Proposals to expand Medicaid in Wyoming are effectively dead after senators voted down Senate File 129 and a House committee pulled its expansion plan from consideration Friday.
The Senate voted 19-11 against expanding health care coverage to more than 17,600 uninsured Wyomingites. Proposals to expand were met on the Senate floor with stiff opposition to federal health care policy.
Sen. Michael Von Flatern, R-Gillette, had sponsored the SHARE plan. Ideology factored heavily in Friday's vote, he said.
He said future Medicaid fights could be a bit tougher.
"The 100 percent chance is pretty well shot," Von Flatern said. "We’ll be paying a little bit more, and it will be a little bit harder to bring forward."
The federal government will pay 100 percent of Wyoming’s costs for expansion through next year. In 2017, the federal reimbursement rate drops to 95 percent.
A key part of the Affordable Care Act, Medicaid expansion provides health care to low-income people who cannot afford private insurance. Many have jobs.
Gov. Matt Mead, a Republican, opposed expansion in Wyoming for most of his first term. But this year, he urged lawmakers to approve an expansion bill, saying Wyoming can no longer afford to forgo federal funds.
"We must continue to tackle the tough issues around health care: access, costs and insurance," Mead said. "We must recognize what health care means to individuals and to our economy. While I respect different views, the fact is today we are left with working poor without coverage.
"Wyoming has fought against the ACA, and we lost. ... I look forward to the Legislature finding a meaningful way to operate within the ACA to address Wyoming's health care needs."
SF129 was heavily amended, at one time requiring personal health savings accounts.
It was also amended to require people to have jobs to receive the benefit. Skeptics doubted that the employment provision would have gained federal approval.
Sen. Leland Christensen, R-Alta, said Wyoming needs to find its own way to take care of the uninsured. He said the Affordable Care Act is not the answer.
"This is no time to abandon the Wyoming way of doing things," Christensen said. "We have options. I’m convinced we can find a better option for the people of Wyoming."
Shortly after the Senate vote, the House Labor, Health and Social Services Committee Chairwoman Rep. Elaine Harvey, R-Lovell, withdrew the House version of Medicaid expansion.
"With all of the Senate’s work, they still fundamentally believe this is not the right thing for Wyoming," Harvey said. "I could continue with the hearing. We could go through an exercise in futility, but at this point, whatever we do, it won’t pass the Senate."
Sen. Charles Scott, R-Casper, said the proposed expansion plan, based on the Wyoming Department of Health's SHARE plan, does not provide enough incentive for program participants to curb wasteful spending.
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He said the plan would lead to an increase in hospital visits but would not fix the hospitals' ongoing struggles with mounting uncompensated care debts.
Scott warned legislators not to trust the federal government.
"You know the federal government is going to back off of its promise to pay 90 percent," he said. "You know that because when you look at their finances, they’re in bad trouble across the United States."
Proponents of Medicaid expansion say it is time to stop looking at what might happen and fix the problem in the state.
"We have an obligation as the leaders of this state to find a solution to this problem," Sen. Chris Rothfuss, D-Laramie, said. "It’s not our obligation to figure out what’s going to happen five years from now."
Sen. Larry Hicks, R-Baggs, said all spending comes from taxes or debt. The federal government has crippling debt.
“This put us one step closer to economic collapse,” he said.
Still others, such as Sen. Stephan Pappas, R-Cheyenne, said the state’s hospitals, especially in rural areas, are stuck with uncompensated care. He supported the bill.
Wyoming health care advocates say they will continue their work in the interim session to bring the legislation back in the next session.
Eric Boley, president of the Wyoming Hospital Association, said legislators realized a need for action on Medicaid expansion this session.
He said hospitals around the state are stuck with hundreds of millions of dollars in uncompensated costs annually as uninsured people are treated at emergency rooms.
"The fact that we added votes this year and the amount of attention they gave this, I think they’re taking it seriously," Boley said. "I’m looking forward to coming up with something that will take care of people in the state."
Tom Forslund, director of the Wyoming Department of Health, had told lawmakers that expansion wouldn't affect the state's general fund because it would relieve pressure on other state health programs.
Chesie Lee, lobbyist for the Wyoming Association of Churches, supported Medicaid expansion.
"We've worked on this for three years now, and to think that they've not been able to come up with a way to cover the people who are in that coverage gap is extremely disappointing," Lee said. "It's not like the money's not there. It is there. It's a matter of the political will to do it."
Von Flatern said the discussion will continue in coming sessions.
The Associated Press contributed to this report.