Gov. Matt Mead again said no to accepting the Medicaid expansion available from the federal government in his Nov. 29 budget message. And again we say, “Fine, but what’s your solution?
The people most interested in the answer could be the more than 16,000 Wyoming residents who do not receive health insurance because the state rejected Medicaid expansion. It was a requirement of the Affordable Care Act until the U.S. Supreme Court ruled that states could choose whether or not to accept expanding coverage. The affected people are those without children earning up to 138 percent of the federal poverty level.
Wyoming hospitals also keenly follow the debate.
When Wyoming first rejected the Medicaid expansion earlier this year, the Wyoming Hospital Association President Dan Perdue said, “We’re concerned that a lot of people who don’t have insurance will continue to use the emergency rooms for their primary care.”
He said that people without insurance often go to an emergency room even for minor medical issues because they have no other choice. Uncompensated hospital care cost $200 million in Wyoming in 2011, Perdue said.
Hospital administrators have been frustrated that they must deal with the expected financial fallout from the state’s choice to refuse federal money for a population whose care they often cover.
After the 2013 legislative session, Mead said he wasn’t shutting the door on future decisions regarding taking the expanded Medicaid money. He asked the Wyoming Department of Health to investigate alternatives to Medicaid expansion. State health officials had predicted that the rejected Medicaid expansion could have saved Wyoming $47 million over seven years.
But in his budget message, Mead apparently decided against the report’s recommendations, although he complimented Health Department Director Tom Forslund “for his part in bringing forward thorough material on Wyoming’s options.”
But next the governor wrote, “However, with regard to the optional Medicaid Expansion, I cannot, now, in good conscience, recommend the State sign on to a plan that is both poor in design and poor in implementation.”
Simply, the governor joins a number of legislators in putting their mistrust of the federal government first in their decision-making. The federal government has agreed to pay for all the costs of the expansion group until 2017. At that point, states would be responsible for paying 5 percent of the costs and then would have to pay 6 percent in 2018, 7 percent in 2019 and 10 percent in 2020 and beyond.
But Sen. Charles Scott (R-Natrona) expresses why Wyoming legislators would turn down this money that would help the poorest citizens when he says, “The key issue is whether you can trust the federal government to keep its promises. We don’t.”
Plenty of other Republican governors have made the same choice in refusing the Medicaid expansion money. But GOP governors in New Jersey, Arizona, Michigan, New Mexico, North Dakota, Ohio and Nevada made the opposite decision. As Republican Gov. Chris Christie of New Jersey said in announcing his decision to take the money, “It’s simple. We are putting people first.” He added that it was also a pragmatic choice because “expanding Medicaid will ensure New Jersey taxpayers will see their dollars maximized.”
In refusing the money for Wyoming, Mead said Wyoming will “look for opportunities and to continue to monitor” how the ACA is working.
We think that it’s essential to go beyond looking and monitoring to proposing concrete solutions if the state wants to turn down federal-financed health care assistance for more than 16,000 people.