For the last few years Wyoming has considered taking advantage of part of the Federal Affordable Care Act which pays states to expand Medicaid services to the so called working poor. While states have some up-front costs, the federal government pays for 100 initially and 90 percent after that. In Wyoming it would pay for close to 18,000 additional low income people to get health care coverage. Despite the federal money, lawmakers have consistently refused to adopt expansion. Why? The answer is varied.
On Friday the Senate began debate on the latest version of Medicaid expansion. Prior to the debate Senator Ogden Driskill said he would vote no.
“I can tell you from where I sit it rips your heart out from both sides cause there isn’t a good decision to be made on this one because we’ve truly not been left with good choices.”
Driskill is a Republican Senator from Devils Tower. He was the only member of the Senate Health and Labor Committee to vote against the bill. Supporters say the bill will bring health care to those who cannot afford it and reduce uncompensated care to hospitals who are struggling to deal with debt. Driskill says this bill is not the solution people would like to think it is.
“I don’t think this fixes our uncompensated care at our hospitals, I don’t think it’s still gonna treat our under insured or uninsured in a really compassionate and honest way, it does little to change behaviors to do the right thing the right way.”
Driskill also thinks that despite what some in the state think, long term costs to the state will rise to the point where it will eventually become a very expensive program.
That’s the problem Casper Republican Bill Landen has with it.
“You know regardless of whether the feds pay 100% or 90 % it’s going to cost the state of Wyoming money and its going to be on-going and that’s what gives me some misgivings.”
Senator Eli Bebout scoffs at the idea that the state has given away money by not adopting expansion in the first two years of the program. Bebout contends that most of the Affordable care Act has not worked and Medicaid expansion is no exception. He says all you have to do is look at other states.
“And they are having problems with administration, they are having cost problems, you know you are not getting to the people that you were trying to get to, the private sector has been hurt. And quite frankly one of the things it was supposed to help was emergency rooms and then you go look at Oregon and instead of the emergency room visitations going down, they actually went up 15 to 20 percent.”
Bebout adds that in Wyomng the current Medicaid program rises in costs every year. He expects those costs to be greater if they expand Medicaid to a new population.
In the hallway outside the House of Representatives, Evansville Republican Kendell Kroeker echos the long term cost concerns. Kroeker shares a common view by opponents, that there is no way that the federal government with its current debt structure will continue paying states 90 percent of the program.
“And I just don’t think we can depend on those federal funds for the long term and I think we will end up setting a program up that would commit the state to money it couldn’t afford. And I don’t think we’ve even have this discussion if it weren’t for that carrot that was dangled out there by the federal government.”
But Kroeker’s opposition goes beyond that.
“I think we’ve reached the point in our society where everyone is looking for free handouts and it’s not a case of them being in a dire need and I think the people who have that dire need I think the state finds a way to take care of them and meet their needs.”
While some say adopting Medicaid Expansion is a moral issue, Senator Larry Hicks of Baggs says that true morality is to say no. That’s because the federal government cannot afford it. He says the solution to no health insurance is to help people afford it.
“Job training. Education, opportunity…work can do those things. That’s how we really give people that opportunity to move up in their social class. Just by giving people more money may make us feel good it really doesn’t solve the overall systemic problem of our society.”
Most legislators say reforming the health care system is really what’s needed. Gillette Republican Norine Kasperik has a number of ideas.
“I believe we need to talk about meaningful tort reform, I am bringing a bill to address that. I believe we need to talk about payment systems, we need to talk about real costs and what’s happening in hospitals in regards to pricing.”
Another idea is to try to find ways to help hospitals pay for their uncompensated care. This might involve money from the state. Otherwise the ideas are few and most say it’s not a good idea for Wyoming to get into the health care system. They say it’s best left to the private sector. Monday the Senate will continue its debate on whether or not to expand Medicaid.