That’s all from an updated study released last week by the state Department of Health. The big-picture projections are the same as those presented to lawmakers earlier this year: Expansion would likely cost the state $18 million in the first two years, while the federal government would pay $135 million. Roughly 19,000 Wyomingites would enroll in Medicaid, if it were broadened to 138 percent of the federal poverty line — about $35,500 annually for a family of four.
But the study is full of other details, all couched in caveats that they are based on assumptions, findings in other states and on studies by national groups.
One such possibility is that the costs to exchanges, the public insurance market created by the Affordable Care Act, may go down by as much as 15 percent. That isn’t to say the costs of the plan would go down; that decision would be up to the insurer. But the costs overall are projected to drop should Medicaid be expanded.
The Health Department’s study assumes that many of the people who currently enroll on the exchanges would instead automatically qualify for expanded Medicaid, taking some of the sicker people off of the exchange and making those pools stronger and cheaper for the insurer.
The report has more projections for the estimated 19,000 people who would enroll in the first two years of expansion. Fifty-six percent would have been uninsured before. Fifty percent will be employed, 38 percent will be retired or not looking for work, and 10 percent will be unemployed and actively looking for a job.
Roughly 74 percent will have at least a high school diploma; 40 percent will have some college education. The older enrollees, those over 45, will be more likely to be enrolled and not working than younger groups. Indeed, the 19 to 24 age group would have the highest number of people employed, according to the report’s projections.
Women would be more likely to enroll than men, particularly young women. Expansion may lead to a slight decrease in death for older Wyomingites, as well.
The utilization of health care services — meaning how often people go to the doctor, for instance — would increase. But because Medicaid pays less than the private insurers that many of these people would’ve previously had, revenue to providers will likely drop as a result of expansion. Provider revenue will still be in the black, according to the report.
A study quoted by the Health Department’s report found that after expansion, the use of health care increased; financial hardships decreased; depression reports decreased, though no physical health marker was statistically different. Finally, the study found no evidence that expansion affected employment.
In the upcoming session, the Legislature is perhaps more seriously looking at expansion than it has in years past. A bill that would give the governor authority to expand Medicaid was approved by the Revenue Committee in November. It will now be considered by the full Legislature, which has had little appetite for the proposal in years past.
Asked about the possibility of expansion earlier this month, Gordon told the Star-Tribune that he would give the bill, if passed by the Legislature, “a fair hearing.” He has previously opposed it.