SHERIDAN — As the 2014 session for the Wyoming Legislature approaches, a statewide coalition that formed following the defeat of Medicaid expansion in the 2013 session has been doing presentations to educate citizens and encourage them to lobby their legislators to pass Medicaid expansion in the upcoming session.
The Wyoming Coalition for Medicaid Solutions wants to see Wyoming participate in the optional Medicaid expansion that is part of the Affordable Care Act so that approximately 17,600 Wyoming citizens can gain health insurance through Medicaid, according to its Facebook page.
The people who could benefit from expansion don’t currently qualify for Medicaid, even though they are low income, or for subsidies through the new federal health insurance marketplace, essentially falling through the cracks of health care coverage, local coalition representative Hollis Hackman said in a presentation at the library Tuesday.
The presentation was attended by approximately 10 local residents. Hackman said he will likely offer another presentation in January after the Legislature’s Labor, Health and Social Services Interim Committee meets and discusses a few options for Medicaid expansion that could potentially end up on the House or Senate floor for debate.
“Like-minded providers and organizations in the state that wanted to see Medicaid expansion in the state gathered together as a group and formed this loose coalition,” Hackman said. “We have continued to meet because we are looking out for the folks that could be included in regard to receiving care under expansion. Many of these folks are folks that we’re providers of care for, and we understand their need and the potential benefit, so we’re very supportive.”
In his presentation, Hackman covered the basics of Medicaid and why the coalition thinks expansion is a good idea.
Medicaid is a health insurance program for low income and medically needy people that is co-funded through state and federal dollars and managed at the state level. It provides free or reduced cost medical care for children, low income families with children, pregnant women and people who are disabled, blind or elderly.
The Affordable Care Act, also known as Obamacare, requires some mandatory expansion of Medicaid that offers greater coverage for children and people who are already eligible under current guidelines but are newly identified. In Wyoming, the mandatory expansion will cover approximately 10,600 more people at a cost to the state of $99.9 million, Hackman said.
The ACA also encourages an optional Medicaid expansion that would allow single, childless adults ages 19-65 who don’t currently qualify for Medicaid because they don’t have children or a disability to qualify based solely on an income level that falls below 138 percent of federal poverty level, which is approximately $16,000 annually.
The federal government would pay for those who qualify for the expansion 100 percent through fiscal year 2016. Federal subsidy for the program would decrease gradually to 90 percent by FY 2020. The optional expansion would cost the state approximately $51.2 million, but Hackman said offsets and shifting state programs into Medicaid expansion programs would actually save the state $47.4 million over the next seven years.
Legislators and others who are against Medicaid expansion have said they worry about the federal government being able to deliver on its promise to fund expansion 100 percent since the current state/federal split for Medicaid is 50/50 and the federal government is in a large amount of debt. People are also concerned because Medicaid reimburses hospitals at about 70 percent for the cost of care of Medicaid patients, meaning that extra 30 percent of unpaid bills is passed onto those who can pay in full.
Hackman said he doesn’t have a good answer to concerns about the federal government being able to deliver on its promise. However, he thinks some reimbursement from Medicaid is better than complete write-offs for people who simply don’t pay their bills.
“The problem we have right now in the state is with uncompensated care, and that’s people who don’t have insurance that wind up going to the ER for any variety of problem that maybe doesn’t necessitate an ER visit,” Hackman said. “They don’t have any insurance, and they don’t have a primary care provider, so the hospital’s ER is the only place that they go, or that they can go. That’s their only access to care. That cost then is absorbed by the hospitals and everybody else that pays for insurance. And that’s projected to be a couple hundred million dollars a year in Wyoming.”
Sheridan Health Center Director Cathi Kindt was at the presentation and noted that when people go to the emergency room because they are not insured, it’s not managed care. It’s a desperate fix for one problem and does not provide any follow-up or continuing care for health issues that may be at the root of the emergency such as diabetes or heart disease.
Hackman also said in his presentation that 25 states have already elected to participate in optional Medicaid expansion, which costs Wyoming taxpayers money.
“This is a large federal program; anyone who is paying federal tax is going to pay into the support of that program. What that means is for the 25 states that are implementing optional Medicaid expansion, there will be a bill for that, and we’re all going to help pay for that bill,” Hackman said. “It’s just that our folks in the state of Wyoming won’t be reaping any benefit from that because the state’s electing, at this point anyway, to not pursue optional Medicaid expansion.”
The Labor, Health and Social Services Committee will debate a few options for Medicaid expansion in January. Gov. Matt Mead has endorsed one option called Medicaid Fit that would expand Medicaid but require those who qualify under the expansion to pay a co-pay for services and possibly offer proof of employment in order to prevent abuse of the system.
Hackman said the coalition would likely support any expansion that “meets muster” for federal Medicaid expansion requirements and will offer help to those who need it.
There are approximately 83,000 people in Wyoming who are uninsured, Hackman said. Eighty percent of them are blue collar workers who are too young for Medicare and too poor to buy insurance, even through the federal exchange where they may not qualify for government subsidies.
“It’s the working folks in this state who are being affected,” Hackman said.