Wyoming's Legislature has for several years rejected Medicaid expansion, despite studies indicating it would save the state money.
Now, with the state facing a major budget shortfall, Gov. Matt Mead is recommending lawmakers expand Medicaid, arguing that accepting federal money for the program will help the state weather the economic downturn.
But many of the Wyoming lawmakers who resisted expansion in the past say they are likely to continue to oppose it, even as the state looks for ways to save money.
Expansion critics contend increasing Wyoming's Medicaid rolls will cost the state more money in the long term than the temporary relief millions of federal dollars would bring to the state.
Supporters of the program disagree and note that hospitals, doctors, clinics and nursing homes would also benefit from more people possessing health coverage.
Medicaid expansion is a key component of the Affordable Care Act. In Wyoming, about 17,000 adults earn too much money to qualify for traditional Medicaid, but earn too little to obtain a subsidy on the Obamacare exchange. Yet they would qualify for Medicaid if the state opted to expand.
The federal government will pay 95 percent of the state’s costs of expansion through 2017. That match drops to 90 percent in 2020 and beyond.
Mead, a Republican, says the Legislature needs to expand Medicaid to boost the state financially at a time when revenues from coal, oil and natural gas are declining. Mead talked about expansion Tuesday when he unveiled his recommendations for the state’s two-year budget.
The governor opposed Medicaid expansion in the past. But with the U.S. Supreme Court upholding major components of the ACA, Mead said he believes health care reform will remain the law of the land.
Currently, the state is paying millions of dollars for Wyoming Department of Health programs that the feds would cover if the state expanded Medicaid, he said.
Mead wants lawmakers to pay $24 million in exception requests, which is funding that is outside of the Health Department’s standard budget. If lawmakers expanded Medicaid, the federal dollars would cover all the department’s exception requests, plus nearly $10 million of the department’s standard budget, Mead said.
“If we do not expand Medicaid, we would have to spend from the General Fund,” he said.
Lawmakers convene in February to adopt a budget that will fund state government operations. Many remain opposed to expansion, despite the governor's recommendation.
Rep. David Northrup, R-Powell, has opposed expansion in the past. He said Obamacare could change with a new president, and that could affect the amount of money the federal government is willing to pay states for expansion.
The Legislature will adjourn months before the November presidential election, which means Northrop will vote no on expansion.
“I’m a no vote until we find out that it’s going to be funded, that the feds are going to do their part,” he said.
Casper’s Sen. Jim Anderson, a Republican, also opposed expansion in the past. He will continue to oppose it, he said.
In states that have expanded Medicaid, more people qualified for Medicaid than previous estimates anticipated. As a result, health care is costing those states more money, even with the feds picking up a large chunk of the costs, he said.
“I see what the governor’s doing with budget on that, but I still am opposed to Medicaid expansion,” he said.
Rep. Kendell Kroeker, R-Evansville, also remains in opposition for the same reason.
“The more I see other states do it, the more I’m glad Wyoming didn’t do it,” he said. “And the more I think it would be a mistake to expand Medicaid.”
But Brianna Jones, executive director of the watchdog group, Equality State Policy Center, pointed to April research by the Robert Wood Johnson Foundation that found states are saving money through expansion. The Equality State Policy Center supports expansion.
The foundation found savings and revenues by the end of this year are expected to exceed $1.8 billion total in eight states that have expanded Medicaid: Arkansas, Colorado, Kentucky, Michigan, New Mexico, Oregon, Washington and West Virginia.
Researchers concluded every expansion state should see financial benefits when more people have health coverage.
“We know that states that expand Medicaid realize significant budgetary benefits. Their experience -- reduced spending on the uninsured and programs for high-cost patients -- will also be realized in Wyoming,” Jones said.
Sen. Chris Rothfuss, the Democratic leader in the Senate, appreciates how Mead demonstrated the savings to the state’s budget if Wyoming opted for expansion.
“The Legislature is going to have to opt to spend $33 million additional dollars to not expand Medicaid,” he said.
Mead estimated that if the state expanded Medicaid, hospitals, clinics, doctors and nursing homes would be treating patients who now lack coverage. Hospitals also write off millions in uncompensated care each year. With expansion, the providers will receive an estimated $268 million in additional federal money.
“This is a tremendous amount of money in terms of economic development for the state,” Rothfuss said. “This is a quarter of a billion dollars for the state.”
Rep. Eric Barlow, R-Gillette, has voted for and against expansion in past sessions, depending on the proposals. He says he’s open to listening to Mead’s Medicaid pitch in detail.
Barlow noted that some Health Department programs that help low-income people would have to continue -- and be paid for -- while the state waits for Medicaid expansion to kick in.
“We can’t leave a gap between shutting those down and Medicaid expansion,” he said.
Sen. Cale Case, R-Lander, voted for expansion last year. He doesn’t think anyone should be billed $10,000 for treatment because they lack coverage.
“That happens to people all the time,” he said.
Still, Case is doubtful that Mead’s arguments will win over the majority of lawmakers.
“I don’t think that’ll be a successful effort,” he said. “I don’t think the state’s fiscal problems increase the likelihood of Medicaid expansion.”