Without Medicaid Expansion Wyoming Lawmakers Try To Solve Health Care Needs

Apr 10, 2015

Cheyenne Regional Medical Center emergency room
Credit Bob Beck

Despite a heavy push by hospitals and businesses the Wyoming legislature once again voted down Medicaid Expansion this year.  It means the state will not receive 120-million dollars in federal funds a year to address some 17 thousand people who do not have health care coverage and it will also not help address the millions of dollars of uncompensated care faced by hospitals who are forced to treat those without insurance.  The Legislature’s Joint Health and Labor committee will spend the next several months trying to find a Wyoming solution to these issues without federal dollars. 

Wyoming Governor Matt Mead remains upset that the legislature ignored his plea to expand Medicaid.  He says turning away 120 million dollars doesn’t make sense.  The governor says now trying to spend state dollars to address health care needs makes even less sense.  He notes that health care is expensive.

“But I don’t see us doing it as a state for $50-million or $60-million and I don’t see where we are going to get $50 or $60 million dollars in perpetuity.”

Senator Charles Scott of Casper agrees with him.

“Yeah and it will have even a tougher time now that the price oil has collapsed.  You know our state revenues are down and you can’t do a large expensive program the way you could a few years ago.”

Scott co-chairs the committee that will look into the issue and he says a state plan is best for one simple reason.  The legislature has made it clear that it doesn’t support Medicaid expansion.  So his committee will spend the next several months studying everything from what to do with people who can’t get health insurance to the impacts that lack of insurance has on hospitals.

Lovell Representative Elaine Harvey is the other committee co-chairman.  As she sits outside the House chambers at the close of the legislative session she admits that Medicaid Expansion would have helped low income people in the state, but  now it’s up to the committee to find ways to make health care available and affordable.

“We do have the highest Medical Costs in the nation, so why is that and what can we do about it.”

Harvey is a fan of what are known as Wyoming Health Centers.  They are essentially clinics that provide health care coverage to low income people on a sliding fee scale.  They provide primary care and can act as a regular health care provider or what is called a medical home to low income people.  The problem is that there are only a handful of these facilities in the state and there are lots of people that don’t have access to them.  Harvey wants to see if they can fix that.

“So we are going to identify some of those gaps and see what we can do to bring health care back to primary care.”

Wyoming Primary Care Association Director Jan Cartwright oversees the centers in the state.  Obviously she believes that expanding the centers would help provide health care to more people. But she says they are costly.  And it’s surprising that some in the state would look to pay for Health Centers themselves.

“Well I do think it’s ironic that we would put forth state dollars to do all of that while it’s an easy and affordable move to just expand Medicaid and bring in all those federal dollars.”

Cartwright says Medicaid expansion would have brought more money into the state’s health care system reducing health care costs, for a simple reason. 

“Medicaid is health insurance and it does provide them the opportunity to go seek care at any provider they want to see.”

Health insurance generally keeps people out of the emergency room too.  Many hospitals are like the Cheyenne Regional Medical Center and are required to provide free charity care to low income people, it’s part of what is known as uncompensated care.  Phyllis Sherard is the Vice President of Population Health at CMC.  Part of her job is to find a solution to this problem and she says Medicaid expansion would have done a great deal, because it would have gotten people out of the emergency room and into cheaper health facilities.  A few years ago her own hospital convincing people to use a local health care center instead of the emergency room and it worked.

“We started to see a great a deal of improvement in the numbers of folks coming through our emergency room a second time, because we were connecting them with a medical home.”

Sherard admits she was surprised when she heard the legislature is now trying to solve these issues without the federal Medicaid dollars. 

Laramie Senator Chris Rothfuss, a strong supporter of Medicaid expansion, agrees.

“The concept of studying something that we’ve already studied to death is a little bit frustrating and it provides the opportunity to say that you are doing something when you are actually not.”

Rothfuss says had the legislature voted to accept the federal dollars, it could have solved the problems the committee is studying and allowed Wyoming to do some innovative things on top of that. 

Senator Charles Scott is confident the committee work will help. But he admits they will only go so far.

“It won’t achieve the objective of many of the Medicaid expansion proponents of increasing the number of people that are dependent on government health care, but many of us are not in sympathy with that objective.”

The committee will begin its work soon and plans to present some ideas to the legislature next February.