CHEYENNE — The state Senate defeated a measure to expand Medicaid to 20,000 low-income Wyomingites on Friday afternoon, delivering the final blow to the Obamacare provision this legislative session.
The amendment to the two-year state spending bill failed with 10 senators in favor of it and 20 opposed. No budget amendment appeared in the House, as lawmakers who supported Medicaid expansion said they didn’t attempt it because the opposition was even stiffer.
This is the fourth consecutive year the Legislature has rejected Medicaid expansion. At least 32 states have adopted the program.
Gov. Matt Mead’s office estimated it would bring $268 million to the state at a time when revenues are down and some hospitals are struggling to absorb costs of people who cannot pay for health care. But lawmakers in the Senate argued expansion would be endorsement of a program they ultimately believe the federal government will not be able to sustain.
Mead included expansion in his recommended budget for the Wyoming Department of Health. The Joint Appropriations Committee slashed it. Friday’s budget amendment was the last opportunity in 2016 to add it back in.
Other arguments included claims that people would move off private health insurance for Medicaid and people would retire early if they knew they would be covered by Medicaid.
The proponents for Medicaid expansion include Mead and Healthy Wyoming, a coalition of 37 business, health care and religious groups. Healthy Wyoming hosted a pro-Medicaid rally, called Wyomingites across the state and recorded their comments on expansion, paid for a radio ad, organized and advertised online, directly lobbied lawmakers, encouraged individual Wyomingites to call lawmakers, recruited groups to support the effort and penned newspaper op-eds.
They said they will continue to fight for Medicaid expansion.
Sen. Charlie Scott argued most passionately against expansion.
“What you’ve done is create a system that tends to hold people in bondage,” the Casper Republican and chairman of the Labor, Health and Social Services Committee said. “Bondage, Mr. (Senate) President. It’s a welfare bureaucracy of the health department.”
He said hospitals and doctors would order more expensive tests and perform more expensive procedures to maximize the money they could get from Medicaid, which reimburses at lower rates than private insurance. He said research shows people’s health doesn’t meaningfully improve under Medicaid. He said many of the people — he believes about half — who would qualify for expansion currently pay for private insurance. If they canceled their policies, that would hurt insurance.
The knowledge that they can get Medicaid will entice people to retire early.
“I can retire three years before I get to Medicare,” he said.
Sen. Chris Rothfuss, the Democratic leader in the Senate, argued against what Scott was referencing, saying by some measures, the health care of Medicaid recipients had improved.
Rothfuss, of Laramie, disputed Scott’s numbers of people who have health insurance. He said the Legislature is as responsible for the 20,000 without health insurance as it is for the construction industry and the oil sector.
A single adult could earn up to $16,243 a year and qualify for Medicaid, or $312 a week, a minimum-wage income.
Some of the Medicaid expansion population may not have jobs. Others are working poor, he said.
“But isolating that small group that we’re unhappy with neglects the group where we know just needs our assistance, they’ve fallen on hard times.”
That includes recently unemployed energy workers, he said.
The measure before lawmakers said Medicaid expansion would be cut if the feds began to pay the state less for Medicaid. It only committed Wyoming to expansion for two years.
But Sen. Dan Dockstader, R-Afton, said he didn’t want to expand Medicaid because it would be hard to cut. This year lawmakers have received numerous emails from across the state from residents who are begging them not to cut various programs.
“If we venture down this road, wouldn’t we be simply in the same situation?” he asked.
State revenues are down due to the sluggish oil, natural gas and coal industries. In a news conference earlier Friday, Republican leadership said the Legislature will ultimately adopt a budget that will have cuts in most state agencies and will borrow from the state’s rainy day fund.
Minutes after the budget amendment failed, an alternative amendment that would also have expanded Medicaid was also defeated.
In a statement, Mead said he was disappointed it failed. Mead originally opposed expansion but now supports it as the Supreme Court has upheld major provisions of the Affordable Care Act.
“We will not provide health care coverage for 20,000 Wyoming citizens,” he said. “Wyoming’s hospitals continue to struggle with the burden of uncompensated care. Millions of federal tax dollars paid by Wyoming people will continue to flow to other states.”
Members of Healthy Wyoming said they will continue to meet and advocate for expansion. They hope new lawmakers following this year’s election may be more receptive.
Brianna Jones, executive director of the Equality State Policy Center, said she doesn’t think the beliefs of the Legislature mirror those of average Wyomingites.
Influential donors to political campaigns may have swayed lawmakers in opposition, she said.
“The diverse coalition that you can see shows the broad base of support,” she said. “To be honest, I think one of the things that‘s causing our legislators to dig in their heels is fear of the election booth.”
The federal government is currently reimbursing 100 percent of states’ costs for expansion. That reimbursement begins to decrease later this year. It incrementally decreases through 2020 and beyond, when it is 90 percent.
However, Eric Boley of the Wyoming Hospital Association said Wyoming may still have a chance of getting full federal reimbursement.
“The president’s budget proposal is to extend 100 percent of coverage for the first three years to whichever states enter into the program,” he said.
Jason Mincer, of the American Cancer Society Cancer Action Network, said Medicaid expansion has life-and-death consequences. Medicaid covers tests that low-income people can’t afford out-of-pocket.
“They can’t get screenings and they can’t get affordable treatment,” he said.