Wyoming leaders spent 2012 hoping federal health reform would just go away. This year, they’ll have to learn to live with it.
They don’t have a choice anymore. The U.S. Supreme Court upheld most parts of the Affordable Care Act and President Barack Obama won a second term in office.
In the upcoming session, legislators must decide whether to fully comply with the law and extend Medicaid coverage to another 28,200 poor and medically needy people. They will also consider forming a group to monitor the federal insurance exchange that’s expected in Wyoming.
Gov. Matt Mead has recommended Wyoming opt out of the optional parts of Medicaid expansion. But Mead left open the possibility of changing his mind and encouraged lawmakers to weigh in on the issue.
Full Medicaid expansion could save Wyoming roughly $47 million over six years by allowing the state to spend less on other health programs, according to a Wyoming Department of Health study. The federal government promises to initially cover the entire cost of newly eligible enrollees, although the state would eventually have to contribute 10 percent.
Despite the possible savings, some lawmakers remain leery. They doubt the federal government will keep its funding promises.
“I believe that like I believe in the tooth fairy,” said Sen. Charles Scott, co-chairman of the Legislature’s Joint Labor, Health and Social Services Committee. “That’s another entitlement, and they can’t pay for the entitlements they’ve got.”
To address that concern, Health Department Director Tom Forslund floated the idea of a legislative trigger that would allow the state to opt out if the federal government reneges on its funding promises.
Health reform supporters, meanwhile, say concerns about the federal commitment are overblown.
“There is no precedent for us to think they won’t keep their end of the bargain,” said Barb Rea of the pro-health reform group Consumer Advocates: Project Healthcare. “And there is every reason to think they want this to be successful.”
Wyoming can’t entirely avoid the expansion. Officials must extend coverage to roughly 10,600 newly eligible children, as well as people who were already eligible for the program, but never enrolled.
The Legislature can choose whether to further expand Medicaid to 17,600 low-income adults. That group must be included for Wyoming to realize any savings, the Health Department study found.
Regardless of what lawmakers decide, Wyoming won’t be an active participant in another key feature of health reform — insurance exchanges — because the state missed the deadline to submit plans to the federal government. Federal officials say they will run an exchange on Wyoming’s behalf.
The Legislature still faces at least one decision related to exchanges, which are virtual marketplaces where consumers shop for insurance. Some lawmakers want to create a group to study the federal exchange and recommend whether Wyoming should eventually partner with the federal government or create its own program.
Given the outcome of the Supreme Court decision and the election, it’s time for state lawmakers to accept the Affordable Care Act as the vehicle for transforming health care, Rea said. She wants legislators to take advantage of the opportunities in the law, rather than continuing to resist.
“We’ve been trying to reform our health care system for decades and we haven’t been able to get it done because of the political nature of the beast and all the vested interests,” she said. “We can’t just keep saying, ‘It’s too hard.’”
Scott, however, remains pessimistic about the law. He predicts big spikes in insurance prices as more parts of the law go into effect.
Instead of fixing health care problems, Scott said he’ll have to focus on minimizing the harm of the federal law.
“I think it is going to be a mess and the state is going to have to come in and pick up the pieces when the mess starts affecting people,” he said.
Legislators will also consider several state-driven health care proposals. One bill would implement a series of major Medicaid reforms. Others would give the Legislature more control over Medicaid eligibility and make it easier for out-of-state companies to sell insurance in Wyoming.
The reform bill grew out of a lengthy Health Department study of ways to address escalating costs in the Medicaid program. Medicaid is expected to cost the state more than a half-billion dollars over the current, two-year budget cycle.
Older adults and people with disabilities account for about 60 percent of Medicaid costs. With that in mind, the legislation includes several reforms directed at long-term care and services for the developmentally disabled. They include tighter nursing home eligibility requirements and a greater emphasis on community-based services over high-cost residential care.
The legislation would also create new incentives for doctors and Medicaid recipients, and it directs health officials to explore hiring private organizations to manage care for some or all of the state’s Medicaid population.
The health committee has already endorsed the bill, and Scott believes it has a good chance with the full Legislature.
“As long as people don’t misunderstand what we are trying to do with managed care, I don’t see anything that is going to cause great opposition,” he said.