Medicaid expansion again on Wyo. lawmakers' agenda

CHEYENNE — Lawmakers in the 67th Wyoming Legislature will decide whether to expand the state's Medicaid program eligibility in the upcoming general session.

If approved, Wyoming will be the last state in the West to do so.

The Legislature's Joint Revenue Committee voted 9-5 on Tuesday to sponsor a bill that would allow the Wyoming Department of Health director, insurance commissioner and governor to negotiate with the Centers for Medicare and Medicaid Services to obtain a state amendment. This would provide Medicaid coverage for all individuals described under the Social Security Act, unless the federal medical assistance percentage is less than a certain amount.

It is the same piece of legislation that wasn't considered for introduction in the 2022 budget session or passed in the 2021 general session. The Medical Treatment Opportunity Act was sponsored by seven state representatives from both sides of the aisle in 2021, and after passing the House for the first time, it died in the Senate.

Lawmakers have had the opportunity to expand Medicaid since 2010, when it was included as part of the Patent Protection and Affordable Care Act. The program was designed to cover all adults with an income below 138% of the federal poverty line and address the historically high uninsured rates among adults.

"The bottom line is, I think the last poll I saw was about 70% of Wyomingites support this. That should matter to us," said Sen. Wendy Schuler, R-Evanston, who previously voted against expansion in the Senate. "In fact, the last time that this came up, I kept track of my own emails, and I had about 200-plus that were supportive and about 20 that were against it."

She said if members of the Legislature are really there to serve their constituents, those voices of support should be taken into consideration.

Schuler wasn't the only Republican who was no longer against Medicaid expansion. Revenue Committee co-Chairs Sen. Cale Case, R-Lander, and Rep. Steve Harshman, R-Casper, said there was a time when they voted "no."

"I voted against this probably 10 times," Harshman said.

"As I look back, I've changed my mind. I've learned more, and I think it'd be really good for our state."

Members of the Revenue Committee heard a slew of benefits from advocates Tuesday, one of the first being Republican state Rep. Edward Buttery from Montana. He said at one point, Wyoming's northern neighbor was No. 48 in the nation in terms of income, and a large number of rural hospitals were on the verge of collapse.

Expanding Medicaid caused division among the government ranks, but Buttery said Montana has seen a positive impact since the expansion was implemented in 2016. He said it has been good for the mental, fiscal and financial health of participants, and saved the state's hospitals. There hasn't been a single rural safety net and critical access hospital closure in the state.

"We have made it sustainable. Even at the lower federal level, it's completely sustainable in the state," he said. "Overall, we performed our job. We provided a service for a large portion of our population, and we've actually made it an economic positive for the state of Montana."

Buttery said he recognized the struggles in Wyoming that Montana solved, which was echoed by Wyoming Hospital Association vice president Josh Hannes.

"If you look at the objective analysis of other expansion states, their experience is quite similar," Hannes said. "In Wyoming, as you all probably heard from me, we have about $120 million a year in uncompensated care that we deliver. The experience from other states has shown that rural hospitals – which is basically all of our hospitals – stand to benefit the most from this."

He said there are hospitals with just a full day's cash on hand. Nursing homes have been lost, and there has been a decrease in services for areas such as obstetrics and mental health.

However, hospitals and governments saving money wouldn't be the only advantage. Many said there would be a direct benefit for the Wyoming residents and their children who are suffering without access to health care. It also would create new jobs in the state.

The Rev. Robert Gerard shared his own personal experience from serving as pastor of First Presbyterian Church in Cheyenne for nearly 14 years. He said he visited around 5,000 residents in hospitals, and saw how being covered by Medicaid helped people to sustain their lives, as well as the other side of the story.

"I saw people who did not have coverage, and how they died earlier because of that, and suffered more. I would go to their houses and their trailers, and they were barely making any kind of a living," he said. "Health care would have helped some of them to live longer. They had diabetes, they had lung diseases, they had all kinds of things that went on."

Significant testimony about how Medicaid expansion could change lives was heard, but there were also concerns brought forward. Sen. Tom James, R-Rock Springs, said he believed there could be cases of fraud by residents who were not under 138% of the poverty line, while others said expansion could be a liability for the state because 10% of the cost is not paid by the federal government.

Despite these arguments, the bill was sponsored.