people?”

— Veteran Wyoming journalist Kerry Drake is editor-in-chief of the nonprofit, online community newspaper, The Casper Citizen. He also moderates the WyPols blog.

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