Committee revives Medicaid expansion


CASPER — A bill to expand Medicaid in Wyoming has been revived by the Legislature’s Joint Revenue Committee after eight hours of testimony Tuesday.

The 9-5 vote promises the proposal will have committee sponsorship during the special session planned for July or a budget session in February, depending on when legislative leaders choose to act on the bill.

When the legislation does make it on to lawmakers’ session agenda, it will be a familiar discussion. The bill the committee has sponsored is the same that died less than two months ago.

Tuesday’s presentation should also have been familiar to lawmakers. Information shared with committee members during the eight-hour meeting was not new. Statistics presented Tuesday by the Wyoming Department of Health were available in March. Several residents who testified Tuesday were repeating remarks made during the recently concluded session. And lawmakers present Tuesday reaffirmed their previously cast votes.

Those opposed reiterated concerns expressed in March — and each year the proposal has come before lawmakers over the past decade. Those concerns included fear of “socialized medicine” and worries that promised savings wouldn’t last.

Committee members who voted against sponsoring the bill also expressed concerns about whether the federal program would force the state to support abortions and “transgender surgery,” as committee member Chuck Gray put it. The Casper Republican said in expressing his no vote: “This bill is really not in my values,” adding he was concerned if Wyoming opted in, it would not be able to back out.

Abortion became a sticking point during the debate. Currently federal law doesn’t allow Medicaid dollars to be used for elective abortions, and Wyoming law prohibits state funds from that use as well. But some opponents worried how long those provisions would remain under the current White House.

Those in favor of expansion argued the federal incentive couldn’t be ignored, and that after nearly a decade no other solutions had been advanced.

Spokespeople for the Wyoming Hospital Association and Wyoming Medical Society testified that expansion would save hospitals money on costs patients can’t — and so don’t — pay for, and that it would help recruit physicians to the state.

Wyoming lawmakers have rejected proposals to expand Medicaid to low-income adults for nearly a decade, since the Affordable Care Act introduced a process for states to do so.

Advocates hoped this year would be different. Wyoming is one of 12 states that has not expanded the federal insurance program, and the Biden administration has made it a priority to flip those states.

A stipulation in the most recent federal pandemic aid package offers a bonus to states that expand the insurance program that for Wyoming would amount to $34 million in savings over the first two years, according to health department estimates.

The savings come from an increased federal match, which promises federal dollars will cover an additional 5% of the state’s existing Medicaid costs for the next two years if states decide to expand.

That incentive won over a handful of lawmakers who had long been against expansion, including Revenue chair and former Speaker of the House Rep. Steve Harshman, R-Casper.

Harshman made several impassioned speeches on the House floor this March encouraging his colleagues to support expanding Medicaid, often focusing on the detail that many of those who would benefit from expansion are working women, largely mothers.

“I’ve always prided myself as the most pro-life speaker in the history of Wyoming,” Harshman said in March. “These are lives too.”

With help from newly won advocates in the House, including Harshman and Speaker Eric Barlow, R-Gillette, the bill passed that chamber. It was the first time the measure had made it that far.

Despite the apparent momentum, however, the bill never made it to the Senate floor. It died in a five-person committee on a 3-2 vote in front of a wide range of advocates including fellow Republican lawmakers, the Wyoming Business Council, the Cheyenne Catholic Diocese and several health care associations.

Expanding the program would cover about 24,000 uninsured residents by opening eligibility to include non-disabled adults who make under a certain income (about $8.25 an hour at 40 hours a week for an individual).

These are people who fall into a “coverage gap,” meaning they cannot afford marketplace or private insurance but don’t meet the criteria for traditional Medicaid. The health department has estimated roughly 54,000 people in the state fall into that gap, and that expanding Medicaid could cover between 14,000 to 38,000 of them, depending on how many people actually apply. The department estimates the true number would fall close to 24,000.

Lawmakers Tuesday rehashed many of the same arguments heard during the regular session but voted to give the debate another chance.

Legislative leadership will have the final say over when the issue is heard — in July or during the budget session in February.

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