A local lawmaker is taking another swing at Medicaid expansion, which would grant health care to a swath of low-income Wyomingites but has fallen on deaf ears in the Wyoming Legislature in recent years.
Rep. Andy Schwartz’s flagship House Bill 244, introduced Thursday, would extend Medicaid eligibility to anyone earning up to 133 percent of the federal poverty level. Medicaid advocates like former Democratic gubernatorial candidate Mary Throne have called the move a “no-brainer” way to ensure coverage for more residents.
“People should have insurance,” Schwartz said. “That’s the bottom line.”
The bill also includes language to allow a work or volunteer requirement (with exceptions) for eligibility and the creation of a tailored mental health and substance abuse program.
Schwartz’s co-sponsors include fellow Teton County Rep. Jim Roscoe, an independent, and Sen. Chris Rothfuss, D-Albany, as well as two Republicans: Sen. R.J. Kost, R-Big Horn/Park, and Rep. Dan Zwonitzer, R-Laramie.
Zwonitzer described himself as “one of the few Republican proponents for Medicaid expansion since the first attempt four years ago” and is hopeful the bill will make it out of committee to the floor this year.
“I’ve consistently been aware that we have a gap between what insurance covers and the federal poverty rate,” he said. “It’s a strong bill both on moral grounds and on fiscal grounds. ... It’s always made sense to me. I know I’m not the most popular Republican by continuing to push it, but I just think it’s a good deal.”
Previous estimates have indicated the amount of federal reimbursement for Medicaid expansion in Wyoming would be more than $100 million per year. Opponents say that even though the federal government is footing the bill now for the nation’s public health insurance program for people with low incomes, the state could end up paying later, something Zwonitzer disputes.
“Historically that’s a sticking point, that we don’t trust the federal government,” he said. “We’ve got to trust it a little bit.”
A handful of other bills introduced thus far touch on Medicaid. One would make midwife services covered under Medicaid; another would establish a Medicaid control unit within the office of the attorney general and create criminal penalties related to the program. A third, Senate File 146, might be more palatable to conservative legislators because it proposes a Medicaid expansion study, not expansion itself.
“We’ve been doing that,” Schwartz said. “The Department of Health has reams of information. It’s time to do it.”
The Wyoming Department of Health has estimated that if the state expanded Medicaid, roughly 20,000 to 30,000 people could qualify for care. But since Wyoming has not expanded Medicaid, parents in a family of three have an eligibility limit of 55 percent of the poverty level. For an individual, the limit is zero percent of the poverty level.
Following a June 2012 Supreme Court decision, states faced a decision about whether to adopt Medicaid expansion under the Affordable Care Act, extending coverage to most low-income adults to 138 percent of the federal poverty level. There is no deadline for states to implement the expansion.
Wyoming is one of 14 states that haven’t expanded Medicaid, according to the Kaiser Family Foundation, and is now nearly surrounded by states that have expanded or are expanding Medicaid. In November’s election, voters in the traditionally conservative states of Idaho, Utah and Nebraska approved ballot initiatives to expand the health insurance program to an estimated 363,000 low-income people. Schwartz and co-sponsor Zwonitzer said they would like to see the Wyoming Legislature act before it comes to a ballot vote.
“I really think it’s in Wyoming’s best interest to accept Medicaid expansion in a way that works for us so that we can continue to evolve over time with the federal government,” Zwonitzer said. “In Idaho, obviously the citizens were strongly in favor of it, but they’ve tied the hands of their Legislature. I believe if we put it to a vote in this state it would pass, and it’s better to have the flexibility of the Legislature to respond to emerging concerns and fiscal constraints as time goes on.”
Even if Schwartz’s bill manages to pass the House and then the Senate, Wyoming’s new governor, Mark Gordon, doesn’t support Medicaid expansion. After his election, Gordon told reporters: “I just don’t think it’s necessarily the right solution for Wyoming at this time.” His office confirmed Thursday that his stance hasn’t changed.
Co-sponsor Rothfuss, who has “probably run a Medicaid expansion bill every year since Medicaid has been a topic,” said he’s tired of excuses.
“The Wyoming Legislature has failed utterly to provide any alternatives to Medicaid expansion despite several years to work on the problem,” he said. “With each passing year, more and more states begin to participate, and the excuses not to participate keep falling one after another. The idea that the ACA will be repealed, the idea that the feds will stop providing over 90 percent in matching funds, the idea that this is bad for red states and rural states, all of those concepts are proving inaccurate. And we know that our hospitals and our medical associations continue to strongly advocate for expansion, so we’re hopeful that this year the [legislature] will revisit the concept and have a more favorable outlook.”
Schwartz said he’s taking the bill “one step at a time.”
“It’s unlikely to pass, but I think there’s more and more recognition that we have to do something,” he said. “If it doesn’t happen this year, I’ll run it again next year.”