Medicaid expansion bill wins final House approval

CHEYENNE — In an unprecedented vote, the Wyoming House of Representatives gave its final support Wednesday to a bill authorizing the expansion of Medicaid coverage to an estimated 24,000 low-income residents in the state, marking a level of support among lawmakers that has not been seen since the program was first offered to the state nearly a decade ago.

House Bill 162, which won approval from the body by a narrow 32-28 vote, would direct state officials to pursue a plan to expand Medicaid coverage to Wyoming residents whose income is at or below 138 percent of the federal poverty level ($17,774 for an individual; $36,570 for a family of four). Medicaid expansion would cover approximately 24,000 residents in its first two years of implementation, with people under the age of 35 making up roughly half of those who would be newly eligible, according to recent estimates from the Wyoming Department of Health.

Proponents of Medicaid expansion have advocated for the proposal with added urgency this year, largely due to new federal incentives available to the 12 states that have declined to expand Medicaid over the last decade. Under the latest federal stimulus bill signed into law earlier this month, those states could gain a 5-percent boost to their traditional Medicaid matching program, which Wyoming traditionally receives at a 50-50 split and includes a far wider population than the expansion-eligible one, if they decide to opt into Medicaid expansion for their low-income residents.

During debates Monday and Wednesday, several leading lawmakers who had previously opposed Medicaid expansion spoke of their newfound support for it. While Medicaid expansion comes at a cost of $20 million per biennium to Wyoming, Rep. Steve Harshman, R-Casper, one of the longest-tenured members of the body and previous speaker of the house, told his colleagues that the new boosts to the traditional Medicaid expansion would bring the state $54 million in savings.

“So, that’s a net of $34 million (in the) general fund, and say we’re wrong and (the cost of expansion) is doubled, so now it costs $40 million,” Harshman said. “We’ve still got a net, and so that’s the idea behind this thing.”

While some lawmakers spoke against Medicaid expansion due to concerns that Wyoming would never be able to leave the program, if desired, Harshman emphasized the bill, as amended, would allow state officials to opt out if the federal match fell below 55 percent for the broader program or below 90 percent for the expansion.

House Majority Floor Leader Albert Sommers, R-Pinedale, said he had never previously voted for Medicaid expansion during his tenure in the Legislature, but he felt the time was right for Wyoming to opt into the program.

“I just keep waiting for it to get fixed,” Sommers said of the state’s health care challenges. “It hasn’t gotten fixed, and I don’t see the solution, and I’ve been listening for a long time.”

Before the vote Wednesday, Rep. Bill Fortner, R-Gillette, offered an amendment to essentially kill the bill, and he was joined by a handful of other freshman lawmakers who spoke out against the proposal for a variety of reasons. Fortner worried of the state being left “holding the bag” on Medicaid coverage if the federal government reneged on its end of the deal.

“I believe this is going to lead to more taxes as the federal government backs out of it,” Fortner said of expansion. “I think to protect the future generations, I believe that a better option would be to look at restructuring insurance policies or plans.”

Other opponents argued Medicaid expansion could create an overreliance on federal programs among Wyoming residents. Rep. Jeremy Haroldson, R-Wheatland, said if lawmakers aren’t careful, they will create a “golden handcuff that will keep and hold people in poverty.”

“In my town, we just came through a huge snowstorm, and one of the things we had to do is supplemental feed, and so, when we supplemental feed our animals, what happens if we keep supplemental feeding them even after the snow is gone? What’s going to happen? They’re going to keep coming to eat,” Haroldson said. “So, we need to be very careful that we don’t allow that to be the reality, so when we look at this concept of government-funded health care, we are going to take, and we are going to create a monster that we can’t handle, and it will continue to grow.”

Rep. Dan Laursen, R-Powell, argued Medicaid expansion “puts the most vulnerable among us at the back of the line,” but his point drew pushback from Rep. Lloyd Larsen, R-Lander, another longtime lawmaker who has had a change of heart.

“I don’t know that I’m tracking with this idea that if we expand it, the real poor are all of a sudden going to have to step to the back of the line,” Larsen said. “They’re not in line now.”

Larsen added that Medicaid expansion is meant to assist state residents who either don’t make enough to afford standard health insurance plans or can’t qualify for federal subsidies. He also emphasized that the proposal was not a new one, as lawmakers first began mulling the possibility in 2013.

“This is not something that we just come up to the saloon and jumped off our horse and went in and said, ‘Here I am,’” Larsen said. “We’ve been looking at this thing for eight years, and it has changed ... Do we know all the answers? No, but I will submit that we know a lot more of the answers now than we knew eight years ago.”

The bill’s main sponsor, Rep. John Romero-Martinez, R-Cheyenne, also spoke in favor of the proposal, urging his colleagues who previously opposed the measure to support it.

“It amazes me how willing we are in other situations to take care of, if there is just one, but in this case, we know there’s thousands, because the data is real and genuine and factual,” Romero-Martinez said.

With the 32-28 vote of approval from the House, the Medicaid expansion bill will now head to the Senate – which declined to give a hearing to an identical bill in its chamber prior to a cutoff deadline Monday – for further consideration. In conversations with reporters earlier this month, Senate leadership expressed hesitations over the proposal, arguing some of the same points brought up by opponents during House debate Wednesday.

“Expansion is really something that sounds like a good idea. It’s pretty sexy. They’re willing to give us whatever it takes to get us signed on,” Senate Majority Floor Leader Odgen Driskill, R-Devils Tower, told reporters. “It’s a Hotel California – once you’re in, I don’t think you’re getting out of it.”

House Bill 162 will need to gain three votes of approval from the Senate and the signature of Gov. Mark Gordon to become law.