Wyoming leaders will likely wait until after the presidential election before deciding whether to expand Medicaid coverage to roughly 30,000 low-income residents.

Last month’s U.S. Supreme Court ruling gave states the power to opt out of Medicaid expansion – one of the key provisions of the federal health care law – without losing all of their federal funding for the program. Gov. Matt Mead wants to consult with state lawmakers before the state chooses whether to participate, his spokesman said this week.

The Legislature doesn’t meet again until January, meaning a decision won’t come until after the election. Republican candidate Mitt Romney has promised to repeal the health reform law if he’s elected president.

Mead opposes the Affordable Care Act, calling it bad policy for both the state and the country. But unlike several Republican governors, he didn’t immediately rush to reject the expansion in the aftermath of the June 28 Supreme Court ruling.

“The decision to maintain current level of Medicaid coverage or expand it will be made after Gov. Mead meets with legislators, health care providers and others,” Mead spokesman Renney MacKay wrote in an email. “The magnitude of this decision needs this office and legislators weighing in.”

Mean has questions about how the expansion would be paid for and whether it is sustainable. He, along with other Republican governors, has asked federal officials to provide more details about the ACA’s requirements in light of the Supreme Court ruling.

“Once those answers are compiled, Gov. Mead will work with legislators to go over the state’s options and make changes to any laws, if necessary,” MacKay wrote.

Pragmatic approach

In an interview before the Supreme Court’s ruling, Mead said the Affordable Care Act lacked the flexibility to work in Wyoming. But he’s also taken a pragmatic approach to the law, writing last year in support of pursuing components of a state-run health insurance exchange to prevent a federal takeover of the program.

Mead has also said Wyoming must develop a viable alternative to federal health reform, rather than simply opposing the law.

Medicaid provides health coverage for the poor and medically needy. About 90,000 people in Wyoming are enrolled in the program, which is funded jointly by the state and federal government.

The expansion would add more than 30,000 newly eligible people to Wyoming’s Medicaid program by 2016, according to preliminary estimates provided by the Wyoming Department of Health.

About 80 percent of those enrollees would be childless adults, who are ineligible for the program based on income alone. The remaining would be parents who make less than 133 percent of the federal poverty level – or about $30,000 a year for a family of four.

The federal government is supposed to cover the entire cost of covering people who are newly eligible for the program. By 2020, states are expected to provide 10 percent of that funding.

Even without the expansion, Medicaid is expected to cost Wyoming more than a half billion dollars over the current, two-year fiscal cycle. During the past decade, the state’s Medicaid budget has grown more than six-fold, according to the governor’s office.

Divided opinions

Some state lawmakers are skeptical the federal government will pay the entire cost of the expansion. One of them is Sen. Charlie Scott, R-Casper, who chairs the Senate Labor, Health and Social Services Committee.

“I believe the feds are going to keep that promise like I believe in the tooth fairy,” he said. “I don’t see how they can afford it.”

Scott helped develop a state program to cover low-income residents who can’t afford to buy their own health coverage. But he doesn’t believe expanding Medicaid is the best way to cover the uninsured. He calls the program inefficient and says it creates incentives for people to use expensive, emergency room services for basic care.

The lawmaker predicts there will be little support for expanding the program, either from his colleagues in the Legislature or from Mead.

“It is just a very high cost way to solve that problem,” he said. “There are better ways to cover low income (residents.) It’s hard to think of a worse way.”

Health reform advocates say opting out of the program would mean thousands in the state will remain uninsured. And when they inevitably seek care, most likely in expensive emergency rooms, those costs will shift to people with health coverage, noted Barb Rea of the Wyoming group Consumer Advocates: Project Healthcare.

“The people with nowhere to go will still have nowhere to go,” she said. “And we won’t be able to get a handle on eliminating this cost shifting.”

There’s a public misconception that Medicaid already covers all of the state’s low-income residents, Rea said. In reality, many poor adults don’t qualify for coverage. Expanding the program would help address the issue.

“We think it is a very important piece of the Affordable Care Act and we hope our leadership understands it is a piece of a bigger picture that will help,” she said.

Contact Joshua Wolfson at 307-266-0582 or at josh.wolfson@trib.com. Visit http://trib.com/news/opinion/blogs/wolfjammies to read his blog. Follow him on Twitter @joshwolfson.

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