Despite some recent setbacks, Congress will eventually move to either replace or make serious changes to the affordable care act. Wyoming’s congressional delegation says that should help reduce insurance premiums in the state, but that may not be the case. Wyoming saw a growth in those who have insurance under the affordable care act and current congressional fixes could do more harm than good.
Towards the end of the Wyoming legislative session, a veteran lawmaker was excited about getting rid of the Affordable Care Act. Casper Senator Charles Scott is the longtime chairman of the Senate Health and Labor Committee. Scott has always favored health care reform, especially when it comes to Medicaid, but he has called the Affordable Care Act a disaster.
Scott fought for years against having the state expand Medicaid and he was hoping that reports of getting Medicaid block grants would be great for Wyoming because that would mean money with no strings attached.
“Be able to implement health savings accounts, be able to put meaningful cost controls in, stop the abuse of going to the emergency room for things that may be emergencies, there’s a whole host of things we can do.”
Sara Collins with the Commonwealth Fund said it’s not all good news. She noted that the block grants might remove coverage from those who currently qualify. That’s because the state will likely get less money. She added that proposed legislation changed how basic Medicaid is funded.
“Right now they get a match from the federal government and that grows with enrollment. Depending on how the budget cap is structured it might be possible that the state of Wyoming will have less money to help poor or disabled people get health care.”
To get the repeal and replace legislation approved, congress is negotiating with states who expanded Medicaid. Collins says had Wyoming expanded, that low-income population would have gotten to keep their coverage and the state would have been able to add work requirements and things it wanted to do. But she says there is no appetite in Congress to let states like Wyoming to expand in the future.
Gillette Representative Eric Barlow predicted as much last month.
“States that expanded Medicaid, they’re going to be in a different bargaining position than Wyoming, Wyoming chose not to. So there’s going to be a limited amount of money to go around.”
Which means Wyoming could have less flexibility with Medicaid dollars than those who expanded. Also, Barlow noted that Wyoming is a high-cost state when it comes to health care and he is not overly optimistic that getting rid of the affordable care act will change that. Blue Cross Blue Shield is the only insurance provider available in Wyoming under the federal marketplace. Wyoming’s delegation is looking forward to getting a provision into the new bill that would allow residents to buy insurance across state lines. But even State Senator Charles Scott said it won’t reduce costs.
“The insurance companies will insist on selling insurance based on the costs where you live and those are higher here in Wyoming. Because we are short physicians, because there is no competition because Medicare discriminates against Wyoming because we don’t have meaningful Tort reform.”
Another issue is that proposed legislation would do away with subsidies in favor of tax credits.
Wendy Curran with Blue Cross Blue Shield of Wyoming said that will impact state residents.
“Somewhere over 90 percent of residents who have insurance through the health insurance exchange, do receive some form of cost share reduction. That’s a pretty significant bunch of people who’ve been reliant on cost subsidies to enable them to have insurance.”
Curran admits that eliminating some mandates could reduce costs, but overall she says many in the health care community are worried that congressional action could force many in the state to give up their coverage.
“That puts a burden on hospitals, that puts a burden on costs, we have cost shifting and that ultimately puts a higher burden on us in what our premiums are.”
From a company standpoint, Curran says they are hoping that any reforms will take a while to implement so that the insurance industry can adapt. If not that will cause problems for the insurance industry and consumers.