By James Chilton
Medicaid expansion was once again rejected by the Wyoming Legislature on Friday.
The Senate defeated its Medicaid expansion bill 19-11, spurring a House of Representatives committee to pull its version of the bill on the assumption it would have no chance of passing.
After days of debate, including discussion on a dozen different amendments, Senate File 129 was up for third and final reading Friday morning. In its final incarnation, the bill still included a work requirement for nondisabled adults -- something the bill's main sponsor, Sen. Michael Von Flatern, R-Gillette, said would almost certainly kill the plan's chances with the federal Centers for Medicare and Medicaid Services.
But in the end, Von Flatern came to accept that language's inclusion in the bill, even if he didn't support it. On the floor, he continued to push for passage, asking fellow senators to "keep our eye on the ball."
"What we're doing is taking $120 million into this state and creating the equivalent of 800 jobs," Von Flatern said.
"But more importantly, we're taking care of the health of 17,000-plus people who now fall through the cracks. We're trying to improve their condition."
But Sen. Charles Scott, R-Casper, remained unconvinced, citing numerous problems he still had with the bill. He said the bill still didn't have any cost controls in it, adding that it would not do enough to address the issues of hospitals writing off millions of dollars in uncompensated care.
Moreover, Scott said he did not believe the federal government would keep up its promise to continue paying 90 percent of the costs of Medicaid expansion indefinitely. Instead, he argued the government would begin reducing that share down to 50 percent, leaving the state to figure out how to make up the difference.
"We will be under tremendous pressure from providers and beneficiaries, and we'll have to come up with $60 million in general funds," Scott said.
"I only see two places we're going to get that kind of money: higher education, K-12, the whole education system; or payments to cities and counties. And my guess is both would get hit."
Scott said those two priorities were "much more important to the state of Wyoming than this (Medicaid) program," and as such, he urged the bill's defeat.
Other senators like Larry Hicks, R-Baggs, argued against the bill's impact on the growing U.S. federal debt. Hicks said he could not in good conscience support a program he believed would continue to increase the national debt, which he said remains an enormous problem.
"There's no such thing as 'federal funds,' just taxes and debt," Hicks said. "Our debt is a toxic asset on the global economy."
Senate Majority Floor Leader Eli Bebout, R-Riverton, said simply that the Senate had failed previous attempts to pass Medicaid expansion because the time was not right. And after all the debate and consideration, he said that now is still not the time.
With that, SF 129 failed on a final vote 11 aye to 19 no. Minutes later, the House Labor, Health and Social Services Committee met to discuss the House version of Medicaid expansion, HB 245.
The committee had met earlier in the day to take public testimony on Medicaid expansion. But as it reconvened shortly after the Senate vote, committee chairwoman Rep. Elaine Harvey, R-Lovell, announced her intention to pull HB 245 from consideration.
"With all of the Senate's work, they still believe this is not the right thing for Wyoming," Harvey said. "I could continue on with this hearing, we could go through an exercise in futility ... but at this point, I don't see a point in it."
Harvey said that whatever the House were to do with HB 245, it simply wouldn't pass the Senate, "no matter what plan we come up with." Knowing that, she said she didn't want to waste the public's time or that of her committee members.
"Our goal was, if the Senate vote was closer, we would have continued on," Harvey said. "But by resoundingly defeating the bill, there is no point in taking it on. It's not going to happen."
She encouraged members of the public to continue their work on the issue, adding that lack of health care continues to be a serious problem in Wyoming.
"We have people that are not being taken care of, and we need to find a solution to that," Harvey said. "And with that, this meeting is adjourned."
Eric Boley, the president of the Wyoming Hospital Association, was disappointed with the Senate's vote Friday, though he said the final vote numbers indicated that Medicaid expansion has been making some progress among legislators.
"We made some progress this year, and we'll be back," Boley said. "We think it's still important, but we're also anxious to work with the legislators to come up with what they consider to be a Wyoming solution to this problem. It's not going to go away."
Gov. Matt Mead, who had encouraged legislators to pass some form of Medicaid expansion in his State of the State address last month, also expressed disappointment.
"While I respect different views, the fact is today we are left with working poor without coverage," Mead said in a prepared statement. "We are left with Wyoming taxpayer dollars funding health care of other states. We are left without a solution for $200 million of uncompensated care that our hospitals must absorb and pass on to the rest of our citizens, and we are rejecting $120 million dollars meant for Wyoming.
"Wyoming has fought against the (Affordable Care Act) and we lost," the governor continued. "The ACA remains the law. I look forward to the Legislature finding a meaningful way to operate within the ACA to address Wyoming's health-care needs."
Von Flatern, meanwhile, said that with Medicaid expansion effectively dead until the Legislature's 2016 budget session at the earliest, the window for Wyoming to receive 100 percent federal funding for the first year of expansion has likely closed.
"The 100 percent chance is pretty well shot," Von Flatern said. "It'll be a little harder to bring forth (in future years) knowing the (cost) will be greater to the state of Wyoming at that point."
Von Flatern added that he believed ideology played a big part in the Senate's decision to kill Medicaid expansion this go-round. He said Wyoming already receives enormous amounts of funding from the federal government with little objection from some of the same voices decrying Medicaid expansion.
"I wouldn't doubt, as a state, for 600,000 residents, we're receiving more than we send," he said. "You add all these taxes up -- severance, federal mineral royalties, abandoned mine lands -- all that together, you'll come up with more than we send."
(c)2015 Wyoming Tribune-Eagle (Cheyenne, Wyo.)