If after 11 years you don’t succeed, try, try again.
That’s the approach state Sen. Cale Case, R-Lander, is taking with Medicaid expansion in Wyoming. On Monday, Case confirmed to Cowboy State Daily he’s planning to resurrect an effort to expand Medicaid by adding an amendment to the upcoming 2025/2026 biennial budget.
“I believe in this,” Case said.
There have been nine bills brought forward for more than a decade seeking to expand Medicaid in Wyoming, and two additional efforts made by Case to pass Medicaid expansion in other budget sessions.
Unlike a standalone bill that requires a two-thirds vote of approval to be introduced during the upcoming budget session, a budget amendment requires no introduction vote and only a majority vote of support to pass.
During the 2023 legislative session, Case tried to add Medicaid expansion to the supplemental budget, but his effort was rejected by a 24-7 vote in the Senate.
The Legislature did, however, pass a bill expanding postpartum Medicaid coverage in Wyoming in 2023. Case believes the larger Medicaid expansion proposal would similarly help new mothers and children.
Medicaid expansion is a federal health care program that allows states, if they choose, to expand Medicaid coverage to people who earn up to 138% of the federal poverty level threshold. Traditional Medicaid coverage involves a 50% match between the state and federal government. Under an expansion, the federal government pays 90% of the costs of the new Medicaid members.
Not Just Unemployed
Case said there’s a common misconception that only people making little to no income will benefit from the expansion. In reality, he said many working-class people in Wyoming make too much to qualify for Medicaid, but don’t receive health insurance through their employers because it isn’t a full-time job. Under current income guidelines in Wyoming, an applicant cannot make more than $12,675 a year and qualify for Medicaid coverage.
“You can get Medicaid if you’re very poor, you can’t get it if you’re shoulder poor,” Case said. “Why can’t you get it? Because you’re working.”
According to data provided by health advocacy group Better Wyoming, 56% of the 19,000 new members that would be added through the expansion are currently employed. A total of 58% of the new enrollees make less than the federal poverty level.
Rep. John Bear, R-Gillette, has been a vocal opponent of Medicaid expansion in recent years and said he opposes Case’s newest effort, calling it “antithetical to true conservatism.” He said many more people than what is in the estimated enrollment figures would end up being covered, as he believes it would inspire people from other states to move to Wyoming and enroll in the coverage.
“It would become a large part of the state budget,” he said.
The fact that people who are employed could benefit from the expansion is a concern, not a positive, for Bear. He also has concerns it would encourage full time workers who are currently insured to start working less in order to receive what they see as better coverage offered by Medicaid.
“It’s an expansion of coverage for able-bodied people,” he said. “What it does is drive people to work less.”
Also, under current Medicaid rules in Wyoming, having a low income alone does not qualify someone for coverage. There are other standards considered such as types of disabilities, age, status of children in relation to family income and the number of caretakers in a household that determine eligibility.
“You could be the lowest-income person on earth and still not qualify unless you met one of these other requirements,” said Nate Martin, executive director of Better Wyoming.
Need Local Help
Case believes local hospital boards and districts need to rally behind his effort as he believes Medicaid expansion would unquestionably help local hospitals around the state by reducing overall emergency room visits.
Many however have criticized the fact that the costs of Medicaid and Medicare have consistently grown in recent decades without corresponding raises in the rate of Medicaid reimbursement to hospitals and other health care providers.
Case said there has been too much dependence on Cheyenne-based medical groups and state lobbying groups in previous efforts to pass Medicaid expansion.
“If every hospital board in every community would get behind this it would be a done deal,” Case said.
Dave Bell, a member of the Sublette County Hospital District board, and Kelly Simone, a member of the West Park Hospital District board in Cody, both said their boards haven’t had any discussion about Medicaid expansion, but believe it could be a worthy topic to address. Both said they’ve been focused on local projects.
Case said he believes a new hospital being built in Riverton would particularly benefit by Medicaid expansion in covering overhead costs.
Martin said although Better Wyoming supports Case’s effort, the group will not actively lobby for it in the upcoming session. Instead, it will focus on increasing the Wyoming Department of Health’s budget.
“Our group has chosen to focus on achievable, concrete gains we can win that will deliver real benefits to people’s lives right now,” Martin said.
Case also believes the majority of the Legislature and Wyoming residents support Medicaid expansion, but blames particularly vocal members of the far-right for nixing previous efforts.
“They’re worried about the right-wing bloc,” Case said. “They don’t worry about their normal constituents, they worry about the vociferous constituents.”
The makeup of the Legislature hasn’t changed since 2023 and no effort to expand Medicaid has received a close vote in a number of years. Still, Case said he has hope his effort could pass based on certain efforts by his Republican colleagues to “toughen up” against what he sees as an aggressive far-right.
Bear compares Case’s effort to pass Medicaid expansion through a budget amendment to former President Barack Obama’s 2008 campaign pledge to not require Americans to have to buy government health care, yet charging a fine later for those who didn’t.
“It’s a method to go around the proper process of a representative process,” Bear said.
How Does It Work?
According to 2023 data, in the first two years of expansion, an expected 19,000 new members would be covered under Medicaid in Wyoming, involving $22 million in state money and $177 million in federal funds over a two-year period.
If a $54 million incentive from the 2021 American Rescue Plan Act is considered, there would be a net $32 million savings to the Wyoming Department of Health in the program’s first biennium. The opportunity to use this incentive will expire by March 2025, so the Legislature is likely the last opportunity Wyoming will have to take advantage of the program.
A separate COVID-era rule requiring states to not disenroll Medicaid members has already expired.
Once the state enters a Medicaid expansion agreement with the federal government, it must comply with federal guidelines, but the state can always withdraw from participating. The complicity with federal guidelines is one of the reasons some Republicans in the Legislature have opposed the expansion.
The Wyoming Department of Health estimates it would cost the state $11 million annually to fund the Medicaid expansion after federal grant money runs out.
Case mentioned how Wyoming has some of the slowest population and economic growth in the Rocky Mountain region and its gross domestic product has fallen based on relative inflation. It is the only state in the region that hasn’t passed any form of Medicaid expansion.
“It’s the best thing we could do economically for the state,” Case said. “It would put millions of dollars in the local community.”
Leo Wolfson can be reached at leo@cowboystatedaily.com.
