Gov. Matt Mead says he will again push state lawmakers to expand Medicaid to 17,000 low-income adults by including the Obamacare program in his budget requests.
Past attempts to expand Medicaid have failed in Wyoming's Republican-dominated Legislature. But with revenue from oil, natural gas and coal on the decline, tens of millions in Medicaid dollars could help the state, Mead said.
“I think it’s appropriate for members of (the Joint Appropriations Committee) and the Legislature, as a whole, to take a look at that and see if we want to again forgo that money during these tough budget times,” Mead said Wednesday in an interview in Riverton.
The Wyoming Department of Health is currently obtaining from the federal government an estimate of the amount of money the state would receive if it expanded Medicaid -- a key component of the Affordable Care Act. It could total $60 million or $70 million, Mead said.
As part of the regular state budgeting process, Mead gives lawmakers his budget requests by Dec. 1. He said he will submit two versions of the Health Department budget -- one with and one without expansion.
His spokesman, David Bush, later said that by submitting two versions of the budget the governor "wants the Legislature to be able to see the contrast and the effect expansion may have on the budget.”
Mead is taking a different approach to expansion this year.
Medicaid expansion has traditionally first been reviewed by another legislative committee -- Labor, Health and Social Services -- where bills have faced stiff opposition in past years.
Last legislative session, for instance, the committee replaced a governor-supported Medicaid expansion bill with a plan used in Indiana. In 2014, committee members preferred a plan from Arkansas over a Health Department-recommended Medicaid expansion proposal.
“It’s a health issue,” Mead said. “But let’s get to the nuts and bolts in terms of our revenue picture.”
Health Committee Chairman Sen. Charlie Scott, R-Casper, has resisted attempts to expand Medicaid, calling it European-style socialism last year. A message left Thursday at his home was not returned.
Mead’s stance on the Affordable Care Act has changed since he was sworn in as governor in 2011.
Four days after taking office, Mead announced Wyoming would join other states in a lawsuit challenging the ACA. The Supreme Court largely held up the law as constitutional, as it did in June in another legal challenge.
Mead opposed expansion early in his first term. But by early 2013, he had asked the Department of Health to study alternative models for expanding Medicaid. Still, in August of that year, he said he didn’t have a stance on expansion. He wanted information about Medicaid available so he could work with the Legislature on a decision on whether or not to expand.
Mead said he still opposes the ACA. His support of expansion is about being practical, he said.
“The legal challenge has been done and I think the legal challenges were appropriate,” he said. “But now it’s with us. And it is so intertwined with so many people across the country. We’re hopeful it can get better, but I just don’t see much chance that this is going to be wiped off the books when a new president comes in. So now I have to say, 'What do we do for our citizens who don’t have health care? What do we do for our budget? What do we do that is the best for Wyoming citizens?' understanding it is the law of the land.”
The Joint Appropriations Committee will be the first to review the Department of Health budget recommendations that include federal expansion dollars. Members of the JAC had differing opinions about whether they would support Mead.
Senate Vice President Drew Perkins, R-Casper, said he’s willing to listen to the proposal. But he’s opposed expansion in the past. Perkins believes it takes people off private insurance and puts them on the government program, although Obamacare backers say people eligible for Medicaid expansion couldn't afford to buy health coverage.
While the federal government will cover 100 percent of the costs of expansion in Wyoming through 2016, the match declines to 90 percent in 2020 and beyond. States pick up the remainder.
Perkins doesn’t believe the federal government will have the money over the long term to continue to pay for expansion. Under that scenario, Wyoming would be left with an expensive dilemma of whether to continue the program with state money, he said.
“I don’t think that, when you have a revenue crunch, you start doing things that aren’t good for the state in the long run,” he said. “You have to take a longer-term view of it.”
Sen. John Hastert, D-Green River, says the state should have expanded Medicaid years ago. He thinks Mead would be bolder if he submitted a Health Department budget with only expansion money in it.
“If he feels so strongly about it, he should submit one budget and have Medicaid expansion in it and go with it,” he said. “The Appropriations Committee would do what they do anyway.”
Rep. Cathy Connolly, D-Laramie, also thinks that expanding Medicaid will greatly help people who need health coverage.
“In general as an appropriator, I will be very, very interested in having that conversation,” she said.
Rep. Mike Greear, R-Worland, said he doesn’t like how Mead plans to put such a large, controversial request in a budget bill. Lawmakers are trying to decrease what’s known as “legislating by budget,” or inserting major policy into the budget bill, he said.
“Medicaid expansion needs to be voted on separately, by itself,” he said.
Greear has opposed expansion in the past. Since he hasn’t seen Mead’s request, he doesn’t know how he’d vote. He has previously voted to advance bills out of committee that he opposes because he wants the entire House to consider them, he said.
Sen. Jeff Wasserburger, R-Gillette, voted against expansion last year. But he will now support it, he said.
“Two lawsuits have declared the ACA constitutional,” he said. “It is the law of the land. So essentially what’s happening is the citizens of Wyoming are paying taxes to the federal government, and we’re not taking in return the money we could receive. We fought the good fight, we lost. We need to accept it.”
Wasserburger said smaller hospitals throughout the state are financially struggling to absorb the cost of treating people without insurance -- some of whom would qualify for Medicaid expansion.
He also is concerned about revenues from mineral production.
“The governor’s right,” he said. “We’re going to need the money.”