Senate Takes a Good Medicaid Plan Apart, Piece by Piece

Senate Takes a Good Medicaid Plan Apart, Piece by Piece

1 163

On Monday, Medicaid expansion opponents in the Wyoming Senate complained there was no way for the state to possibly track the cost savings the Department of Health plans to use to finally give the state’s working poor health insurance.

Senate President Phil Nicholas (R-Laramie) and Sen. Michael Von Flatern (R-Gillette) listened, then went to work. On Wednesday morning they offered an amendment that fully responded to all of the bitching and moaning expansion critics did just 48 hours earlier.

The pair threw out the mess their colleagues left them, after opponents had insisted on adding what Von Flatern called a “poison pill” to Senate File 129. It was in the form of a new requirement that all able-bodied Medicaid expansion recipients would have to work 32 hours a week to get a watered-down version of the full Medicaid benefits others already qualify for automatically.

Without stripping out that provision, there was no way the Center for Medicare and Medicaid Services (CMS) would ever grant the waiver Wyoming needs to expand Medicaid to an estimated 17,600 low-income, childless adults. So Nicholas and Von Flatern returned to the original version of SF 129 that included the SHARE plan federal officials said would likely get CMS’s approval.

Next, they answered the complaint from senators who said there was no way for the state to track the so-called savings in existing health programs the Department of Health (DOH) said would make the SHARE plan “revenue neutral.”

By reducing the cost of health programs that were no longer needed or could be significantly reduced because the working poor would now be able to get assistance through Medicaid, the DOH said the expansion could be paid solely with federal dollars beginning in 2016. Nicholas and Von Flatern created a tracking system that allowed health officials to identify potential savings that could go into a new “Medicaid Expansion Reserve Account.”

The best part of the solution was the way federal dollars could be used to fund the first year of Medicaid expansion, while savings would be stashed into the reserve account, and not even a dime from the account could be spent without the Legislature’s authorization. Lawmakers would be able to save money and be ready for the time the feds cut back their share of the cost to no less than 90 percent by 2020.

The entire revision was the result of hard work by two statesmen who had developed a foolproof plan to answer literally every criticism senators had made against Medicaid expansion.

But the problem with foolproof plans is that often fools still need to approve them. A high percentage of state senators in Wyoming either didn’t understand how these new elements improved the proposal, or they realized it and simply didn’t care.

Some members insisted on dividing the revised SF 129 and voting separately on portions. It’s unknown whether their action was because they weren’t smart enough to grasp the totality of the plan, or they just wanted to torment supporters by killing off a piece at a time.

But when the haze that had covered the entire process was lifted, a majority of senators left their indelible mark on the final product. They stomped on that sucker like a giant stink bug, and seemed to be quite happy with their smelly little handiwork.

The whole process took about two hours, and for supporters of Medicaid expansion who could see how much the proposal had been improved overnight, it was indeed painful to watch.

The Senate put back the work requirement that will doom the state’s waiver request, even if the CMS accepts the dreck that’s left over once the upper chamber and the House get done with it.

Sen. Charles Scott (R-Casper), the longest serving state senator in Wyoming’s history, was the most interesting to watch as the majority saved only a tiny framework of the plan. Someone who still cares might be able to put this wretched Humpty Dumpty back together in a manner that could even faintly resemble Medicaid expansion, but only if the viewer scrunched up his face and intently stared at it while squinting into the sun.

The Senate got rid of the tracking process many had screamed for the day before, so these self-important watchers of the taxpayers’ money didn’t have to bother giving the newly identified health program savings a thumb up or down. They ended up saving the concept of the Medicaid expansion reserve account, but with no one identifying what money could be stored in them, it didn’t matter much.

They reminded this observer of bratty little kids who went on a shopping trip with mom and screamed they wanted a shiny toy they had picked out together and promised to share. When their mother tossed the item into their cart, the precious tykes yelled that it was no longer good enough, because they saw something they liked much better in the aisle up ahead.

And by the time mom pulled out of the supermarket parking lot, the new treasure was broken into what seemed like a hundred pieces, and the kids pointed at each other, hoping there really wouldn’t be enough blame to go around this time, so they would be spared any punishment.

Scott, the Senate’s most vocal critic of Medicaid expansion two years in a row, changed his mind last month when he saw an opening for his beloved health savings accounts to be used for an alternative expansion plan. He had foisted the accounts onto the state a few years ago when he convinced the rest of the Legislature to adopt his “Healthy Frontiers” plan, which died after a single year due to lack of interest and lawmakers taking away the money.

After the Senate opened up debate on SF 129 by taking a jackhammer to Scott’s additions, he has spent most of his time pontificating for his colleagues that any plan someone else offers is inferior and would no doubt bankrupt the state.

Majority Floor Leader Eli Bebout (R-Riverton), who penned the poison pill amendment Monday and got it put back in the bill Wednesday, has also acted like Debbie Downer all week, looking for ways to show everyone Medicaid expansion is an awful idea, just as he had determined more than two years ago.

SF 129 is still alive, if barely, and resembles nothing as much as a cadaver tied onto a stick, being carried around and occasionally tossed into the air as if that would revive him.

Watching legislators who should know better go out of their way to spike a version of Medicaid expansion that showed real promise was much more heartbreaking than just watching them say “no” over and over last year. The working poor deserve much better than this insulting treatment from their representatives in the Capitol. Then again, so do we all.


  1. The evidence is clear. If you are poor, the Republican legislators want you to suffer. You better know this, when you vote.

Leave a Reply