GUEST OPINION: Expand Medicaid in Wyoming

By on February 3, 2015

Jackson Hole, Wyoming – Groups supporting Wyoming’s acceptance of federal funds to add adults to Medicaid coverage have amassed a long list of strong reasons that are both economic and compassionate.

But that may not be enough for some Wyoming legislators who are being pressed by emotional arguments, including animus toward “Obamacare,” anger about government aid to poor people and a suspicion of all things federal. Even when lawmakers are convinced that Medicaid expansion would help their low-income constituents, they are getting pressure from state and national groups to vote “no.”

It’s been three years since the U.S. Supreme Court ruled that expanding Medicaid to include low-wage adults without children is optional, and the governor turned the decision over to the Wyoming Legislature. The option comes with incentives of 100 percent federal funding through 2016 and then a step-down to 90 percent by 2020.

This year, the vehicle for doing this is Senate File 129 – Medicaid SHARE. That stands for Wyoming’s Strategy for Health, Access, Responsibility and Employment. (You can read an explanation of SHARE at www.health.wyo.gov. The link is on the home page.) Arguments during a long initial debate in the Senate have sounded those three emotion-laden reasons mentioned above.

Here are facts presented by supporters of Medicaid expansion in Wyoming:

• “Medicaid expansion” means making health care coverage available to a new group – low-wage adults without dependent children. About 17,600 could be expected to apply.

• Medicaid in Wyoming has nearly universal participation by health care providers, and it has a low administrative cost of about 4 percent.

• Low-income adults are too poor to get subsidies in the private insurance market, they don’t get employer-sponsored insurance and they can’t afford to buy it themselves. They fall into a coverage “gap” with no recourse except the hospital emergency room. (Low-income means earning up to 138 percent of the Federal Poverty Level, or less than $16,000 a year.)

• Wyoming hospitals report losing $232 million last year on unpaid bills.

• Medicaid expansion funding comes from a tax collected nationally. Revenue raised in Wyoming provides no benefit for Wyoming people, if we don’t expand.

• While we delay expansion, we turn our back on millions of dollars that could be helping people who need health care and hospitals that need to be paid for their services. (Watch a “Medicaid counter” tick off $310,653 a day at equalitystate.org.)

• Seventy two percent of people in the Medicaid expansion group are working at low-wage jobs.

• The Wyoming Department of Health figures it can pay the state’s 10 percent share out of savings created by Medicaid expansion.

• WDH estimates Wyoming’s state match would be $43.2 million through 2020, leveraging about $9 for every $1 we spend.

• Millions of dollars in health care spending will stabilize hospitals and the whole health care sector in Wyoming, in addition to the economic opportunity created by spending in communities across the state and by a healthy workforce.

Against that are messages that this is “Obamacare.” (It’s not.) Or opponents doubt the ability of people who haven’t had insurance to use healthcare wisely and responsibly. Or they predict the federal government will renege, and the Wyoming Legislature will lack the courage to take back this expanded eligibility. Or they point to the high cost of current Medicaid recipients, who are elderly, blind and disabled and not the same kind of group.

A message from Jeff Hyman of the Jackson Hole Tea Party is typical, misquoting that supporters claim “Medicaid expansion allows us to stop paying into other states’ health care systems.” He concludes, without explanation, Medicaid expansion is “bad for Wyoming, it is bad for our healthcare system and it is bad for current Medicaid recipients.”

Legislative debate on SF129 includes an “escape clause” to drop participation if the federal share drops below 90 percent. Legislators also are considering features that will incent responsible health care and penalize wasteful use of emergency departments. Maybe that will provide the assurances lawmakers need to expand Medicaid coverage for this “gap” population.

Even the most aggressive and emotional opponents to Medicaid expansion acknowledge the status quo is disastrous, yet they offer no alternatives.

The Wyoming Coalition for Medicaid Solutions is the main group working on Medicaid expansion. Members include the Wyoming Hospital Association, Wyoming Primary Care Association, AARP, League of Women Voters, Wyoming Medical Society and American Heart Association.

The Wyoming Business Alliance is actively supporting Medicaid expansion this session, which brings a powerful argument for how health care for thousands of uninsured workers is good for Wyoming and its economy. The Wyoming County Commissioners Association also is supporting Medicaid expansion as an important factor for the fiscal stability of county-supported hospitals.

Supporters hope factual arguments – and a conservative and prudent expansion plan – will win the vote and get health care coverage for 17,600 of our low-income neighbors.

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