Medicaid expansion

Screenshot, Wyoming Legislature

After finally passing the Wyoming House of Representatives this year, a legislative committee has set the stage for Medicaid Expansion to be debated during an upcoming special session of the legislature. Stefan Johansson is the Deputy Director of the Wyoming Department of Health. He explains to Wyoming Public Radio's Bob Beck why the issue has momentum this year.

provenzaforwyoming.com

The Wyoming Legislature's 2021 general session is wrapping up. It's been the first session for freshman Democrat Representative Karlee Provenza. Provenza represents Laramie and ran on her background with community organizing and her experience with criminal justice reform.

Wyoming Public Radio's Catherine Wheeler spoke with her about how her first session has gone.

Jimmy Emerson, DVM via CC BY-NC-ND 2.0

Once again, the Wyoming legislature has rejected Medicaid expansion. Despite testimony providing overwhelming support for the measure and some federal aid to encourage more states to adopt the program, the Senate Labor and Health Committee voted three to two against the bill.

Bob Beck

The Wyoming House of Representatives has given final approval to a bill that would expand Medicaid in the state and provide health care coverage to an estimated 25,000 people.

American Heart Association

The Wyoming Legislature will be addressing a number of issues surrounding health care when it convenes next week. One will be Medicaid expansion and another is the return of an effort to give optometrists the ability to perform certain eye surgeries.

Some believe that should be left up to Ophthalmologists who specialize in such things. Doctor David Wheeler is the President of the Wyoming Medical Society joins Bob Beck to discuss views on those bills.

ideastations.org

The Wyoming Legislature will take another crack at Medicaid expansion. The legislature's Joint Revenue Committee approved a proposed bill that will ask Gov. Mark Gordon to explore options for Wyoming's participation in expansion and determine whether it's financially viable for the state. Eventually lawmakers would need to approve a Wyoming plan.

In the 2018 midterms voters in the deeply conservative states of Idaho and Utah went against their Republican controlled legislatures on healthcare. They both voted yes on initiatives to expand Medicaid under Obama’s Affordable Care Act.

But it didn’t end there. Republicans in both Capitols pushed back.


Since the legislature might once again be considering Medicaid expansion for those who can't afford insurance, the Senate is considering a bill that would pay for a study.

American Cancer Society

According to a report by the American Cancer Society’s Action Network, Wyoming could do much more to reduce cancer rates. Each year, the report evaluates ten different policy areas that deal with prevention and quality of treatment in each state. Out of those ten areas, Wyoming only did well in two—oral chemotherapy fairness and funding for the state tobacco prevention program.

Wyoming Medical Center Facebook

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.

Survey Gauges Public Opinion On State Budget

Jun 6, 2016
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 / Wyoming Public Radio

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. 

Ivinson Memorial Hospital

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.

DHHS

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.

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