Senate Shamelessly Pops ‘Poison Pill’ into Medicaid Expansion

Senate Shamelessly Pops ‘Poison Pill’ into Medicaid Expansion

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After adding a “poison pill” work requirement to a Medicaid expansion bill its sponsor said would mean automatic rejection of Wyoming’s federal waiver request, the Senate on Monday approved the measure 18-11 on its initial reading.

The main question to ask senators now is, “Why did you even bother to pass Senate File 129?” If all they’re going to do is approve a meaningless bill that doesn’t have a chance of being enacted — apparently in the hope an uninformed public will give them credit for at least “doing something” to help the working poor — why not at least be honest and tell people they don’t care? Aren’t they proud of what they’re doing?

Proponents of Medicaid expansion are still glad to see the bill live to see at least another reading in the Senate, with the hope the work requirement amendment offered by Majority Floor Leader Eli Bebout (R-Riverton) can be stripped out of SF 129 on its third and final reading, which should come Wednesday. If that’s not possible, they at least want to see the Senate provide some flexibility in the provision so it doesn’t automatically kill expansion of the program.

Bebout’s amendment requires the state to negotiate with the federal government to include a provision that Medicaid expansion recipients who are not disabled are required to work at least 32 hours a week. Without that provision, Wyoming will not agree to expand Medicaid so an estimated 17,600 low-income, childless adults — three-fourths of whom already work — will be able to get health insurance.

Watered-down health insurance, not as good as traditional Medicaid, but insurance nonetheless.

Bebout explained to the Senate he knows his amendment is controversial. “But I think it’s very important we put in this provision, because if they are able and can, then they should in fact work,” he maintained.

But Sen. Michael Von Flatern (R-Gillette), who sponsored SF 129, which includes the SHARE plan that the federal Center for Medicare and Medicaid Services (CMS) told Wyoming officials would likely be approved for a waiver, strongly opposed the amendment.

“You cannot force [enrollees] to work for the Medicaid program, so CMS will turn us down right away,” Von Flatern said. “That’s the poison pill aspect of this.”

Anyone with even a limited knowledge of how the waiver process works and the history of Medicaid expansion knows he’s right.

The senator said Bebout’s amendment is confusing, because there is no definition of what a disability is, and whether the provision would cover physical and/or mental disabilities.

Bebout said he will clarify the disability question in a later amendment. “It’s really not intended as a posion pill,” he said. “We have made a lot of progress on Medicaid expansion in terms of waivers that are available to the state today that were not available two years ago. … I think it is something [the federal government] would certainly consider.”

But there is a major difference between considering a few new options and doing something that the feds fundamentally oppose. Von Flatern said while he would also like to see a work requirement in the bill, he assured his colleagues “this will not fly with CMS, so I urge your defeat of this.”

So the Senate approved by a 17-13 vote an amendment that’s sure to kill the expansion effort if the bill passes as it is now written.

And this is supposed to be the sensible chamber of the Legislature. Even if SF 129 makes it out of the Senate, just think about what kind of other unworkable provisions and bizarre mandates could come out of the right wing of the House, where crazy is considered the norm. They might decide the disabled don’t deserve a free ride for all that new health insurance they’ll be getting, and they should also work for it right alongside the “able.” Or they could increase co-pays and premiums for the poor ten-fold, so no one can even afford to sign up for the program.

After the Senate poisoned the well, it turned to the question of how much money hospitals in Wyoming might be able to recoup in funds that are now lost to uncompensated and/or charity care.

Sen. Charles Scott (R-Casper), chairman of the Senate Health, Labor and Social Services Committee, approved of SF 129 when it contained his plan to include health savings accounts. But the full Senate rejected his costly plan last Friday, and Scott didn’t see anything else on the horizon he could support — especially a proposal like SHARE, which is actually revenue-neutral because of savings in other programs.

Scott claimed Medicaid expansion would only reduce the $200 million annual uncompensated care at hospitals by 6 to 7 percent. The number is so low because Scott insists on using highly questionable two-year-old estimates that 4,600 of the state’s 17,600 uninsured working poor actually have some type of private health insurance, so only 13,000 actually need Medicaid expansion.

“You may see a little more or a little less than [a 6 to 7 percent reduction] but you aren’t going to see enough that you can say the problem is solved,” Scott said.

Other senators, though, said in states that have expanded Medicaid, uncompensated care has dropped by up to 40 percent. Those numbers are documented by states and the federal government.

Another irritating part of the debate Monday was the insistence by opponents there’s absolutely no way the feds will live up to their promise to never pay less than 90 percent of of Medicaid expansion costs after 2020. These legislators appear to have come to a unanimous consensus that the costs will soon be split 50-50 between the feds and Wyoming, just like traditional Medicaid is funded now, and they present those figures as fact — with absolutely nothing to back it up.

Scott, who originally moved for passage of SF 129, used every argument he could think of to push for “no” votes by the end of the debate. He said the state won’t raise taxes on minerals or the rate of sales tax, because “they’re as high as they should be,” so the only thing left for Wyoming to do is cut funds for higher education and aid to cities, towns and counties.

“If you vote for this, you’re condemning those people to a major cut two years, three years, four years down the road,” he said.

With “supporters” like Scott, Medicaid expansion certainly doesn’t need any enemies. But it has a lot of them in the Senate anyway, and undoubtedly more in the especially conservative House.

Sen. Bruce Burns (R-Sheridan) told fellow senators they have seen the intense political pressure that’s been applied to get them to support Medicaid expansion. “Imagine the position you’re putting future Legislatures in — the pressure (from opponents) to actually take away an entitlement,” Burns said. “How successful do you think that’s going to be?”

Senate President Phil Nicholas (R-Laramie) likely saved SF 129 from being defeated on first reading Monday by asking the Senate “to work the bill through the full reading process (of three readings).”

But Nicholas also had a lot of questions about the measure, along with a healthy share of criticism. He said the Legislature will ultimately have to decide if it’s better to fund Medicaid expansion or cut social service and health programs that are now operated by the state.

The president said some popular programs may have to be sacrificed to pay for expansion, which would take “a lot of courage” on the part of legislators. He said legislators will have “to look at covering more people with the same dollars.”

Nothing has really changed about the Legislature’s attitude against Medicaid expansion for the past two years, even if one bill was finally approved early in this year’s process. Opponents still raise the phony argument that it’s inconceivable the federal government will pick up at least 90 percent of costs.

With passage of the work requirement, the Senate has shown it’s still ignorant about the fact the poor deserve to have access to health care, just like other Wyomingites. There’s absolutely no reason to punish them because they get sick.

Legislators know they can disrespect the poor because low-income people also have no access to lawmakers — unlike the energy industry and others who have no problems getting friendly legislators to listen to what they want.

We haven’t even mentioned that a majority of lawmakers have shown absolutely no remorse about pissing away $110 million in federal funds during the past two years by refusing Medicaid expansion, and they’re poised to do it again unless the federal government is willing to put work requirements on people who are either already working the mostly crappy minimum-wage jobs that are available or are too sick to do so because they can’t afford proper health care.

And these guys have the nerve to complain about the federal government, which is at least trying to keep people healthy while state lawmakers push roadblock after roadblock in front of the working poor, just to make ideological points against Obamacare? It wouldn’t make their actions any less despicable, but a little honesty about what they’re doing would be welcome — and necessary, if they are ever going to be held accountable for their actions.



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