Medicaid expansion is still a possibility in Wyoming, thanks to a compromise bill crafted by Democratic Sen. Chris Rothfuss of Laramie.
The House killed a proposal called Medicaid Fit on Thursday when it rejected House Bill 84. The measure would have offered limited benefits to the 17,600 low-income adults who qualify for the program but fall into the Medicaid gap that denies them coverage because the state of Wyoming hasn’t accepted the federal government’s offer to pay $50 million.
HB 84 fell seven votes shy of the two-thirds majority non-budget bills need to be introduced this session. On Wednesday, two other Medicaid proposals were shot down.
The House killed a bill that would have allowed tribes on the Wind River Indian Reservation and the Wyoming Department of Health to ask for a federal waiver to start a demonstration project to pump Medicaid dollars to fully fund Indian Health Services. Meanwhile, the Senate rejected the so-called “Arkansas Model” of expansion, which would have allowed Wyoming to use federal Medicaid funds to purchase private insurance for those caught in the gap.
Rothfuss, a chemical engineer, said he has been working for several months on his proposal, which includes parts of all the other plans. House Bill 118 is scheduled to be debated in the Senate on Friday, the final day bills can be introduced in either chamber.
“The intent was to put together a bill that would draw as much support as possible, taking the best features of the other legislation and putting it together, effectively engineering a compromise bill,” Rothfuss said after the Senate adjourned late Thursday afternoon.
HB 118 has premium assistance, borrowed from the Arkansas plan, but it extends it to employer premium assistance, which is something that Rep. Eric Barlow (R-Gillette) had in another Medicaid expansion bill.
“It’s got some Medicaid Fit co-pay type approaches for middle or lower incomes, whenever that’s the appropriate response,” Rothfuss explained. “At the lowest incomes maybe you just end up with the traditional Medicaid expansion.”
The senator said his bill “puts all of the options on the table, and directs the governor and the director of the Department of Health and the Insurance commissioner to go to Medicaid Services and negotiate something that’s in the best interests of Wyoming; something that’s cost-effective and cost-neutral, all of the key things we need to get done.”
Rothfuss said if the state is”overly prescriptive” in its legislation, it could endanger the [possibility of negotiating a] waiver “because we’re not the same as Arkansas and we’re not the same as Iowa. We have to do something that provides flexibility and goes a little bit further and includes a couple of other components.”
The bill sets up a health care reserve account that takes all of the net savings that are realized through the expansion – which in the first biennium is estimated at $43.6 million – and places them in an account “so if there are problems in the future, you’ve got something you can deal with.”
For the first year it does a full Medicaid expansion, because the waiver – which will include the tribes – will take some time to negotiate.
“It has a one-year sunset on the waiver, Rothfuss related, “so nobody’s worried about that being the [whole] expansion. It eliminates that after one year and makes that very clear.”
Several lobbyists who have worked tirelessly to get a Medicaid expansion bill passed like Rothfuss’ solution the best of all the proposals. “I like the fact it includes the tribes,’ said Chesie Lee, executive director of the Wyoming Church Coalition.
Lee called SF 118 a simple bill that doesn’t have any restrictions and should pass muster with the feds. She noted that two co-sponsors are legislators who voted against Medicaid Fit and the Arkansas Model.
“There’s a concern that we should at least discuss this [in committee and on the floor],” the lobbyist said.
The waiver that would be negotiated, the senator said, has a three-year sunset without legislative action.
“The purpose of that is to ensure that we have a chance to visit and proactively extend the time frame,” Rothfuss explained. “There’s a concern among a lot of the legislators that this will just be an entitlement and there’s no way to stop it, and nobody would be willing to step up and end the program.”
The senator said even if Wyoming lawmakers are concerned that the feds might back out in the next four years and not fulfill their funding promises, he doesn’t believe it will happen.
“With the time frame and the reserve account we’ve put in place [with the bill], at that point in time you’d have about $80 million available to figure out what you want to do next,” he stressed.
Rothfuss said he’s optimistic the bill will win introduction Friday, but admits there’s probably only a slim chance it makes it out of the Senate Labor, Health and Social Services Committee.
“But without a discussion,” he said realistically, “it won’t go anywhere.”
If the bill doesn’t get through the Senate, Rothfuss said, there’s still a chance it could win approval as a budget bill amendment, particularly if it gets majority votes in both chambers.
“I’m not worried about getting a particular outcome,” he concluded. “I’m worried about getting an outcome.”
If Rothfuss is successful in bringing the GOP and Democrats together with this compromise, it will be a major achievement. Even if HB 118 doesn’t succeed, his effort won’t go unnoticed by his party or the thousands of low-income people he’s trying to help finally get health coverage.
The best feature of his plan is the health care reserve account. By putting away the savings from the first three years, when the federal government picks up 100 percent of the tab, it will be difficult for Republicans to complain that there isn’t a built-in safety net for the state.