UPDATE: The House Labor, Health and Social Services Committee voted 4-4 on Senate File 97 Monday night, which killed the proposed work requirements for Medicaid recipients. The ninth member of the committee, Sen. Scott Clem (R-Gillette) was excused and did not cast a vote.
I used to believe that the refusal to expand Medicaid was a low point for the Wyoming Senate, but they’ve proved me wrong — when it comes to some members’ treatment of the poor, it can get worse.
The state’s failure to expand Medicaid was a huge mistake for myriad reasons: the decision cost us more than $500 million in federal funds over the past four years, kept more than 17,000 working poor Wyomingites from receiving health insurance, and plunged our hospitals into massive deficits because of uncompensated care.
The Senate blew its fifth chance to expand the program last week by killing an amendment to the state budget bill. The vote was 23-7, with just four Republicans joining the chamber’s three Democrats. Given the state GOP’s knee-jerk opposition to the Affordable Care Act and anything associated with it, I didn’t expect any other outcome.
What floored me, though, was the Senate’s insistence that Wyoming needs to move backward on this issue. It’s apparently not enough to keep thousands of extremely low-income residents off the insurance rolls. Other Republican-controlled states have done that. No, Senate lawmakers are trying to go one better by pushing a bill that would remove existing coverage by creating new barriers, including a work requirement for some people on the Medicaid rolls.
The advancement of Senate File 97 has set a new low for the “Equality State.”
State senators are singing an old refrain about helping the poor learn the value of work — a pretense that’s not only sickening, but is demonstrably counterproductive. Leading the chorus is Sen. Larry Hicks (R-Baggs), the sponsor of SF-97.
Hicks called the work requirement “a pathway to a better life.” Taking away people’s access to medical treatment is more like a stairway to heaven.
I forgot one of the tenets of life as viewed through the eyes of many Republican lawmakers: No freebies (except for businesses and entrepreneurs) and no excuses. They had to pull themselves up by their bootstraps, so everyone else does too. And even if the bootstrap analogy doesn’t apply to the financial security some senators enjoy, trust funds and other inheritances also brought hardships, right?
What about the concept that health care is a human right and that even those on the low rungs of the economic ladder deserve to be healthy? Don’t get our senators started on that one. They’ll never shut up.
The situation might be different if these legislators had come to their senses, realized how much they had been penalizing our state, and agreed to expand Medicaid. If Wyoming had, Sen. Chris Rothfuss (D-Laramie) pointed out, there would be more able-bodied individuals in the Medicaid program, so “some of these provisions would make sense.”
But let’s look at who the targets of SF-97 are. They are the Medicaid beneficiaries who would be required to perform 20 hours of work, schooling, community volunteering, or employment training each week.
There are about 60,000 people registered in Wyoming’s “regular” Medicaid program, but the vast majority would be exempted under SF-97 because of their age or health. The Department of Health estimated that just 3,300 individuals would have to meet the work requirements.
Department of Health Director Tom Forslund told the Senate Labor, Health and Social Services Committee that three-quarters of them, about 2,500 people, are single women with children. We’re talking about low-income women raising families by themselves. It’s nothing new to find this devious criminal class in the crosshairs. And rightly so. Everyone knows single moms are hellbent on eroding American prosperity.
They bore the brunt of Wyoming’s welfare reforms in the 1990s as well, but that wasn’t enough to stamp out this noxious underbelly of Wyoming society. Despite its demands on these women, SF-97 offers no programs to assist with child care or transportation to help them meet the work requirement.
That’s what passes for a “hand up” to prosperity for women — don’t help them make sure their kids are safe in a setting that costs less than their pay, or ensure they can get to work or job training.
Present them instead with a Hobson’s choice: keep your healthcare by leaving your children to work, or care for your kids but give up your health care.
If there’s a pullable bootstrap in that Catch-22, it’s pretty well hidden.
Eric Boley, director of the Wyoming Hospital Association, attended the committee’s hearing on SF-97 and pinpointed the problem with this punitive bill.
“As you listen to the testimony, (lawmakers) think this is a great thing and it’ll help people better their lives,” Boley told the Casper Star-Tribune. “But realistically we’re dealing with the poorest of the poor. We’re dealing with single mothers with two children. So we’re not helping them and we haven’t addressed the problem.”
It may come as a surprise to the 25 senators who voted for the bill, but health care experts don’t think work requirements will help achieve their stated goals. Take the notion that it lifts people out of the cycle of poverty.
Studies of other low-income benefit programs with work requirements like the Temporary Assistance for Needy Families found that the restriction has little or no positive impact on long-term employment. According to the Center on Budget and Policy Priorities, those Medicaid recipients whose states required a work component remained poor — and some became poorer.
There’s a reason why the federal government never granted state waivers to force work requirements on low-income people. For decades Republicans and Democrats both agreed that the requirements did not promote health coverage or access to health care for low-income people. That was the federal policy until last year, when President Trump bypassed Congress and authorized such waivers.
The Wyoming Senate swallowed whole the myth that people on Medicaid do not work. According to the Kaiser Family Foundation, 60 percent of non-elderly adults covered by Medicaid are already working.
Jack Ende, director of American College of Physicians, wrote an op-ed for his organization that noted the vast majority of Medicaid enrollees who aren’t working do so for legitimate reasons: a medical condition, a disability, care obligations of an ill family member or the inability to find a steady job.
It may sound like a crazy concept to the Wyoming Senate, but having health care coverage through Medicaid — what they voted to take away — helps people find or retain jobs.
“I’ve seen firsthand how my patients depend on programs like Medicaid to get healthy and stay healthy when no other options are available,” Ende wrote. “It’s clear that work requirements would only stymie patients’ abilities to find work and make it more difficult for physicians to keep them healthy.”
Before the internet trolls try to paint me as a freeloading progressive who just wants everything handed to him, I categorically believe in work, education and volunteering. All three improve us as human beings and it’s nice to get a regular check. I’ve been working for 46 of my 62 years, and all things considered, it’s the way to go.
Will work requirements save state government money? In the long-term, no. The absence of health insurance doesn’t mean people don’t get sick. In fact the contrary is true. And when they do get sick, in greater numbers, it’s more expensive for the hospitals that have to pick up the tab when patients can’t pay their bills. Such uncompensated charity care, meanwhile, drives up the cost of health care at hospital emergency rooms and increases insurance premiums for healthy people.
It will cost the state money to enforce work requirements. Forslund said his department will likely need field offices throughout the state.
“At the end of the day, there are going to be a lot of administrative issues to work through, and it’s not a no-cost effort,” Forslund testified.
Other expenses could include litigation. When Kentucky received its waiver from the federal government and began requiring work for Medicaid recipients, it was immediately sued in federal court. One of the last things Wyoming needs is to be locked in another expensive courtroom battle it could avoid.
The House killed its mirror version of SF-97 on a 34-24 vote for introduction. More representatives voted for the measure than against it but not enough — 40 votes — to achieve the two-thirds majority needed for consideration in a budget session. Now that the Senate’s bill is going to the House, members should again dispatch the measure. There’s no reason to make the same mistake twice. But no matter what happens in the House, the Senate started the whole fiasco.
Voters should remember that.
Ed. note: This column was edited March 6 to reflect the correct vote tally on the Medicaid expansion amendment to the Senate budget bill.