A Casper Republican representative has proposed a constitutional amendment to expand Medicaid, just three days after the House resoundingly killed another effort to broaden the program.
Rep. Pat Sweeney’s bill would let Wyoming’s voters decide whether to expand Medicaid to those making 138 percent of the federal poverty line, which is about $36,000 for a family of four. The bill has a tough road ahead: To successfully amend the state constitution, it would require the support of two-thirds of both the House and the Senate before it would be placed on the ballot in November.
The bill is co-sponsored by a bipartisan group of House members: Sweeney, R-Casper, is joined by fellow Republicans Landon Brown, Dan Zwonitzer, Dan Furphy and Bill Henderson. Three Democrats have also signed onto the bill: Laramie’s Cathy Connolly, Jackson’s Mike Yin and Riverton’s Andi Clifford.
Not only does the bill need two-thirds of both senators and representatives to be put on the ballot, but it’s also on a tight timeline to even get considered by lawmakers. To move forward, it has to be introduced in the House by 6 p.m. Friday. Sweeney told the Star-Tribune that he was working with leadership to ensure the bill was heard.
“Let’s see what the people really want,” the Casper businessman said. “Our representatives, I believe, fairly represent all of our constituents. But are we hearing from all of our constituents? Or are we only hearing from the most conservative voices in the state?”
In a statement, Connolly — a longtime supporter of expansion — said it was a “crucial topic for this legislative session.”
“Too many of our friends and neighbors are without insurance or underinsured,” she said. “Our hospitals are struggling and financially strapped. In addition, Medicaid expansion will bring in hundreds of millions of federal dollars to provide needed healthcare services for all our residents. We have a moral and fiscal imperative to act.”
The proposed amendment comes three days after the House overwhelmingly voted to kill a bill that would’ve let Gov. Mark Gordon study the topic; he could then decide whether to move ahead with expansion (the Legislature would’ve had veto authority). The measure had been supported by the Joint Revenue Committee late last year, a stamp of approval that had given expansion supporters guarded optimism.
But the House voted nearly two-to-one to kill that effort at the earliest hurdle, before the bill could even be debated. Sweeney said that bill was misunderstood and that it would’ve allowed the sort of “Wyoming-based solution” that many state leaders — including Gordon — have called for in place of expansion.
Messages sent to Gordon’s spokesman earlier this week have not been returned.
Under the Affordable Care Act, the federal government pays 90 percent of new costs from expansion, leaving the state the remaining 10 percent. In Wyoming, projections show the state would pay $18 million in the first two years, while the feds would kick in $136 million. In those first years, an estimated 19,000 people here would receive coverage.
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A broad group of medical-related groups had come together this session to lobby in favor of expansion. The group included the state primary care and hospital associations, as well as the Wyoming Medical Society, the AARP and the Equality State Policy Center.
But opponents — including the Wyoming Liberty Group — have said that the state shouldn’t sign up for a program that will cost it millions of dollars in a time of tight budgets. Cassie Craven, an attorney who works for the group, said the House’s rejection of the first expansion bill was a good thing.
“I think it sent the message that we can’t afford this right now, we can’t even consider it, we aren’t in the budget situation to even discuss it,” she said, adding that her group would oppose expansion even if the state wasn’t facing budget problems.
Craven added that in other states, the number of people who’ve enrolled in an expanded Medicaid program has eclipsed projections. But Health Department officials said they’ve taken those overruns into account in their latest estimates.
The supporters of expansion said the focus should’ve been on providing care to Wyoming’s lower-income populations.
“The majority of us are not particularly focused on whether our revenue is going to go up or down but whether the people we are responsible for have health care,” said Dr. David Wheeler, a Casper neurologist and the president of the state medical society.
Chris Merrill, who leads the Equality State Policy Center, called the revenue argument “a red herring” and said the Legislature’s opposition had been about priorities.
“The Legislature seems to be able to find money for the projects it likes,” he said. “A program to market coal, right, to somehow through the force of marketing bring back the coal market in general. The Legislature oftentimes finds money in the form of severance tax exemptions. The Legislature finds money for (University of Wyoming) athletics and buildings, and so they make choices all the time.”
Merrill added that Sweeney was “fired up” about expansion.
If Wyoming were to broaden the program, it would join a majority of the nation and almost all of Wyoming’s neighbors in the West. Sweeney said he feared what happened in Utah, where Medicaid was expanded after a ballot initiative. The Legislature there, he said, wasn’t ready.
“They hadn’t moved the needle,” he said. “All of a sudden it’s wide open, in my mind.”
Sweeney said he previously opposed expansion. He changed his view this year in light of projections by the Health Department that show nearly 20,000 people will receive care at the cost of $9 million annually in each of the first two years. The Health Department’s report on expansion also showed that plans purchased on the federal exchange may get cheaper.
“I believe it will be a benefit to the state’s mental health, and for the state,” he said.
Star-Tribune staff writer Nick Reynolds contributed to this report.