Wyoming’s health care system has managed to do something no other state has matched, and the Wyoming Legislature is totally responsible for it.
Before you shout, “We’re No. 1!” and pat your lawmakers on the back, you need to know that we’re really No. 50 when it comes to providing the uninsured the chance to obtain health insurance.
Wyoming is the only state that has actually seen an increase in its uninsured population from 2013 to 2015. A new Gallup survey found Wyoming’s uninsured rate has gone up 1.6 percent. All other states and the District of Columbia have seen decreases in the number of uninsured residents since the Affordable Care Act (ACA/Obamacare) went into effect. (Read In U.S., uninsured rates continue to drop in most states.)
Even Texas — where slightly more than one-fifth of the total population still remains uninsured — managed to reduce its total uninsured overall. Ranking second to the Lone Star State in this category is Wyoming, where 18.2 percent of residents are without health insurance. On the other end of the scale is Rhode Island, where only 2.7 percent of the people don’t have health insurance.
Take that, Obamacare! Guess the Equality State showed the rest of the nation and the federal government it won’t march lockstep with any system that dares to anger conservatives by helping provide health insurance to its neediest citizens.
Not surprisingly, the seven states that had the biggest drops in their uninsured rates embraced the ACA on behalf of their citizens. They expanded the federal Medicaid program and also chose to run their own insurance exchanges or partner with the feds. The list is led by two conservative states, Arkansas and Kentucky, whose governors and lawmakers decided that rather than play political games they will actually help the working poor in their respective states.
The best improvements were seen in both conservative and liberal states. Arkansas’s rate fell 13.4 percent, while Kentucky’s decreased 11.4 percent. To put Wyoming’s sole rate increase in the U.S. into better perspective, consider that the next three states with the biggest gains — Oregon, Rhode Island and Washington — have all seen their uninsured rates shrink by more than 10 percent.
During the past three sessions, Wyoming’s Republican legislative leadership rejected all efforts to expand Medicaid to nearly 18,000 low-income childless adults, and also told the federal government to run its own health insurance marketplace in Wyoming. Some legislators claimed they were working on a state exchange and ran out of time to implement one. But they had a year to do it, which should have been enough time if the Legislature hadn’t put the whole effort on hold because it incorrectly expected the ACA to be declared unconstitutional.
Even so, ACA advocates say they are very pleased that 20,000-plus people are now eligible to buy subsidized insurance in Wyoming through Healthcare.gov. It’s a beginning, but tax credits for those who obtain health insurance through the federal market are only available to people within a certain income range. No help at all exists for the working poor — another 18,000 who would be eligible for Medicaid if the state would permit it.
Many legislators complain publicly and privately about people they consider slackers and deadbeats who would receive expanded Medicaid. They contend that the poor should have “skin in the game” and pay for the benefits, but apparently don’t realize (or care) that nearly 60 percent of the newly Medicaid-eligible do work at minimum-wage jobs. Many of the rest are too sick to work because they don’t have adequate health care. Imagine that.
“We are painfully aware that Wyoming is leaving another [18,000 low-income adults] uncovered because we won’t let them apply for Medicaid,” said Marguerite Herman, director of Healthy Wyoming, formerly known as the Wyoming Coalition for Medicaid Solutions. The group is still working on the issue, but its focus is on overall improvement in the state’s health care system.
Wyoming’s uninsured rate would have definitely gone down — which, after all, was the main goal of federal health care reform — if Medicaid had been allowed to expand here.
The White House Council on Economic Advisers is probably a pretty subversive group in the minds of far-right state legislators, but here’s its analysis of what Wyoming lost by not joining 28 other states that either expanded Medicaid or reached a deal with the feds to offer a state alternative:
- An additional 14,000 people would have insurance coverage in 2016.
- Improvement in physical and mental health — 2,000 people would report being in good (or better) health, and 1,000 fewer would experience symptoms of depression.
- Two thousand fewer people would have trouble paying their bills due to medical costs.
Herman said the effects of being uninsured can be devastating. “People ignore injuries and illnesses until they land in the hospital, or they ‘manage’ chronic illnesses with episodic visits to emergency rooms,” she said. “They can’t pay their medical bills. They don’t get prescriptions filled. They miss work or lose jobs, and they can’t take care of their families.”
Let’s also not forget the Wyoming Department of Health study that predicted not expanding Medicaid will send 111 residents to premature deaths each year due to lack of health care. That’s an amazing and appalling statistic generated by our own state health experts, but you won’t hear about it during legislative debates about expansion. It should be at the forefront of every discussion on the issue.
Largely because many Republican-led states refused to give President Barack Obama a victory on health care reform, more than 9 percent of Americans of all ages still do not have health insurance. Combined, the 22 states that handled the issue the way Wyoming did will deprive 4.3 million citizens of health insurance coverage in 2016.
Republican Gov. Matt Mead initially gave mixed signals about Obamacare, calling for the creation of a state health exchange but firmly opposing Medicaid expansion. By his 2015 State of the State address to the Legislature, he told lawmakers they can’t keep throwing away more than $100 million in federal money every year and advised them they “must” expand Medicaid. His own party leaders, though, voted against the same Medicaid plan they had asked Mead and the Department of Health to devise.
Earlier this year, the conservative Wyoming Business Alliance surprised a lot of observers when it announced support for Medicaid expansion. Its president Bill Schilling told a pair of legislative committees that the high cost of health care in Wyoming is a major deterrent to attracting both labor and new businesses to the state, but his pleas were callously brushed aside. Ditto the support voiced by good-government groups, hospitals, insurance companies, church associations and municipalities. Honest assessments by respected lobbyists that it’s simply “the right thing to do” fell on deaf ears, even though these are the same people legislators are usually happy to listen to on any other subject.
“While we watch the number of uninsured people climb, Wyoming is missing out on millions of federal dollars that would maintain a healthy workforce, strengthen Wyoming’s low-income families and health care system and boost our economy,” Herman said.
However, the Healthy Wyoming director still has some optimism left four years into the fight for Medicaid expansion.
“We hope lawmakers who chose delay as a policy will take a hard look at the human and economic costs and act now,” she said. “It’s not too late.”
Herman, who has worked tirelessly in this effort, is much more diplomatic than I am. The news that Wyoming is the only state in the country that actually has more uninsured residents now than it did when the ACA went into effect isn’t surprising, given the complete disdain the vast majority of GOP legislators have shown for Medicaid expansion. However, after seeing them ignore all of the consequences of their inaction on the people they supposedly represent, it makes me angrier than ever.
Lawmakers in this state have refused to listen to every single reasonable argument about health and economic benefits, societal responsibilities to help the poor, and their own fiscal negligence in declining hundreds of millions of dollars in federal funds — taxes that Wyoming residents contributed to but may not see in return. When they make a harmful decision that literally impacts the lives of everyone in the state, I don’t give a damn if they’re offended when someone calls them on it.
Will citizens ever wake up and demand the Legislature quit treating the working poor as sub-humans who don’t deserve health care?
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