Ninth Time’s A Charm – Medicaid Expansion Again On Docket For Wyoming Lawmakers

Wyoming is the only state in the West that hasnt approved federal Medicaid expansion, something a small but vocal group rallied to change on the steps of the Capitol on Tuesday.

Leo Wolfson

January 11, 20237 min read

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Some of the most vocal supporters of Medicaid expansion in the Wyoming Legislature said Tuesday they may need to attach their initiative to a budget amendment to get it passed. 

“House Bill 80 might run into trouble when we have a majority floor leader who would like to block it,” state Sen. Cale Case, R-Lander, of the Medical Treatment Opportunity Act, which would expand Medicaid in Wyoming.

Medicaid expansion, which has been voted down by previous Legislatures, would expand the budget for the Wyoming Department of Health’s budget for Medicaid services.

With that track record, Case said it may stand a better chance if it’s part of the supplemental budget, which would navigate around a more direct route of addressing Medicaid expansion in a standalone bill. 

This was the same tactic Case took last year in his effort to get Medicaid expansion passed, a move criticized by many in the Legislature. Although his 2022 budget amendment was eventually approved by the Rules Committee, it was rejected with a 24-6 vote in the Senate.

“Winning the budget fight paved the way that it’s perfectly appropriate,” Case said about another push to expand Medicaid.

Uphill Battle

Both Senate President Ogden Driskill, R-Devils Tower, and Majority Floor Leader Rep. Chip Neiman, R-Hulett, have said they will not support Medicaid expansion, with Driskill going as far as saying he will not allow any related bills to reach the Senate floor. 

A budget amendment may provide a more likely avenue to success than HB 80, legislation that wasn’t considered for introduction in last year’s budget session and was rejected in the 2021 general session.

About 75 people gathered at the steps to the Wyoming Capitol on Tuesday for the Rally for Medicaid Expansion, and effort to urge Wyoming lawmakers to approve expanding the federal program in the Cowboy State. (Matt Idler for Cowboy State Daily)

Rally For Expansion

Although stiff winds blew away some of their signs and at times muffled their voices, about 75 people gathered at the Capitol Steps in Cheyenne on Tuesday to push for approval of Medicaid Expansion, which has been unsuccessful with eight bills in the last two years.

The Rally for Medicaid Expansion participants weren’t deterred by the weather. 

“A lot of people have died because we haven’t expanded Medicaid,” said Nate Martin, director of progressive advocacy group Better Wyoming, at the rally. 

The rally was organized by Healthy Wyoming, a coalition of organizations supporting Medicaid expansion in the Cowboy State.

As the rally went on, a number of legislators shuffled past while walking down the Capitol steps, showing little interest in the event.

Not Giving Up

Putting pressure on state lawmakers was one of the major themes of the rally. 

Although multiple expansion supporters said they feel better about their chances of passing Medicaid expansion than they have in the past, they also acknowledge it’s an uphill battle.

“We’re going to need all hands on deck to win this thing,” said Martin. “We are going to need you at every step of the way.”

Members of Healthy Wyoming, dressed in matching yellow T-shirts, were briefly recognized by Speaker of the House Rep. Albert Sommers, R-Pinedale, after the rally. Sommers supports Medicaid expansion.

Martin and a few others argued that Medicaid expansion would drive revenue in Wyoming. Case, who works in tourism, has said he can’t afford to provide his employees health insurance. 

“Setting up a small business means you don’t take any paychecks,” Thermopolis bookstore owner Kim Bartlett said. “Sometimes that’s for a year, sometimes that’s for three years because everything you make goes back into that business so that it can be a stronger business and support Wyoming’s economic diversity.”

Nate Miller addresses a crowd of pro-Medicaid expansion demonstrators at the Wyoming Capitol on Tuesday. (Matt Idler for Cowboy State Daily)

What The Bill Says

HB 80 expand Medicaid services to all those defined as eligible under the Social Securities Act, an estimated 19,000 people in Wyoming – at a cost of $11 million a year. Nearly two-thirds of this demographic are women and two-thirds are gainfully employed. 

“Next time I encourage you, when you’re out eating or you’re getting some kind of service and say, ‘Are you covered by health care insurance?’ and you’ll get the answer and that’s what we’re talking about,” Rep. Steve Harshman, R-Casper, said at the rally.

More To The Right

The Legislature shifted more to the right after the November elections, likely paving a more difficult path for Medicaid expansion than in the past.

Rep. John Bear, R-Gillette, chairman of the Wyoming Freedom Caucus, said he won’t support Medicaid expansion under any circumstance.

But a few lawmakers have flipped their previous opposition and have signed on to support the cause in recent years, like Case and Harshman, who both spoke at the rally.

“I think the most important thing is, if you’re from Sundance, talk to your representative from Sundance,” Harshman said. “If you’re from Casper, talk to your representative. 

“Because, boy, when you say I’m one of your constituents from Newcastle that makes a big difference when they hear from the people back home, and as representatives of our people, it makes a difference.”

Wyoming is the only state in the West to not have some form of Medicaid expansion. It also was one of the last states in the 1960s to join the Medicaid program, Harshman said.

What Is It?

People who make an income below 100% of the federal poverty level, $13,590 a year in a single-person household, do not qualify for subsidized private insurance benefits offered through the Affordable Care Act marketplace exchange. 

The Affordable Care Act provides subsidies for private health insurance to anyone who earns 100% or more of the federal poverty level. Anyone who earns less falls into a “coverage gap.”

In addition to the below poverty-line population, under the Medicaid expansion, those making up to 138% of the federal poverty level would be covered. Johansson said it’s expected those making under the poverty line would make up about 60% of new enrollees.

The federal government pays 90% of Medicaid costs for enrollees, leaving participating states to pay the remaining 10%. This compares to the 50% now paid by Medicaid enrollees in Wyoming. At 50%, Wyoming gets the lowest federal matching rate for most of its Medicaid groups, which is lower than Montana’s 64% match.

The Wyoming Department of Health recommends setting aside $22 million for the expansion’s first two years. That would be paired with a $177 million federal contribution, which would give Wyoming a surplus of $32 million after the first year of expansion, enough to cover the state’s share of costs in the second year. 

Under the American Rescue Plan Act, states that newly expand Medicaid can get a 5% bump in their traditional federal match for two years, which would bring in a total of $54 million to the state on top of the new federal funds for Medicaid expansion.

House Bill 80 has not yet been referred to a legislative committee.

On Wednesday morning, the House Labor, Health and Social Services Committee will consider separate legislation that would extend Medicaid for 12 months of postpartum coverage.

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Leo Wolfson

Politics and Government Reporter