Medicaid expansion moves to House floor

CHEYENNE — A Wyoming legislative committee voted to move a Teton County lawmaker’s Medicaid expansion proposal to the full House of Representatives late Wednesday by a vote of 6-3. 

Considered something of a pipe dream in Wyoming politics since the establishment of the Aff ordable Care Act — and a subsequent Supreme Court decision — allowed states to expand Medicaid, Wednesday night’s vote marked a small victory for medical associations across the state as well as a bipartisan coalition of supporters who have long pushed for expansion. 

“I’ve been part of the group who’s been working on this for five years,” said Marguerite Herman of the Wyoming League of Women Voters. “I think we made a case for it five years ago, and I hope this is the year the Legislature feels ready to go.” 

Rep. Sue Wilson, R-Cheyenne, and House Majority Floor Leader Eric Barlow, R-Gillette — the two chief architects of the most successful Medicaid expansion bill to reach the House floor — voted in favor of the bill in the House’s Labor, Health and Social Services Committee. They were joined by Reps. Mike Yin, D-Jackson; Pat Sweeney, R-Casper; JoAnn Dayton-Selman, D-Rock Springs; and Jim Roscoe, I-Wilson, who is a co-sponsor of the bill. 

“No” votes included Reps. Tim Hallinan, R-Gillette; Scott Clem, R-Gillette; and Clarence Styvar, R-Cheyenne.Sponsored by Rep. Andy Schwartz, a Jackson Democrat, House Bill 244 is largely based off the 2014 Barlow-Wilson bill, which was among the more comprehensive pieces of legislation to be introduced in support of Medicaid expansion in the past. If passed into law, the bill would extend Medicaid to those making 133 percent of the federal poverty line. Within a few years, it would result in 27,000 Wyomingites enrolling in health insurance, according to state Department of Health data. 

The federal government would shoulder 90 percent of the new costs going forward. In the first two years, the state would pay $33 million, and the feds would cover $246 million more. The bill would also help cut a significant chunk out of a cited $130 million in uncompensated medical costs absorbed by the state’s care providers, whose professional organizations — including the Wyoming Hospital Association and the Wyoming Medical Society — support the bill. 

The legislation also includes work requirements — previously a nonstarter under President Barack Obama but a provision that the Trump administration has signaled it would consider — as well as an amendment added by Schwartz to avoid the “cliff” effect experienced by enrollees who may lose their eligibility if their income suddenly exceeds the federal limits — an effect that some argue could cause people to continue to remain in poverty in order to keep Medicaid coverage. 

Lawmakers have suggested in the past that they would be more open to discussing expansion if the state had a work requirement of some sort. Earlier this week, the Senate Labor Committee unanimously sponsored a bill by Baggs Republican Sen. Larry Hicks that would institute a work requirement for the state’s current Medicaid system. Last year, when a similar effort failed, Hicks said that legislators had maintained that such a work requirement would make expansion a more palatable topic of discussion. 

In arguing against that requirement last year, Laramie Democrat Sen. Chris Rothfuss said it would make more sense in the context of expansion. Rothfuss is a co-sponsor of Schwartz’s bill. 

There is also a provision in the expansion bill that allows the automatic failure of the bill should Gov. Mark Gordon — who is on the record as opposing Medicaid expansion — veto the bill upon it passing both the House and the Senate. Gordon’s predecessor, Matt Mead, initially opposed expansion but reversed course after his 2014 re-election. As he neared the end of his second term, he lamented that the Legislature and the state had left tens of millions of dollars in federal funding on the table. 

At this point, roughly midway through the legislative session, whether or not the bill reaches the House of Representatives for a vote is pure speculation. However, the influence of Barlow, who has sponsored similar legislation in the past, should certainly play a factor in its ability to reach the floor. Passage of the bill may be complicated, though, particularly on the Senate side of the legislature, which is currently considering a bill by Casper Republican Charlie Scott to study the issue before moving forward with discussions around expanding Medicaid. 

Josh Hannes, Vice President of the Wyoming Hospital Association, said in testimony to the committee that Medicaid expansion would lower the number of uninsured patients who enter the medical system through emergency rooms — the most expensive and often least efficient entry points for care — and instead put them in the offices of providers who could cover them. This would help to reduce the costs often absorbed by medical providers like hospitals, who are often left to foot the bill without compensation, he said. He noted other states have already moved forward with expansion — some, like Utah, by ballot initiative — and that no states who have moved forward with expansion have moved away.

There was some reluctance expressed by legislators like Clem, who were concerned that a potential repeal of the Affordable Care Act could potentially rip the rug out from under those Medicaid expansion would protect. Hannes answered, however, that if a repeal were to happen, Wyoming would be “exactly where we are today.” 

Indeed, the bill includes language that would end the program should the federal match drop below 90 percent or if the language within the ACA that allows for expansion is repealed or ruled unconstitutional.

Some supporters of the legislation, like the Equality State Policy Center’s Chris Merrill, speculated that the threat of a ballot initiative on the matter could compel legislators to think about the topic. According to a 2014 University of Wyoming poll, more than 56 percent of the state supports Medicaid expansion, leaving those like Merrill to wonder whether concerns over a potential ballot initiative might be weighing on the minds of legislators. 

“That totally circumvents the legislature and — speaking personally — I think it’s a less-thanideal way of making policy,” Merrill said. “I think they’re thinking of that. Without the deliberative process of elected officials, of people who understand the budget really well, and without hearing from stakeholders and agencies ... the result of a ballot initiative could be a train wreck. That’s something on their minds this time around.” 

Scott mentioned the potential for a ballot initiative for reasons why he wanted the state to study the effects and costs of expansion. Lawmakers have good reason to be cognizant of a potential ballot effort: Residents in neighboring red states Utah, Nebraska and Idaho all voted to expand Medicaid in those states in November. Voters in Montana, where the program had already been broadened, shot down a new funding proposal, leaving expansion there somewhat in limbo. 

Though Wyoming is one of the more difficult states in the country in which to get an initiative on the ballot, Merrill speculates that a campaign for Medicaid expansion would be much more organized and better funded than others in the past, making the potential for a Medicaid ballot initiative a very real possibility. 

“I think the attempts we’ve seen thus far have, in general, been done on an all-volunteer basis; there hasn’t been any money behind it,” he said. “We’re hearing talk of folks assembling real money to do a well-funded ballot initiative. We haven’t seen that yet in Wyoming.”