There was brief talk this legislative session of expansion of the Medicaid program, commonly referred to as Obamacare. That move quickly fizzled out. Here’s why.
Medicaid is a health insurance program for those at or below poverty level. It is funded 50% by the federal government, with the other half funded by the state.
With the aging of America, the program grows each year. It is now one of the largest pieces of our state budget. This spending is regarded as non-discretionary — in other words, we cannot control it. As people become eligible, they are enrolled. The state must then find the money to fund the growing ranks of the poor and elderly.
In theory you could drop coverage under various programs to reduce the expense. Politically it is an impossible task. Every aspect of Medicaid has a constituency and any attempt to pare back coverage produces an avalanche of opposition.
So, you can well imagine why conservative minded legislators, like me, are reluctant to compound our fiscal woes by adding new programs.
Obamacare is Medicaid coverage for adults with incomes between 100% and 138% of the poverty line. In most states that have adopted it, they’ve found their initial estimates of the cost fell far short of the final tab. Many more people enrolled, and at a higher cost, than forecasts predicted.
Expansion comes with an intriguing promise that 90% of the cost will be borne by the federal government.
Prior experience indicates we cannot rely on that promise. Take, for instance, the federal Individuals with Disabilities Education Act. First enacted in 1975 it has steadily expanded in size and cost. It came with a promise the federal government would bear 40% of the cost. That has never happened. On average the feds have reimbursed seventeen percent of the costs, leaving states to make up the difference.
Another example is the Children’s Health Insurance Program, referred to as CHIP. This federal program provides health insurance for children from families with incomes between one hundred percent and two hundred percent of the poverty level. This optional program was adopted by Wyoming with a promise from the federal government that it would cover 88% of the cost. The level of reimbursement fell to 76% and dropped again to its current level of 65%. That, together with growing enrollment and medical bills, means the expense of this optional program is fast growing.
This record of broken promises argues for caution in adopting any more optional expansions of Medicaid coverage. If Wyoming were to adopt Obamacare it is likely, as in other states, the costs would far exceed initial estimates. When — not if — the feds decide to renege on the promised ninety percent cost share the program would be one more in a long line of budget-busters.
Obamacare expansion, like so many other government programs, carries the promise of benefits for a portion of the population. But, as our state revenues continue to dwindle, it would come at an unbearable cost.
Dave Kinskey represents Wyoming Senate District 22 which consists of Johnson County and eastern Sheridan County. A businessperson and former mayor of Sheridan, he can be reached during the legislative session at Dave.Kinskey@WyoLeg.gov.