Wyoming Medicaid expansion set to die in the House

CHEYENNE — While the last day for bills to come out of the Committee of the Whole in each chamber quickly approaches, it appears the sole Medicaid expansion bill will not be heard in the House of Representatives.

House Majority Floor Leader Rep. Chip Neiman, R-Hulett, told the Wyoming Tribune Eagle on Friday that he will not allow House Bill 80 on the floor for debate before the Monday deadline passes. The decision comes after more than two weeks of the legislation waiting on general file, as Neiman weighed whether he believed it was the right policy decision for the state.

He said at this point he has had too many lawmakers tell him not to move forward with the bill, because they couldn't believe the federal government would continue to keep its federal match in place. Neiman said there was a consensus it would be irresponsible to fund the program further, which could lead to potentially pulling funding from education or other areas.

The northeastern Wyoming lawmaker also voiced his concerns for the future of consistent funding in the wake of the state's reliance on extractive industries.

"Everyone's hollering carbon neutral right now," he said. "Well, you know what carbon neutral means to Wyoming? A major reduction in our ability to be able to pay our bills. So, if we're going to add on something like that, just help me understand how we're going to pay for it."

Matter of trust

This was a highly emphasized piece of his argument in opposition to the bill, and it came down to a matter of trust.

"As legislators, we need to recognize that we cannot be making promises that we don't know if we can keep, and especially when we're making promises based on what somebody else said," Neiman told the WTE. "I'm very concerned about whether or not they're willing to keep their word. I don't worry about Wyoming; Wyoming will keep its word. But when we start relying on others, we're not as certain if they'll keep their word. That's where the problem is."

He said there was no one coming to him with long-term solutions for the funding, even as they expressed support for HB 80 and the need for more health care options in the state. When asked whether he believed it was the responsibility of fellow lawmakers or constituents to present policy options for funding, he said it came down to those asking for the coverage.

Neiman wasn't sure how much residents were willing to risk tax restructuring if the federal government failed to follow through on its promise, such as paying income taxes, or additional property and sales taxes to offset the added expense. It was these questions plaguing his decision for movement on the bill.

"I would say it needs to be the same people that want the item," he said. "It's no different than let's say, okay, you want a new vehicle? How are you going to pay for it?"

Although the Wyoming Department of Health projected an initial biennial appropriation of $22 million for the expansion, and $177 million in federal funding, he said it would only grow with time and require further maintenance of effort.

Medicaid postpartum coverage

Neiman had a similar perspective when it came to House Bill 4, another piece of legislation he has been holding back for weeks. The bill would temporarily extend Medicaid coverage for postpartum mothers up to a year after giving birth until 2027, because the current standard is two months.

"I struggle sometimes to wonder exactly how much it's necessary and how much they need it," he said. "And I've been told by multiple legislators there's like 10 or 12 other services that they can dip into right now that provide the services for mental health and some of the longer term, after 60-day care. But I think that's something that Wyoming can do."

Not only was he uncomfortable with taking more money out of the general fund for the extension, he didn't want to provide a program, only to later take it away.

Despite his wariness when it came to the bill, he said he has had many lawmakers reach out and ask him to bring it to the floor. Neiman said if he were to agree to allowing a debate, it would take place on Monday.

His openness to HB 4 was backed Friday evening when Rep. Steve Harshman, R-Casper, withdrew his supplemental budget amendment on third reading related to the issue. Harshman's amendment would have done the same thing as HB 4, but he said he was assured by House leadership it would see the light of day come next week.

Another chance for Medicaid expansion was not as welcome. Sen. Cale Case, R-Lander, made a plea to the Senate on second reading of the supplemental government appropriations bill to pass an amendment expanding the program. He was met with resistance, and it died — leaving no other opportunities in the 2023 general session to end a decade-long fight.

Health care advocacy

Both Medicaid expansion and postpartum coverage extensions have been supported widely by the public, and advocacy efforts have been led by Healthy Wyoming.

Healthy Wyoming Director Ana Marchese told the WTE she was disappointed with Neiman's final decision to refuse to allow HB 80 on the floor. She said the organization is always concerned when legislators refuse to even have a discussion after constituents show strong support for policies, as was revealed in an American Cancer Society Cancer Action Network poll that showed 66% of Republicans wanted Medicaid expansion.

She said the Legislature owes constituents an opportunity for open debate, and there would be consequences for it not passing.

"Lack of expansion will mean that roughly 19,000 low-income Wyomingites won't have access to affordable health care," she said. "This translates into higher uncompensated costs for our rural hospitals, which greatly increases the likelihood of closure."

Marchese wasn't the only stakeholder rooting for both HB 80 and HB 4.

Wyoming Women's Foundation Director Rebekah Hazelton and policy associate Marissa Carpio saw the merits in the legislation for improving maternal health in the state and ensuring women have access to health care. She said the two issues often intertwine as there are far fewer mothers without health insurance in states that have expanded Medicaid and support young women working.

Hazelton and Carpio were especially involved in developing HB 4, which was sponsored by the Joint Labor, Health and Social Services Committee in response to an interim topic.

"One of the biggest things that we've seen is the damage of insurance turnover on new mothers," Carpio said. "So, in the Department of Health's presentation over the summer, we found that almost one in five women lose insurance completely after three months, which is very damaging for a person that still is dealing with pregnancy complications, or just trying to get back healthy, go back to work and take care of their kids."

Hazelton added it is important to help mothers after their babies are born as much as possible, because it leads to successful and supported children.

"The other program that's often pointed to as an insurance benefit or option for women that are coming off the pregnant women Medicaid program is Pregnant by Choice, and that's also known as the family planning waiver," said Hazelton. "That is not comprehensive health care. That covers some reproductive health and contraception costs, but, for instance, doesn't cover mental health services, doesn't cover if your appendix burst or something like that — just general health issues."

Although Medicaid expansion is not an option to better support women this year, they are hopeful for HB 4 in the upcoming week. Marchese advocated for the bill, too, and said Healthy Wyoming is optimistic that lawmakers will join the governor and support postpartum care extension in the state.

Leadership's responsibility

It will come down to the scheduling of the bills on the Monday deadline by Neiman, who said he recognized the reality of the decisions he makes. He was overwhelmed with emotion as the fourth week of the general session came to the end, and spoke candidly about his responsibility as both a lawmaker and leader.

"I have to take everything into account," he said. "It's really easy to give people whatever they want. That's the easy road."

He said he derived no pleasure from denying anyone what they desire, and it breaks his heart when people are struggling. Neiman said he doesn't understand their situation or fully comprehend what residents are going through because he's not in their shoes.

"But the same people that would ask for me to have empathy," he said, "I would ask for them to have a little empathy for somebody that is having to try to figure out how to make this work for everybody."

The long-term future of the state continues to be his focus, he said, adding he struggles to watch legislators that are willing to spend money away from what people need right now and on appropriations he deems unnecessary. He wants legislators to be responsible and consider the consequences of their actions.

He said to look at Montana post-Medicaid expansion and evaluate its spending on the program. Neiman said the Legislature should be proactive about learning from others' mistakes and that he has never been someone to run straight ahead and hope for the best. He feels charged with a responsibility to make sure constituents aren't hurt in the process.

That was the reason for his decision this year, but it doesn't mean the end.

"We will try again next year. The Healthy Wyoming coalition will continue to advocate for Medicaid expansion and postpartum expansion until all low-income Wyomingites have access to affordable health care," said director Marchese. "It may have been 10 years, but we're not tired, and we're not giving up."