Guest column by Kerry Drake
Originally published at WyoFile on February 12, 2013
— Facts, common sense, what’s good for the people — they all fly out the window when some conservative Wyoming politicians are determined to show how much they distrust the federal government.
It’s happened many times before, but never to the absurd level it did when Gov. Matt Mead and 22 state senators killed Medicaid expansion in Wyoming this session.
No matter how one looks at the issue, they blew it — far worse than most people realize.
On a fiscal level, the state could have saved an estimated $47 million over the next six years, according to a Wyoming Department of Health study. By not committing to a full expansion of Medicaid, Wyoming will have to spend nearly $80 million more than it should have.
That isn’t just fiscal ineptitude, it’s legislative malpractice.
At a time when state agencies are dealing with budget cuts and officials have called for fiscal responsibility, killing the program’s expansion was an insane decision. It was the culmination of a string of blatantly stupid moves to show how much disdain Wyoming has for the feds and the Affordable Care Act, known as Obamacare.
After several years of study, the Wyoming Health Care Commission concluded that expanding Medicaid was the best way to cover all low-income adults and families in the state.
In addition to increasing the number of people with comprehensive health coverage, the move would reduce costs in several health-related areas, including the tab hospitals are stuck with when the poor are treated in emergency rooms and can’t pay their bills.
Like every other recommendation the commission made, the Legislature ignored it. When Obamacare expanded Medicaid, Mead led the charge to fight the new law in the courts. When the U.S. Supreme Court affirmed its constitutionality, the justices said states could decide to opt out of the expansion.
Given that small window of opportunity to make another costly decision, Mead and a strong majority of lawmakers did not waste a moment to jump through it.
“Let’s decide what we want and make the pitch to the federal government,” Mead said in his State of the State address. “In other words, let us try within the law that is upon us to find the best deal, the best fit for Wyoming. To do nothing puts the full brunt of the ACA upon us — everything is dictated by the federal government — without an opportunity to tailor the law to our needs.”
Despite the rhetoric that Wyoming can find a better way than Obamacare, so far the state’s only attempt to design a program of its own was “Healthy Frontiers,” a pilot project designed to help a limited number of the state’s working poor receive health care coverage. But legislators pulled the plug while the program was in its infancy because too few residents signed up. There apparently is no “Wyoming way,” or at least none that anyone cares to identify.
Full Medicaid expansion would allow about 18,000 newly eligible adults into the program, with the feds picking up 100 percent of the initial costs, and no less than 90 percent after three years.
Not good enough, said Mead and the Senate, while offering no alternatives. What if the federal government reneges on its commitment?
That’s never happened in the history of the program, of course. And even if it did, theMedicaid expansion bill sponsored by Sen. John Hastert, D-Green River, allows the state to cancel the expansion any time the feds failed to cover at least 90 percent of the costs.
But why let facts keep us from showing how much our state hates the federal government?
Wyoming can only hope for the day it is led by a chief executive who has the wisdom to put aside such anti-Washington nonsense and do the right thing. A governor like Jan Brewer of Arizona.
Did I just write that? Am I talking about the same Jan Brewer who backed the “your papers, please” law in her state to harass minorities? Who lied about her father dying while fighting Nazis? The one whose claims that drug dealers were decapitating people in the desert were patently false?
I am indeed. While Brewer railed against Obamacare just as much as Mead did after the law was passed, even she knows a great deal when she sees one.
“My concerns about the Affordable Care Act are well-known,” Brewer explained. “But it is the law of the land. With this expansion, Arizona can leverage nearly $8 billion in federal funds over four years, save or protect thousands of quality jobs and protect our critical rural and safety-net hospitals.”
Several other states have dropped their opposition — including Nevada, North Dakota and New Mexico. But not Wyoming.
State legislators delayed studying Medicaid expansion until after the Supreme Court’s ruling, then until after the election, because the act would be repealed by President Mitt Romney. Anyone seen him lately?
Mead said he couldn’t get any answers about the program’s implementation from the U.S. Department of Health and Human Services, but other governors were satisfied by the federal response, or at least feel informed enough to move forward with Medicaid expansion.
Last July, Mead wrote that he has “grave concerns” about the financial impact of expanding Medicaid. Without additional information, he added, the expansion appears to “only add to the unsustainable federal debt while taking away states’ prerogative to make the best decisions for our citizens.”
But in U.S. Health Secretary Kathleen Sebelius’ earlier letter to governors who objected to Medicaid expansion, she stressed that states have the “flexibility to design the benefit package for the individuals covered.”
As for Mead’s fiscal concerns, his state’s own Department of Health issued a report last November that concluded Wyoming will actually save nearly $50 million by using federal funds to expand Medicaid.
Historically, Wyoming has never turned down much of that wicked federal money it has used to build its highway system, public schools, higher education, and enhance the infrastructure of cities and towns. Two years ago it denied the extension of unemployment benefits, but that was just a political statement that punished our jobless residents.
The Wyoming Medical Society and Wyoming Hospital Association (WHA) both supported Hastert’s bill. Dan Perdue, president of the WHA, noted Wyoming hospitals now write off a staggering $200 million per year in uncompensated care, which strains the resources of emergency rooms and increases the costs of those who can afford to pay. Medicaid expansion, he said, could substantially reduce the amount of uncompensated care.
Some uninsured residents are now unemployable due to chronic medical conditions that could be cured, but require tests or procedures that are either too expensive or unavailable where they live. These aren’t people who are trying to game the system to obtain benefits they haven’t earned, but simply residents who need help to become healthy, working citizens.
Some conservative legislators who faced primary challenges from the extreme right no doubt jumped on the anti-D.C. bandwagon with more vigor than normal. They can keep their promise to do everything possible to push back Obamacare, but still agree to expand Medicaid next year when faced with no other alternative.
But there’s nothing to guarantee that the same generous funding provisions the federal government offered states this year will return when the Legislature meets again in 2014. Moreover, if lawmakers are still unwilling to expand Medicaid then, it will be Wyoming’s working poor who suffer from acute health problems who will be shut out from coverage for yet another year.
Sen. John Schiffer, one of four Republican senators who supported expansion, couldn’t convince most of his colleagues to join him. But he had an excellent argument.
“Nobody has come up with a better system,” he said. “You can call it antiquated. You can call it expensive. You can call it whatever you want. It’s better than anything out there, because there aren’t any proposals out there.”
The Legislature has appropriated $100,00 for a study of Wyoming’s Medicaid program, with the goal to see if there are more cost-effective ways to use state and federal money to provide health care coverage for more people.
Yes, let’s keep searching for that elusive Wyoming solution to our health care problems.
Unfortunately, while the governor and lawmakers study the issue to death, it’s real people who are suffering and even dying because those in charge stubbornly refuse to accept a federal answer that may actually work.
Click here to read WyoFile’s complete coverage of the Medicaid expansion debate.
— Kerry Drake has 37 years of journalism experience at Wyoming’s two largest daily newspapers. He lives in Casper.
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