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Health care

Emergency room technician Cynthia Smith prepares a room for an incoming ambulance in February 2016 at Wyoming Medical Center in Casper. A bill that would add a work requirement to Wyoming's Medicaid program is advancing in the Legislature.

CHEYENNE – A bill to create work requirements for thousands of Wyoming Medicaid recipients narrowly passed its first reading Friday in the House of Representatives after appearing bound for defeat moments earlier.

Senate File 144 failed its standing vote, which would have killed the bill. But a roll call vote taken just after succeeded 30-28.

Two more votes on the bill remain before it would move on to Gov. Mark Gordon’s desk for ratification.

The bill has faced marginal opposition on its way to the floor this session, despite little research behind the measure and the implications it could have for thousands of Wyomingites now on Medicaid. Another bill proposing work requirements for Medicaid recipients died in the House last year, after having similar success in the Senate.

A compassionate bill?

Many of those who spoke in favor of the bill said that the legislation would help to encourage “able-bodied” Medicaid recipients to re-enter the workforce by requiring them to spend a minimum of 20 hours per week in any combination of a part-time job, volunteering at a community service organization or participating in job training, school or in a drug and alcohol rehabilitation program.

“Some have said this is less a work requirement than it is work encouragement,” said Rep. Dan Laursen, R-Powell, who spoke in favor of the bill. “Taxpayers will thank us, and so will those on these programs, who benefit from the structure of this bill.”

House to take up work requirements for Medicaid

Rep. Scott Clem, R-Gillette, has lobbied for the bill throughout its course through the House. He argued the legislation affects only a small proportion – just 2,000 to 3,000 people statewide – of the state’s 60,000 Medicaid recipients enrolled each month, on average. (There were 57,000 recipients in the state in December, according to the Department of Health.)

“The number of able-bodied adults we’re targeting here is relatively small,” said Clem.

However, the phrase “able-bodied,” some argued, is ill-defined under the language of the bill, and that the burden of proof that someone was actually meeting their eligibility requirements would be difficult to produce – a real risk when the bill contains a provision to “lock out” violators from receiving Medicaid coverage for six months.

“I have real concerns about creating new bureaucratic hoops to jump through for people who are already struggling,” said Chris Merrill, executive director for the Equality State Policy Center. “If they screw up and don’t navigate the bureaucracy correctly, they’re locked out from Medicaid coverage for six months, according to the bill.”

Jason Mincer, a lobbyist for the Cancer Action Network, said this was a glaring oversight of the bill, particularly for people battling cancer or living with diabetes who, under the state’s definition, could be labeled as “able-bodied.”

“If you’re in treatment for cancer — and half the people in Wyoming with cancer go out-of-state for treatment — and you’re there for a considerable amount of time, you may not even know you need to turn in that paperwork (that’s needed for benefits),” said Mincer. “I have concern for folks who might slip through the cracks that way.”

Others questioned whether or not it was appropriate to implement such requirements when other bills intended to address the root causes of poverty – like a bill to improve job training programs at the state’s community colleges – had been killed by the Legislature in the same session.

“I have no problem training folks, but we should revive that bill we just killed so they can receive training,” said Rep. Eric Barlow, R-Gillette, who voted against the bill. “Taking someone who’s already down and pushing them further down? That’s not the community I represent.”

Wyoming Senate kills bill that would've lowered insurance premiums for 3,500 Wyomingites

Nine other states have passed work requirements for Medicaid. All but one of them, however, have voted to expand their Medicaid programs.

The Wyoming Legislature killed a bill to expand Medicaid earlier this session, after it had passed out of committee.

Behind the scenes

Before the bill was read on the House floor for the first time Friday morning, a memo opposing the bill was circulated in the House chambers by the Equality State Policy Center. The memo argued that the legislation would “unfairly target the most economically vulnerable” residents of Wyoming by creating new and unnecessary bureaucratic hurdles in the state’s Medicaid system, particularly hurting single parents with young children and those who are undergoing treatment for challenging diseases, like cancer.

