Here’s the story of Medicaid expansion in Wyoming so far: State lawmakers couldn’t stand the idea of accepting federal money to expand Medicaid (despite the fact that everyone pays more because hospitals have to give away care to uncovered patients).
Legislators did, however, want state officials to come up with some sort of plan. They gave the task to the state Department of Health, which put in months of effort and crafted a proposal that checked all the right boxes: The SHARE plan wouldn’t cost the state anything, is OK with the feds and answers all of lawmakers’ concerns. It’s revenue-neutral for the state budget, which means it won't cost the state money. (We know, because the state checked that out.) It won the approval of Gov. Matt Mead.
Great, right? Approve that, and we’ll be all set.
If you thought that, you probably don’t live in Wyoming. What actually happened was that a committee of lawmakers focused on health voted to reject that plan and accept another one, a plan from Republican Sen. Charles Scott, R-Casper. The trouble here, aside from the rejection of what seems like a sensible, revenue-neutral plan, appears to be that Scott wasn’t totally familiar with the plan he proposed. For one thing, he wasn’t able to respond knowledgeably when others proposed amendments to it. For another, no one knows quite what this might end up costing the state.
If you’re keeping score, that means Wyoming looked a reasonable, carefully assembled proposal in the eye, chucked it and moved forward with a copy-and-paste piece of legislation from elsewhere.
The new plan, which expands Medicaid but leaves some recipients on the hook for co-payments, hasn’t been examined closely. It’s an unknown. And that’s troubling, especially in terms of cost. Is this plan revenue-neutral, or will the state end up on the hook for more than it realizes? No one knows. Financial uncertainty has been a major reason some lawmakers professed to be wary of expanding Medicaid. Now, they’ve adopted a plan that is the definition of financially uncertain.
That’s not easy to explain away, because Scott had plenty of time before the meeting to prepare. He could have more carefully vetted the legislation and given his colleagues on the Joint Labor, Health and Social Services Committee the opportunity to do so. Better, he could have asked the Department of Health to review it. None of that happened.
Instead, the committee debated the two bills, asking the same questions for hours, and moved on. Unfortunately, there were other important things sharing that agenda: workplace safety, for one, along with mental health and the state’s health care facilities. Scott’s failure to vet his own bill and see the health department’s plan for the sensible, cost-effective approach it is ended up shortchanging those priorities in a real way.
The final absurdity to the whole mess came when Republican Jim Anderson proposed an amendment that would give the Legislature, not the health department, final approval of rule-making, essentially requiring Legislative approval both before and after the legislative process. This, luckily, was seen as the unnecessary, counterproductive and possibly unconstitutional effort it was.
Unfortunately, that minor win means nothing for the state’s well-crafted plan. It remains on the cutting room floor.
We hope a legislator other than Scott picks up that plan for consideration. It deserves more respect and a wider hearing than it received.
The ones who truly deserve more respect, though, are the people who need Wyoming to get health care right. This sort of shoddy representation is embarrassing and does nothing to take care of those among us who need help most.