The Wyoming State Legislature convenes on Monday.
This is the place where I remind readers that Wyoming’s Senate has just six women out of 30 senators and the House only eight women out of 60 representatives. The 12 men (and zero women) on the Joint Appropriations Committee who determine the state’s budget are nearly equivalent to the 14 women in both the upper and lower chambers.
In case you’re thinking that equal representation isn’t essential to equitable policy, let me take a moment to disabuse you of that notion. Legislatures with more women consistently advance more policy decisions that benefit women, families and communities. Which, in turn, are good for local businesses and economies.
There are generally two types of policies that are overlooked in majority male legislatures: Policies that are seen as “gender neutral,” so the discussion centers on an imaginary citizen who is male. Examples include Medicaid expansion and minimum wage. Policies that are explicitly about women, like pay equity and the pink tax, generally are dismissed as frivolous or imaginary.
Because the Legislature is set to consider a committee bill on Medicaid expansion, this column examines how Medicaid expansion disproportionately affects women. Next month I’ll look at policies that are disregarded because they are specifically about women.
First the basics: Wyoming is one of only 13 states that has not expanded Medicaid. Kansas is the most recent expansion state, having brokered a bipartisan deal in January.
Those who have made Medicaid expansion — an issue of basic health, access to healthcare, and core Wyoming values — into a partisan issue would like you to believe that expanding Medicaid will bankrupt the state and that expansion has had negative implications for other states.
Yet since 2012:
• In a paper published by the National Bureau of Economic Research, economists found that death rates dropped in the states that expanded Medicaid, saving 19,200 lives over four years.
• A 2018 study from the University of Colorado found that states that expanded Medicaid saw hospital closure rates decrease.
• Studies have found that Medicaid expansion has helped people obtain or maintain work. And a study that specifically compared expansion and non-expansion states found the program reduced the poverty rate by almost a percentage point.
What we discuss less is the outsize effect of Medicaid expansion on women. Yet here is what the Wyoming Department of Health estimates about women and Medicaid expansion in Wyoming:
• A group of younger, predominantly female enrollees, [will make] up an estimated 36% of the total population.
• About two-thirds of enrollees will have incomes below 100% federal poverty level, or FPL; the other third will be between 100% to 138% FPL.
• Approximately 56% will have previously been uninsured.
• Older individuals in the expansion will be less likely to be employed than younger enrollees.
The Kaiser Family Foundation estimates 13% of all Wyoming women are uninsured. The reason? Cost.
“Affordability of coverage and care continues to be a significant concern for many women,” according to a foundation fact sheet on women’s health insurance policy. “The leading reason why uninsured (non-elderly) adults report that they haven’t obtained coverage is that it is too expensive.”
The inability to afford insurance coverage goes hand-in-hand with the fact that 75% of all minimum wage workers in Wyoming are women. (Minimum wage is another “gender neutral” policy area where women are the primary group affected yet almost never discussed by elected officials.)
The rate of Wyoming women working in low- and minimum-wage jobs is almost three times that of Wyoming men. Which is why the Wyoming Department of Health estimates that women between the ages of 18 and 29 who work full-time would be nearly three times as likely as their male counterparts to enroll in an expanded Medicaid program.
Health coverage matters for women. Uninsured women often have inadequate access to care, receive a lower standard of care when they are in the health system and have poorer outcomes. Women with health coverage are more likely to obtain needed preventive, primary and specialty care services, and have better access to new advances in women’s health.
Add to this the recent research out of Georgetown University’s Health Policy Institute that demonstrates Medicaid expansion is good for new moms because it increases their use of postpartum care, which is specifically associated with lower maternal morbidity and mortality.
Medicaid expansion is beneficial for all people. But it seems to confer particular benefits on new moms and younger women in Wyoming who work full-time in low-wage jobs. We might not talk about this — or them — as much as we should. But they deserve our support.