EDITORIAL: No matter the reason, time for Medicaid expansion is now

Wyoming Tribune-Eagle (Cheyenne, WY)

Nov. 10--Even if it's not for the "right" reason, momentum seems to be shifting in the Wyoming Legislature toward finally passing some type of Medicaid expansion bill.

It's about time.

For at least the past five years, state lawmakers have found one reason after another to reject hundreds of millions of dollars from the federal government to extend health-care coverage to the poorest residents:

"We don't trust that the Affordable Care Act, or Obamacare, will remain the law of the land."

"We don't want people to get used to having coverage, only to have to take it away again if the federal subsidy dries up."

"These low-income folks are just being lazy. If they really wanted to, they could get a job and pay for their own health insurance."

While all of this hand-wringing and excuse making continued year after year, approximately 20,000 Wyoming residents at a time have gone without health insurance. Instead of visiting a general practitioner early on, their health has to deteriorate until they have no choice but to make a trip to the hospital emergency department.

That immoral reality has left hospitals to absorb around $120 million a year in uncompensated care because a stubborn group of elected officials chose to play politics instead of doing the right thing.

But that may be changing. The first test will come Tuesday morning at Laramie County Community College. Starting at 8 a.m., members of the Joint Revenue Interim Committee will debate whether to sponsor a bill that, as currently written, would authorize Gov. Mark Gordon, Department of Health Director Mike Ceballos and Insurance Commissioner Jeff Rude to work with federal agencies to "explore options for the expansion of Medicaid eligibility."

If the collaboration "reveals viable and fiscally advantageous options," an expansion plan can be developed. Unfortunately, the bill still requires the Legislature to review and approve the plan, even if that means calling a special session to do so. Since special sessions are rarely held in Wyoming, that means even if this bill is approved early next year, it likely would be mid-2021 before expansion would go into effect.

But at least the conversation continues. And this time, even some of those who have consistently opposed extending Medicaid eligibility are getting on board with the idea. Why? Because the state's financial situation continues to worsen, and they're desperate to find new sources of revenue.

That's not the best reason to expand Medicaid, of course. But let's set aside the justice perspective and instead focus on the potential economic impact of finally doing what 36 other states -- including our conservative neighbors in Montana, Nebraska, Idaho and Utah -- have opted to do or are in the process of doing.

Raising the threshold for qualification to the 138% of the federal poverty level would cost Wyoming an estimated $33 million in the first two years. But the feds, which continue to pay 90% under the ACA, will kick in more than $250 million to cover the rest.

But wait, you say, that's still a budget impact for a state that already faces an estimated $185 million budget shortfall over the next three years. No wonder we haven't done this yet.

True, it will take an initial investment (which doesn't have to come from the general fund, by the way, but if the lodging tax passes, the money saved could be used to fund Medicaid expansion). But the anticipated economic benefits are vastly larger. States that have implemented Medicaid expansion have seen their uncompensated care costs roughly cut in half, according to the nonpartisan Center on Budget and Policy Priorities. In Wyoming, that would mean an extra $60 million a year that could go back into our communities.

Then there's the extra spending that comes with more people having health-care coverage. Montana, for example, has seen $350 million to $400 million in new spending in its economy each year since adopting Medicaid expansion in 2016, according to a report from the University of Montana.

Medicaid expansion helps create new health-care sector jobs, and health-care providers have more money to spend in their communities. That translates into more tax revenue and more opportunities for economic growth. Not to mention places that offer better, more affordable medical services tend to attract more people.

One sticking point in the general session earlier this year was over whether a work requirement should be attached to Medicaid expansion. For those not exempt due to age or medical condition, there would have been a requirement to work, volunteer, attend school or participate in a job training program for at least 20 hours a week.

Although we don't like to see more hoops for low-income residents to jump through, we can live with it if it gets coverage to more people who need it.

Wyoming lawmakers should be embarrassed by their failure to expand Medicaid coverage up to this point. Most won't be, of course, but that doesn't matter. All that matters is extending coverage to as many Wyoming residents as soon as possible. Here's hoping 2020 is the year they finally get it done -- no matter the reason.

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