Medicaid expansion

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The Wyoming Medical Center in Casper has cut 58 positions to meet budget reductions due to a downturn in the local economy. The hospital says they also don’t plan to fill 57 vacancies.

Medical Center CEO Vicki Diamond said the reductions will save the organization over $7 million dollars, but cuts will not harm medical services. For example, no nurses were reduced. 

Chief Financial Officer Yvonne Wiggington said fewer people have insurance and that has led to a rise in charity care and bad debt.

University of Wyoming

As Wyoming faces tough choices about how to balance its budget, a new survey from the University of Wyoming looks at what the public would choose. 

It's the first scientific look at citizen opinion on the budget.

“Effectively we have three choices to face a budget deficit: Raise revenue, that’s increase taxes, cut services or agency budgets, or thirdly take money out of our savings account, the rainy day fund," said Rob Godby, one of the organizers of the survey. "And we were trying to figure out what combination or single action was most popular with people.”

Bob Beck

The Wyoming legislative session has come to an end and few seem to be leaving Cheyenne feeling satisfied.

One of the few people leaving with a positive feeling is Casper Representative Tim Stubson. Stubson was heavily involved in crafting the state budget and voted against such things as Medicaid expansion and voted for a number of budget cuts.  But he says when you look at the state’s finances those cuts were needed.

A bill that was touted as an alternative to Medicaid Expansion died in the House of Representatives. House members did not consider the bill on the final day to debate Senate bills for the first time. 

Senator Charles Scott has long opposed expanding Medicaid, but wanted to help a few hundred low income Wyomingites get health care services. The plan was to study and find alternatives to the lack of low income health care services in the state.

Bob Beck

Wyoming lawmakers are addressing a revenue shortfall that could reach 600 million dollars by 2018, by making some budget cuts and using some of the nearly $2 billion dollars they have in savings. But things could get worse very soon, especially since the state is losing a major source of income for school construction, which is coal. 

Bob Beck / Wyoming Public Radio

A bill that is intended to be the Wyoming’s alternative to expanding Medicaid was approved by the State Senate Monday. 

The bill is sponsored by Casper Senator Charles Scott, a longtime opponent of Medicaid expansion. If the bill passes, Scott said the legislature will design a program that will provide medical assistance to those who cannot afford health insurance.

The Senate voted 20-10 against a budget amendment that would have expanded Medicaid for two years. It would have benefited nearly 20-thousand Wyoming low-income residents who either cannot get insurance or afford it. 

Governor Matt Mead pushed hard for the expansion and even Senate Appropriations Chairman Tony Ross was a supporter, saying the 278 million dollars the state would receive would help balance the budget. That money would have been used to pay for the expansion and other health care services. 

Wyoming Governor Matt Mead told the state legislature that it needs to be proactive during these tough budget times, but not to prioritize savings over people.

During his annual State of the State message Mead expressed disappointment over a number of budget cuts made by the Joint Appropriations Committee in recent weeks.    

Governor Mead asked legislators to support Medicaid expansion in his biennial budget. That request was rejected which led to additional budget cuts. During his state of the state address he expressed concern about that.

Bob Beck

  

Legislators have been talking about reforming health care in the state for at least 25 years. Access to health care providers is difficult, finding affordable health care is a challenge, and so after another Medicaid Expansion defeat the legislature’s Health and Labor committee spent the summer trying to find ways to improve health care in the state without spending much money. 

Gillette Representative Eric Barlow said the committee crafted 17 bills that will address a wide range of issues in health care. One bill involves nurses.

Melodie Edwards

The state of Wyoming along with the Northern Arapaho and the Eastern Shoshone tribes have successfully submitted an application for a Medicaid Waiver.

If the Center for Medicaid and Medicare approves the application, the Medicaid Waiver could inject almost $17 million dollars a year into tribal health services on the Wind River Indian Reservation where there’s a severe shortage of healthcare providers.

The legislature’s Joint Appropriations Committee has rejected a request by Governor Matt Mead to include Medicaid Expansion in the state budget. 

Casper Republican Representative Tim Stubson says expanding Medicaid in the budget would remove some cost containment provisions that lawmakers included in previous legislation. He noted a study that said expansion would pull 5-thousand people out of the state’s insurance market.

Bob Beck

Wyoming Governor Matt Mead says it’s time for the state to dip into its rainy day funds to get through some lean economic times. 

Falling oil and gas prices and declining coal revenues are reducing state revenues. He says the state will need to use some of the nearly two billion dollars in savings to get through the next two year budget cycle. While the state can reduce spending, Mead says there are still a lot of needs such as funding for local governments.

Bob Beck

Earlier this year when the legislature voted down Medicaid expansion, lawmakers realized that some hospitals were struggling to make up for the fact that some people cannot afford to pay their medical bills.  So after a lot of discussion, they provided roughly three million dollars to be spread among the smaller rural hospitals. But some thought that was not enough, so two legislative committees are looking into what else can be done to help. 

Wyoming’s decision to not set up a set health care marketplace could haunt it if the United States Supreme Court rules that federal marketplaces or exchanges cannot receive federal subsidies. The King vs. Burwell case could impact close to 20 thousand Wyoming residents, especially the 17 thousand who would lose subsidies to purchase insurance. 

Wyoming lawmakers are considering working with communities to allow them to determine their own health care needs.

The Joint Labor and Health committee is trying to find ways to improve health care in the state and reduce costs to hospitals. Hospitals say the care they are required to provide to poor and uninsured patients is costing them millions.

