Medicaid expansion has been a hot-button issue in Wyoming for years. Activists are pushing harder than ever to make Wyoming the next expansion state. And while expansion is popular among Wyoming residents, the state legislature has consistently opposed it. If it fails this year, activists say they'll make their voice heard at the polls and make another push in 2023.
Gina Smith is a direct support professional who works with the elderly in Cheyenne. She would like to be a certified nursing assistant (CNA), but her dreams were put on hold last Halloween when she wound up in the hospital, in need of a heart catheter.
Smith was not making enough to afford her own insurance or to qualify for the premium tax credit to help subsidize her insurance, but she was making too much for traditional Medicaid.
"I have three children," Smith said. "My husband is disabled, he's on social security. And we still don't qualify for Medicaid in Wyoming. So I have fallen in the gap."
The Medicaid gap exists in Wyoming and the eleven other states that have chosen not to expand Medicaid. Expanding Medicaid would bring up the ceiling for who is eligible, thereby closing "the gap" between making too little and making too much. Most of the people who would benefit from this are employed.
The expansion would let Smith return to the CNA program. It would also help an estimated 19,000 Wyoming residents afford preventive care, and reduce out-of-pocket expenses when they do wind up in the hospital.
"I work hard," Smith said. "I pay taxes. I don't have anything to show for it, except for a long list of medical debt and possibly filing bankruptcy."
States were given the option of expanding Medicaid following the passage of the Affordable Care Act. Most did, but that option has been repeatedly shot down in deep-red Wyoming.
But the zeitgeist is changing.
On Monday, about 200 people gathered in front of the State Capitol Building. As legislators began their biennial budget session, the crowd on the steps outside rallied for Medicaid expansion.
The gathered crowd was an eclectic mix, from uninsured mothers to business owners and even religious leaders.
A new poll says a majority of Wyoming residents now support expansion. That includes Republican Casper Representative Pat Sweeney, who changed his mind following a presentation in a legislative committee in 2019.
"It appeared to me that we needed to move forward," he said. "The light switch really clicked on for me at that point, so I started advocating."
Some of his Republican colleagues worry that the cost to Wyoming will exceed the $10-12 million the state is expected to contribute.
But he's convinced that Medicaid expansion will save hospitals money by reducing indigent care while helping working mothers like Gina Smith immensely.
"I believe it's a good thing for the citizens of Wyoming," Sweeney said. "We know that it will provide for additional health needs and care. I just see the benefits for our people."
Healthy Wyomingis the coalition of nonprofits that planned the rally Monday. Last year, the coalition hosted vigils for those who died because of a lack of health insurance. And ahead of this session, it got signatures from business owners across the state calling on legislators to expand Medicaid.
Dewey Gallegos co-owns the Pedal House, a bike shop in Laramie. He was one of the business leaders who signed his name to the letter.
"It seems like it's something that should be a human right - to be able to be healthy and happy and be able to just live your life without worrying about some accident causing bankruptcy for you and your family," he said.
Some small business owners have come around on the idea of Medicaid expansion, as the cost of health insurance keeps rising and many find themselves unable to offer it to their employees.
But for Gallegos, his support stems from a more foundational conviction.
"All the countries that have free healthcare for their population, it just seems like a more intelligent design," he said. "If someone is sick and there's someone who can help them, then that should just be available no matter what they get paid or who they are. It just seems like it should be a human right, not something we do for profit."
The Wyoming Department of Health issued a new reportlast month saying that other states that have expanded saw increased use of medical treatments, including preventive care, improved mental health, stronger financial stability and even a decrease in mortality.
Smith said expansion would greatly improve her life.
"If I was to get Medicaid, I think I would be more prosperous," she said. "It would financially alleviate some burden off of me. I'd have more health checkups, I would be able to get a cardiologist on board that I need. It would be a good thing. It would be a very good thing."
For the time being, Smith is trying to avoid as much stress as possible. Without ready access to medical care, avoiding stress is important for her heart. But that's difficult when you're a mother of three children working two jobs.
"I thought everybody had the right to live," she said. "That's a human right. But they're making it very difficult. Very, very difficult."
