Improving health care in Wyoming is one of the state’s biggest challenges as it strives for a future of economic prosperity.
This board has made its position clear in the past that accepting federal Medicaid expansion is the best route forward. Not to say it’s a magic pill that will solve all of our health-care related issues, but we think it’s a step in the right direction. A bill to that end now moving its way through the Legislature is not likely to pass, but there is another piece of legislation related to the matter that has our attention.
Several Republican lawmakers are pushing a bill that would study Medicaid expansion. Those lawmakers, who have in the past opposed expansion, now propose putting $230,000 toward a study of Medicaid expansion. Given the status of the measure’s sponsors, it seems certain it will pass.
It undoubtedly comes as a result of our neighboring states that have had Medicaid expansion put to the ballot. In 2018, voters in Nebraska, Utah and Idaho – certainly not liberal strongholds — approved ballot measures to expand Medicaid coverage. While it would be more difficult for such a measure to end up on the ballot in Wyoming, it seems lawmakers who have resisted accepting the federal money are preparing for that possibility. Utah saw it pass with 53 percent of the statewide vote, the same margin was garnered in Nebraska, and more than 60 percent signed off in Idaho.
Surveys in 2014 and 2016 indicated that the majority of Wyoming voters would be in favor of accepting the federal dollars. While some Wyomingites don’t think the ACA is good federal policy, they evidently thought it was worthwhile to take the money to cover around 20,000-30,000 residents. A scientific review in 2016 found that while 41 percent of Wyoming residents supported the budget adopted in March of that year, support would have increased to 52 percent had lawmakers expanded the Medicaid program. An election year study in 2014 saw that while 70 percent of Wyomingites surveyed didn’t approve of the ACA, 56 percent approved of Medicaid expansion.
It would be close, but there’s a decent chance the measure would pass if it came to the ballot in the Cowboy State.
Lawmakers in Idaho and Utah have worked to undermine the voters’ will by doing everything they can to block the benefits of Medicaid expansion. Would it be any different if Wyoming voters approved a ballot measure to accept federal money? We doubt it; Wyoming lawmakers’ prior inaction certainly suggests that they too would resist implementing expansion by any means available.
We fear this will end up being another study that sits on the shelf and is ignored because legislators don’t like what it has to say. Tax Reform 2000, anyone. Paying hundreds of thousands of dollars for a study is pointless and a waste of money unless lawmakers now opposed to expansion are willing to have their minds changed.
Wyoming’s longest-serving lawmaker, Sen. Charles Scott of Casper, one of the leading opponents of expansion, said, “(I)f there’s enough flexibility” from the federal government, it might be worth a reconsideration of the policy. We hope the Republican supermajority in the Legislature will go along with that. If they can’t commit to doing that, they should reject the bill to study the matter.
Another bill working its way through the Legislature would impose work requirements for some Medicaid recipients. The bill now in the Legislature to expand Medicaid also includes a work requirement. Some lawmakers have indicated such a requirement could make expansion more palatable. While proponents of expansion should be willing to compromise to achieve their desired outcome, imposing work requirements is also flawed.
In order to make sure Medicaid recipients are meeting their requirements, complicated bureaucratic infrastructure would need to be established across the state. How much public money would actually be saved as the state targets an estimated 1,700 to purge from the Medicaid rolls? It seems unlikely the savings would be meaningful, and would ultimately be a symbolic gesture.
Worse, it seems more likely a move to complicate the reception of services. In Arkansas, around 10,000 people were required to report their work activities to the state. Of those, only about 1,400 satisfied the requirement, while more than 8,300 didn’t report any activity at all. In Wyoming, it’s not as if those people purged will just not seek health care; they’ll end up in emergency rooms burdening the finances of our hospitals and seeking services from nonprofits. One way or another, we’ll pay. It is an oversimplification of the circumstances of poverty to assume these estimated 1,700 people are just too lazy to do the work that would grant them affordable health care. Forcibly cutting people off from services only leads to worse lifestyles that hurt our communities.
The old arguments that Wyoming can’t rely on the federal government to own up to its fiscal share of covering Medicaid under an expansion program are tired. Those fears haven’t manifested in the states that have expanded. Bottom line, we haven’t seen a better proposal come from those opposed to the ACA and Medicaid expansion. One only needs to look at the congressional debacle of 2017 to know there’s no easy answer to providing access to affordable health care. If there’s a better solution out there that can be brought at the state or federal level, let’s see it.
If legislators are unwilling to consider the expansion option, what use is another study? We can’t know what that study will reveal, but we need to know today whether conservatives skeptical of Medicaid expansion are willing to consider it a viable option. If they can’t, they shouldn’t bother studying it.