Watered down Medicaid expansion proposal survives in the House

by Ron Feemster
— February 21, 2014

In its last act before adjourning Friday evening, the Wyoming House of Representatives passed a budget amendment that authorizes the state to negotiate with the federal government and create a Medicaid expansion plan for Wyoming.

The plan would then be presented to the state Legislature during its regular session next year. The Legislature would decide what, if any, action might be taken to expand Medicaid in the state.

A nearly identical amendment failed in the Senate Friday morning. The amendment resembles in important ways Senate File 118, authored by Sen. Chris Rothfuss (D-Laramie). That bill survived the two-thirds hurdle to be introduced in the Senate by a vote of 21-9. But after debate, it was defeated 21-9.

Unlike Rothfuss’s bill, third reading House budget amendment 34 does not call for immediate expansion of Medicaid under the normal rules of Centers for Medicare and Medicaid Services. Taking out this provision, which has proved unpopular with many Republicans, seems to have put the amendment over the top.

Rothfuss’s bill would have offered immediate health coverage to the estimated 17,600 people too poor to buy subsidized coverage on the Affordable Care Act exchange. But it would have done so by expanding the existing Medicaid population to cover them in what is often known as “straight Medicaid expansion.”

Rep. Mary Throne (D-Cheyenne) withdrew an amendment that would have restored the first year of Medicaid expansion after Barlow’s amendment passed. With that, no proposals that could have expanded Medicaid in Wyoming this year remained alive in the state Legislature.

The state’s failure to cover its poorest residents immediately will cost Wyoming at least 15 of the 36 months of full federal subsidies for Medicaid expansion. In addition to the human costs, the state is passing up millions of dollars in federal money that would have been spent on Wyoming people who need medical care.

Gov. Matt Mead said in his State of the State address that Wyoming needs to find an alternative to Medicaid expansion, but none has emerged during the first two weeks of the budget session.

The budget amendment will go to conference committee for House Bill 1 and Senate File 1. Joint Appropriations Committee co-chairmen Sen. Eli Bebout (R-Riverton) and Rep. Steve Harshman (R-Casper) are sure to lead the committee, but the other members have not yet been chosen.

It is far from clear that any version of the House amendment can survive conference negotiations after the sharp defeat of a mirror amendment in the Senate Friday morning. But few people who have followed the rocky path of Medicaid expansion bills in Wyoming expected to see even this watered-down amendment alive two weeks into the session.

In the eyes of many advocates, it would take a miracle for the amendment to emerge unscathed from conference committee.

If that should occur, the Legislature would supplant its 2012 law forbidding any state agency or employee to take action to implement the Affordable Care Act without legislative approval. That law — which was also passed as a budget amendment in a budget session — has hamstrung the state Department of Health.

Among many other groups, the tribes on the Wind River Indian Reservation would be happy to see the department able to talk with Centers for Medicare and Medicaid Services. A bill that would have allowed the Department of Health to discuss possible Medicaid waivers for clients of Indian Health Service failed to win introduction in the House last week.

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