Melodie Edwards

This year, while Wyoming lawmakers were voting down Medicaid Expansion in the state, they also approved a Medicaid Waiver for the state’s two tribes, potentially pumping some $16 million of aid into the reservation’s health system. The health crisis on the Wind River Reservation is now at critical levels, but tripling the amount that the tribe’s receive for health care could help.

In March, Northern Arapaho member Cherokee Brown’s daughter brought her a tooth. She didn’t think much about it. Kids lose teeth.

Melodie Edwards

In the recent legislative session, lawmakers approved a Medicaid Waiver for tribes on the Wind River Indian Reservation that could give the tribes federal money to expand healthcare.  But there’s still one more hurdle: approval by the Center for Medicaid Services, a federal agency.

Representative Lloyd Larsen of Lander says he expects the process to go smoothly. “We don’t expect the application process to take too long because they’re working closely with CMS.”

Bob Beck

A few weeks ago the Wyoming legislative session came to a close and Governor Matt Mead admitted that he had a number of concerns. The biggest was the failure of the legislature to pass Medicaid Expansion. The governor tells us that he knew it would be a tough sell, but it was tougher than he thought.

The Wyoming Legislative session ended today and in his closing remarks Governor Matt Mead urged lawmakers to find a solution to a number of health care problems in the state.   The legislature voted against taking more than 100 million dollars in federal money to expand Medicaid and provide health care services to 17,600  people. Mead said legislators need to find solutions.

Medicaid expansion has been defeated again. 

The Wyoming House of Representatives soundly voted down an amendment to the state supplemental budget that would have provided federally funded Medicaid services to nearly 18-thousand low income Wyomingites. 

Cheyenne Republican Sue Wilson said the people who would qualify are working, but cannot afford insurance.

Even though Medicaid Expansion was killed in the State Senate last week, Wyoming’s free clinics will continue providing primary care to the so-called “working poor.”

Sarah Gorin is the Executive Director of the Downtown Clinic in Laramie, which supported the bill.

"It’s pretty disappointing because it would have benefitted our clients," she said.

Bob Beck / Wyoming Public Media

The Wyoming Senate has killed a bill that would have provided Medicaid Services to nearly 18 thousand people.  Only 11 of the 30 Senators voted for the bill.   Riverton Republican Eli Bebout said the time was not right, but Laramie Democrat Chris Rothfuss disagreed.  He said the need for expansion is great.

“For the last three years we’ve have the lives of 17,600 folks here in Wyoming in our hands to some degree with their access to affordable health care.  And we’ve worked hard over those years to come up with the best approach for Wyoming that we could put together. “

While a Medicaid Expansion bill has its skeptics in the State Senate this week, a waiver to expand it for Native Americans is getting warmer reception.

The Joint Appropriations Committee has included a waiver in the state supplemental budget that would provide health care to some 3,500 low-income Northern Arapaho and Eastern Shoshone on the Wind River Indian Reservation. Representative Lloyd Larsen from Lander says just last year about 40,000 health care visits went uncompensated. Larsen says Wyoming has a legal obligation to pay up.

The State Senate gave initial approval to a bill that would remove binding arbitration in collective bargaining cases between cities and firefighters. That is when an arbitrator rules on a dispute and both sides must accept the decision. 

Republican Dave Kinskey, the former Mayor of Sheridan, says his community has too often been forced to live with the ruling of an arbitrator who lives out of state. 

He says non-binding arbitration would lead to quicker negotiations and return accountability to local government.

Bob Beck / Wyoming Public Radio

The Wyoming Senate gave initial approval to a Medicaid Expansion bill, but added an amendment that could keep the state plan from being adopted by the federal government. 

Riverton Republican Eli Bebout added a requirement that participants work up to 32 hours a week unless they’re disabled. The government has previously refused to consider such requirements, and Gillette Republican Michael Von Flatern called it a poison pill that hurts the bill. 

Bob Beck / Wyoming Public Media

The State Senate has started debate on legislation that expands Medicaid to more people in the state. The bill is based on the SHARE plan that was developed by the State Department of Health. It provides health care services to participants who pay into the program like typical health insurance. 

The Senate rejected a plan by Casper Republican Charles Scott to require Health Savings Accounts. Bill Sponsor Michael Von Flatern of Gillette says he supports an amendment that requires the expansion be paid for mostly with federal money.

Bob Beck

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.

The Senate Labor and Health Committee has approved a Medicaid Expansion bill on a 4 to 1 vote.

The bill models the Wyoming Department of Health’s Share plan, but also includes a Health and Wellness account that participants would use for medical co-pays. Despite the vote, the bill continues to have lukewarm support. 

Casper Republican Bill Landen voted for the bill in committee, but he may not support it on the Senate floor.

Bob Beck / Wyoming Public Media

A legislative committee considering legislation to expand Medicaid will now consider a second expansion proposal. 

This proposal is one favored by Governor Matt Mead and crafted by the Wyoming Department of Health with help from federal health officials. The so-called Share plan legislation is sponsored by Gillette Republican Michael Von Flatern and three other Republicans.

"To show those in the legislature as well as the rest of the public that the Republicans, there is actually quite a few of us that consider this the way to go, and we need to expand Medicaid.”

The Director of the Wyoming Department of Health says if the state approves Medicaid expansion it could be awhile before it gets implemented.  

Tom Forslund told the Joint Labor, Health, and Social Services Committee last night that he predicts that it wouldn’t take effect in Wyoming until January 1st of 2016. Co-Chairman Elaine Harvey said she was told that if Wyoming adopted a simple plan that it could be approved by the Spring. Forslund said a simple plan would help.

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