Every session of the Legislature begins with prayers in the House and Senate. No matter what denomination the clergy belongs to, invariably the opening prayer includes a request for the lawmakers to listen and take special care of the needs of the poor.
A few legislators’ actions show they’re heeding those words, but not many. For the past three years, the vast majority of senators and representatives have done just the opposite, going out of their way to make sure life never becomes too “easy” for the poor. They act as if people choose to live in poverty.
During that time, the Republican politicians in charge have not exercised any type of leadership on the issue of Medicaid expansion. During the last term, the House speaker and Senate president did not make passing the expansion a priority, or even an issue worthy of much discussion.
Meanwhile, Gov. Matt Mead began his first term in office strongly opposed to the Affordable Care Act (ACA) and all of its components, including Medicaid expansion. There were occasional hints from the governor that he was easing up a bit on the issue, but the bottom line is he never urged the Legislature to pass it. He said the Legislature should make the decision, and he would have to look at any bill that was approved and decide whether to sign it into law.
That’s not leadership, it’s passivity to the Nth degree. His small flip-flops on expansion were actually worse than doing nothing at all, because they offered the poor hope that was never realized, and their dream of finally getting health insurance was dashed.
When the question first came up if Wyoming would expand Medicaid so a new class of people — low-income, childless adults — would be eligible for the program, there were nearly 18,000 citizens who would have benefited. As the issue rises anew, that same number of Equality State residents still do not have access to affordable health care.
These are the working poor who fell into the Medicaid gap: eligible to be on Medicaid, if the state would approve it, and not able to get any insurance subsidies from the ACA.
The faces of the poor caught in the gap have changed, but the almost 18,000 estimate still holds true. Some, including me, were fortunate enough to get jobs, and now have insurance plans paid for by their employers. Those of us who have climbed out of the gap don’t want to leave the others behind.
Another reason the faces of the working poor have changed is because some of the people in the gap have died in the interim, including those who became casualties of Wyoming’s War on Medicaid.
There’s no way to sugarcoat this, no matter how our officials wish they could: The poor got sick and because the state decided they couldn’t obtain health care, they died.
It’s not like the state couldn’t see those fatalities coming. The Wyoming Department of Health conducted a study in 2012 that estimated 111 people will die annually if Medicaid is not expanded. If they actually cared, our legislators would have prevented that outcome.
But they didn’t.
Last year, several Republicans joined all Democratic lawmakers in finally passing a last-minute bill that allowed the state to negotiate with the feds on a waiver for a pilot program that tested a “Wyoming solution.”
That could have helped, but so far it hasn’t. Everyone acknowledges the plan developed during the talks, called SHARE, would likely be approved by the Centers for Medicare and Medicaid Service (CMS), but the committee in charge of making a recommendation chose to not even consider it.
Instead, the Joint Labor, Health and Social Services Committee approved an alternative proposal offered by its co-chairman, Sen. Charles Scott (R-Casper), with no guarantee it will be accepted by the CMS. While SHARE would require poor people to pay small premiums and co-pays they cannot afford, Scott’s plan is more punitive.
Simply known as the “Medicaid alternative,” Scott’s new bill requires the poor to make copayments and contribute to health savings accounts, which many also cannot afford. For putting what Scott calls “their own skin in the game,” the poor would get a watered-down version of Medicaid, with no services for the mentally ill or substance abusers. These are some of the people who need such help the most.
Things have changed since last year. Medicaid is suddenly a big deal for some Republicans who want an expansion plan, any plan, to pass this session. Officials aligned in this new coalition include Mead.
At a meeting last week, Scott’s committee listened to Wyoming Department of Health Director Tom Forslund outline the differences between SHARE and its alternative. I thought two things were noteworthy.
First, after the meeting appeared to be over, Forslund held onto his microphone to make one more announcement: Mead prefers the SHARE plan, but he’ll approve any plan the Legislature puts on his desk. He doesn’t want these or any other bills to compete, he just wants an expansion bill.
Second, Forslund stressed that an expansion plan that is the simplest would have the best chance of being enacted quickly. In Wyoming’s case, he said that would be traditional, real (my word) Medicaid, which a majority of states — even some Republican-led ones — have adopted. Both the SHARE plan and Scott’s bill wouldn’t be effective until Jan. 1, 2016, even if one does pass now.
For an example of a Republican governor who decided to expand Medicaid in his state, watch this video.
In the video, Gov. John Kasich of Ohio is chastised by a Tea Partier for “foolishly” expanding Medicaid. The governor’s eloquent answer, which starts at the 2-minute mark, is an incredible summation of why government needs to help the poor.
“People are healthier, they’re getting their lives back, they’re getting jobs,” he said. “We’ve been able to keep our promises to the mentally ill. Turning down [Ohio’s share of federal funds] on an ideological basis, when people could lose their lives because they get no help, doesn’t make any sense to me.”
Now that’s leadership. Kasich even managed to work in a Bible verse and note that Ronald Reagan, whom he calls “the patron saint of all conservatives,” expanded Medicaid.
Mead needs to do what should be known henceforth as “pulling a Kasich.”
Instead of sending a department head to say he’ll sign a Medicaid bill, Mead should haul the Republican legislative leadership into his office and flatly tell them Wyoming is going to end this heartless nonsense and finally expand Medicaid, pick a plan and give them their marching orders. For Pete’s sake, they’re in the same political party.
Next, Scott needs to get over his intense dislike of the poor and quit trying to win over the Tea Party legislators. Scott, the longest serving legislator in our state’s history, also needs to show leadership on what’s become the most high-profile issue this Legislature will deal with this year.
Come on, gentlemen, pull a Kasich. It won’t hurt you, it will help the poor, and it will show that people in Wyoming really do believe they are their brother’s (and sister’s) keeper.
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