Senate committee kills Medicaid expansion

CHEYENNE — After clearing the House in a historic vote last week, a bill authorizing the expansion of Medicaid coverage to an estimated 24,000 residents in Wyoming was defeated by a Senate committee Wednesday morning.

House Bill 162, which had gone further in the legislative process than any prior Medicaid expansion proposal, would have directed state officials to pursue a plan to expand Medicaid coverage to Wyoming residents whose income is at or below 138% of the federal poverty level.

Under the bill sponsored by Rep. John Romero-Martinez, R-Cheyenne, Medicaid expansion would have covered an estimated 24,000 residents in its first two years of implementation, according to a recent report from the Wyoming Department of Health.

The push to expand Medicaid coverage in Wyoming had gained added momentum this session, in part due to federal incentives offered to the 12 states that have declined to expand Medicaid over nearly the last decade. Under the American Rescue Plan, those states would gain a 5% boost to their traditional Medicaid matching program, which Wyoming receives at a 50-50 split, if they decide to opt in to Medicaid expansion for residents who earn too much for traditional Medicaid and not enough for private subsidies.

While Medicaid expansion comes at a cost of $20 million per biennium to the state, the boost in federal funding to the traditional Medicaid program would bring an estimated $54 million to Wyoming’s coffers over the next two years. The net $34 million gain to the state was one reason that several lawmakers in the House who previously opposed Medicaid expansion had reversed course.

The proposal, however, was rejected by the Senate Labor, Health and Social Services by a 3-2 vote, with lawmakers opposed to Medicaid expansion raising a wide range of concerns over the proposal.

Sen. Lynn Hutchings, R-Cheyenne, worried about expansion’s impacts on the U.S. federal debt, which sits at around $28 trillion.

“Where are we going to get the money to fund this program?” Hutchings asked. “Even in our state, we’re asking people to cut back over and over and over, and we’re now saying, ‘Let’s jump on this program, where the federal government is going to promise us all this money for two years.’ What’s going to happen on year three? We’re going to be back where we started, and I’m just afraid for our nation.”

Others argued Medicaid expansion would encourage “socialized medicine” by giving the federal government more of a role in the country’s health care system. Sen. Troy McKeown, R-Gillette, who voted in favor of a separate Medicaid expansion bill during a committee meeting earlier this session, struck a more oppositional tone Wednesday, stating the proposal would lead to more dependence among state residents on federal assistance.

“It doesn’t take much effort to get to 100% on the poverty level. If you look at that, that’s a $7.25-an-hour job,” McKeown said. “We don’t want to make people go to work. We just want to give them health care. It just runs counter. We’re just building more and more dependency.”

Estimates show that roughly 60% of those eligible for Medicaid expansion in Wyoming would be actively working, while an additional 5% of the population would be unemployed, but seeking work.

While a majority of lawmakers on the committee opposed the bill, several Wyoming residents testified virtually from across the state in favor of Medicaid expansion. Sheridan resident Danielle Arnoux spoke of her mental health challenges as a single mom during the COVID-19 pandemic, which she was only able to address through Medicaid benefits offered through the federal CARES Act last year.

“I truly resent the fact when I hear people talk about how if I have Medicaid, it’s going to cause me to be dependent. I really am disappointed that anyone would think that that is true,” Arnoux said. “I’m sure that there is a small number of people who take advantage of programs like that, but I tell you – I work every day, I have a son and I’m barely making ends meet.”

“We live in the wealthiest country in the world, and I have to beg to get some kind of health care,” Arnoux added.

The proposal also drew the support of several industry groups, including the Wyoming Hospital Association, the Wyoming Medical Society and the Wyoming Business Alliance. During the meeting, Jan Cartwright, executive director of the Wyoming Primary Care Association, noted the state relies on federal funds for a wide range of other programs included in its biennial budget.

“Wyoming receives more federal subsidies than any other state, but now we’re going to draw the line on people who are poor? That’s where we’re going to say that we don’t want to take federal money?” Cartwright said. “Right now, all of us are paying the cost of care for people who cannot pay for it themselves through higher insurance costs and higher hospital costs.”

Lawmakers received mixed testimony regarding many other states, particularly those in the West, that have opted to expand Medicaid. Dr. John Mansell, a Gillette-based physician, pointed to Montana as a warning, arguing hospitals in the state have seen severe drops in their profit margins since lawmakers adopted Medicaid expansion.

