Medicaid Expansion: Some messages need to be delivered in person
— January 14, 2014
I did something last Thursday that I had never done in my 38 years as a journalist. I’ve been to hundreds of legislative committee meetings, but always to observe and take notes. This time I sat at a table in front of 12 Wyoming lawmakers and told them why they need to expand Medicaid.
As a columnist and editor, I’m used to giving legislators and others unsolicited advice, so that wasn’t new. But this was the first time I did it in public, with an audience, and I knew most members of the panel didn’t want to hear what I had driven to Cheyenne to say to them in person.
Others who came to speak were heartfelt but skeptical, already convinced that whatever points they had to make would fall on deaf ears. And why not? The Republican-controlled House, along with Republican Gov. Matt Mead, killed Medicaid expansion last year, refusing to take $50 million in federal funds to provide health care to about 16,000 low-income adults without children as dependents.
Nothing changed in the past year except more people would now be eligible for Medicaid – 17,600 — and the lawmakers’ obsession with hating the Affordable Care Act (ACA), or Obamacare, has grown exponentially.
Edna Ramsey was in line ahead of me, and when it was her turn she stood before the Joint Labor, Health and Social Services Interim Committee. She explained she doesn’t qualify for Medicaid because she lives in Wyoming, which won’t expand it, and she makes too little to get subsidies the ACA provides to help the poor obtain a policy from the health insurance exchange. I knew what she said was true, because I’m in the same position.
This insane Medicaid gap is hurting 5 million people in 25 states. With Edna and me, at least two of them were in the meeting room.
“I don’t go to the doctor unless I absolutely have to because I can’t afford it,” she said, explaining why she wants them to take the federal money for the expansion. But in less than a minute she stopped reading from her piece of paper and looked directly at the legislators, her voice quivering.
“Now that I am here, I don’t think it’s going to happen because I don’t see anyone that cares,” Ramsey said, and briskly left the room.
Part of me wanted to bolt, too. Based on the panel’s discussion so far, it seemed like a lost cause. Yet I knew I had to go through with it, because the people who made a terrible decision last year should spend a few minutes hearing about the problems from someone who has to deal with them. They don’t have to read my column, but they couldn’t get up and leave. At least they didn’t.
I asked them to imagine that 17,599 people were in line behind me. These are the working poor – the store clerks, day-care providers and janitors they see all of the time, and who they are supposed to represent. All of them are caught in the Medicaid gap the Legislature and Mead created.
I reminded them that a Wyoming Department of Health (DOH) study found the state could save $47 million over the next six years by expanding Medicaid. If they didn’t, it would have to spend $80 million more than planned during the same period.
“I am perplexed as to how you could turn down such a large amount of money, and help no one, simply to cling to abstract political ideals,” I said.
Then I mentioned another part of the study that hasn’t gotten much attention, but should. It noted that people with insurance can obtain health care on a regular basis, so they lead healthier lives and live longer. The DOH estimated if Medicaid is expanded, within five years, 111 deaths could be prevented annually in Wyoming.
“So say goodbye to 111 people in the group behind me, you don’t have to imagine them anymore; you can pretend they didn’t exist,” I said. “Next year, forget about another 111. And then another …”
I told them my story: Fired a year ago, I lost my health insurance and couldn’t afford COBRA coverage. When I tried to sign up for Obamacare, I was told my wife and I couldn’t get Medicaid because of Wyoming’s decision, and we weren’t eligible for ACA subsidies. Our only choice was to buy health insurance for $1,300 a month. It was the cheapest plan available.
But later that week I learned from a Medicaid official in Denver that our income is close to the federal poverty level figure that could trigger the subsidies. If my wife and I can make a little more money – which we certainly plan to – we can get a better insurance plan that would only cost us about $30 a month. The plan we would have been charged $1,300 a month for would likely be free.
So a childless adult can be so poor he or she would qualify for Medicaid – but can’t enroll because of Wyoming’s callous decision – and would not get a subsidy, either. Reach the magic income level, though, and the insurance becomes incredibly inexpensive.
That doesn’t make any sense to me. I hope it didn’t to the committee, either, because it’s a real-life example of how messed up this system is, and that was the message I wanted to send – along with the fact that their political games to destroy Obamacare are killing some of us, especially vulnerable workers stuck in minimum-wage and part-time jobs.
The committee still rejected Medicaid expansion as the federal government now defines it, but did approve two watered-down bills that keep the issue alive. Co-Chairwoman Rep. Elaine Harvey (R-Lovell) told The Associated Press there is a tremendous amount of interest in Medicaid expansion throughout the state. In fact, while the hearing was in session, scores of citizens rallied outside the Herschler Building in Cheyenne to show how upset they are at Mead and the Legislature over the issue.
“I think it is the responsibility of this committee to bring it forward for a full legislative discussion,” she said. “I would hate to think that 12 people would decide for the whole state to not do any kind of Medicaid expansion at all.”
I would, too. The entire Legislature has nearly a month before the budget session begins to prepare for that debate by learning why Medicaid expansion is vital to the state’s health, and while the compromise bills would help some people, they wouldn’t be remotely as effective as the expansion planned under the Affordable Care Act. I’ll explain why in another column.
— Veteran Wyoming journalist Kerry Drake is the editor-in-chief of The Casper Citizen, a nonprofit, online community newspaper. It can be viewed at www.caspercitizen.com.
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