“Most Medicaid recipients are already working for low wages in unstable jobs with volatile and unpredictable hours and limited leave options,” the memo said. “They use SNAP [formerly known as food stamps] and Medicaid as work supports to help them stay afloat while they’re working jobs or are between jobs. Most Medicaid enrollees lack access to other affordable health insurance, and most people who use the program are children, elderly, single parents with small children, and people with severe disabilities.”

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In general, groups like the American Cancer Society have opposed work requirements for Medicaid and, on Thursday, a lobbyist for the group contacted reporters with the Star-Tribune opposing the bill, stating that many undergoing treatment for cancer would be caught by a gap in the law that would set waiting periods between when an “able-bodied” individual on Medicaid would be removed from the program, and when they could apply for a health care plan on the federal exchanges created under the Affordable Care Act.

“Many cancer patients and survivors physically cannot work during treatment or recovery due to intense side effects and symptoms,” Noe Baker, a spokesperson for the American Cancer Society Cancer Action Network, wrote in an email. “In fact, between 40 and 85 percent of cancer patients stop working and experience absences ranging from 45 days to six months. We know that having access to health coverage is the No. 1 factor in whether someone survives a cancer diagnosis.”

Wyoming lawmakers shut down bill to expand Medicaid coverage

At the same time, a memo pushing back against the claims made by the ESPC had been introduced by David Owen, a Salt Lake City-based lobbyist who has argued in favor of welfare reforms in other statehouses. In the one-page memo, Owen argued the bill was specifically designed not to target the state’s most vulnerable – only able-bodied adults “exploiting the system” – noting the bill specifically exempts individuals under the age of 18, individuals mentally or physically unfit for employment, parents with young children (under 8 years of age, according to the bill’s text) and seniors from the work requirement.

He also argued that the claims included in the fact sheet distributed by the ESPC ignored figures from the State Department of Health that showed “70 percent of able-bodied adults on Medicaid in Wyoming aren’t working,” the letter said.

“If they had done any research on the issue to verify the false claims they are repeated, they would know that the information they included was incorrect,” the memo read. “This bill was based on actual data from the Department. This bill was based on research showing that work requirements have been successful in other welfare programs moving able-bodied adults from welfare to work. This bill was based on expert input—even the federal Centers for Medicare and Medicaid Services, after extensive review and research, is encouraging states to adopt Medicaid work requirements for able-bodied adults.”

Even facing the risk of people who need Medicaid potentially being kicked off coverage, Owen said there is ample flexibility for the department to adapt to the needs of enrollees, making sure that the bill only targets the people it is intended to target: able-bodied individuals who can work and are “taking advantage of the system” by not working.

“We’re not talking about helping everybody; we’re talking about helping some,” he said. “If you can help people transition off of dependence and get back into the workforce … I don’t know what other people’s values are, but if we helped 100 people in Wyoming do it, it’s worth it.

“It’s not a matter of hating poor people, it’s not a matter of thinking poor people are bad, it’s recognizing that sometimes, as people, all of us get trapped,” he said. “Sometimes it’s really tough to break that cycle. The Obama Administration tended to look at the fact there were 46 million people on food stamps and treated that like a victory. To me, it’s a huge defeat. If you have 46 million people on food stamps, that’s really wrong.”

Owen is currently working on behalf of the Florida-based Opportunity Solutions Project, a national organization that has lobbied groups like Congress, the U.S. Department of Agriculture and the National Economic Council on causes such as Medicaid reform – including implementing work requirements and rolling back expansion programs – food stamp reform and free market reforms to health insurance policy at the state and federal level, according to disclosure forms.

The group has recently been involved in debates about Medicaid expansion in Utah as well, lobbying state lawmakers to roll back expansion there.

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Politics Reporter

Nick Reynolds covers state politics and policy. A native of Central New York, he has spent his career covering governments big and small, and several Congressional campaigns. He graduated from the State University of New York at Brockport in 2015.

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