“Every day in Wyoming, in our clinics, we see Medicaid patients from other states who fled California, Washington, Oregon and even New York, because they have Medicaid coverage in their state, but their health care infrastructure has broken under the weight of the increased volume of patients whose program doesn’t pay enough to cover the cost of care,” Mansell testified. “I’m advising you, as a physician who has been practicing for 30 years, five years from now, you will not be happy you expanded Medicaid.”

Members of the Wyoming Hospital Association, however, pushed back on the characterization that Medicaid expansion has been disastrous for Montana. Josh Hannes, the association’s vice president, said his conversations with healthcare officials in Montana have indicated that the state has seen substantial benefits from the expansion program.

“Montana has experienced budget savings every year since they have expanded their Medicaid,” Hannes said. “They continue to predict budget savings into this fiscal year. Again, our conversations with our partners in Montana indicate no attempt or desire for them to leave the expansion group.”

Hannes also noted the Wyoming Department of Health’s recent report on Medicaid expansion found that net revenue for health care providers would likely increase, while private premium costs would likely decrease between 5% and 15% under the program.

The committee spent roughly three hours discussing the bill during its meeting Wednesday morning, closing the testimony with a handful of representatives who were in favor of the proposal. Rep. Steve Harshman, R-Casper, who previously served as House speaker for four years, said he supported the measure after voting against it several times over the past decade, noting the state could negotiate better reimbursement levels with the federal government through the bill.

“I’ve always prided myself as the most pro-life speaker in the history of Wyoming. These lives matter, too,” Harshman said. “I think I’ve come full circle on this, because there’s not a better plan. None of you have it. I don’t have it. It’s not out there.”

The Medicaid expansion proposal then failed on a roll call vote, with Hutchings, McKeown and Sen. Anthony Bouchard, R-Cheyenne, voting against the bill. Committee chair Sen. Fred Baldwin, R-Kemmerer, and Sen. Dan Furphy, R-Laramie, voted in favor of the bill.

The bill’s failure in the Senate Labor, Health and Social Services Committee was foreseeable to some lawmakers, as a few members of the Senate attempted to have the proposal considered by a different committee during floor debate Tuesday afternoon.

With the bill needing to win committee approval by Wednesday to remain alive, Sen. Cale Case, R-Lander, made a motion for HB 162 to be considered by the Senate Revenue Committee, rather than the health-focused Senate committee. Case, who chairs the Senate Revenue Committee, argued the proposal was deserving of debate on the Senate floor.

“Did anybody have any doubt what would happen to this bill if it was referred to the Labor Committee?” Case asked on the Senate floor. “Our committees are very predictable. We know who’s on them, and we know everybody like a book now. It’s not going to come out of the Labor Committee … it will come out of (the Revenue Committee), I think.”

The motion to change the bill’s committee assignment was backed by Senate Minority Floor Leader Chris Rothfuss, D-Laramie, who brought the initial version of the Medicaid expansion bill identical to the House version that was defeated Wednesday. Rothfuss’ bill, which gained committee approval earlier in the session, was never considered for a vote on the Senate floor.

“This is the type of decision that may be life or death for people in the state of Wyoming,” Rothfuss said. “We know that for the past eight years, we’ve provided no alternatives, no options, no opportunities and realistically very little debate. … Even if you don’t like this policy, you know it’s more important than the other issues that we’re going to be working instead.”

But several senators spoke against the motion, arguing the bill needed to be considered by the committee focused on health-related topics. Senate Vice President Larry Hicks, R-Baggs, said the body has debated and rejected Medicaid expansion proposals several times in the past, and, setting himself up for a joke, he noted members of the House are trying to make animal cruelty a felony.

“I’m afraid that if we bring this out, and we debate this on the floor, it’s the equivalent of beating a dead horse, and you all may be convicted with felony charges for doing so,” Hicks said.

Sen. Charles Scott, R-Casper, argued the proposal needed to stay with its assigned committee, describing Medicaid expansion as a complex matter.

“There are some federal inducements that, frankly, I don’t understand, and I think the whole thing is complicated enough so that a committee who has not heard this one will not have time to do justice to it in the time left,” Scott said.

Ultimately, Case’s motion to have HB 162 moved to the Senate Revenue Committee failed by a 22-8 vote in the Senate on Tuesday afternoon.