Senate to Working Poor: Drop Dead (and at Least 111 Will)

Senate to Working Poor: Drop Dead (and at Least 111 Will)

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The Votes for this bill are at the bottom of the article.

Medicaid expansion opponents threw out everything they could think of Friday to defeat Senate File 129: half-truths, red herrings, misinformation and flat-out lies.

They won. And they did it by such a decisive margin — 19-11 — they convinced the House to drop its own Medicaid expansion bill a half-hour later, because no matter what the panel or the full House did, the issue wasn’t going to be supported by a Senate that chose to once again deny health insurance to 17,600 working poor people.

Rep. Elaine Harvey (R-Lovell) said the Senate spent a week on SF 129 and amended it, changing all of her panel’s suggestions to just approve the SHARE plan that had been negotiated between the Wyoming Department of Health (DOH) and the federal government. In the end, Senate Republicans made sure they included a “poison pill” they knew the Center for Medicare and Medicaid Services (CMS) would not accept.

Even knowing that the bill would be dead on arrival when the state’s waiver request would be denied by CMS, the 19 opponents couldn’t wait to vote “no” and just kill the measure now.

In a 2012 report, the DOH estimated if Medicaid expansion is not approved, 111 Wyoming residents will die each year because they lack even basic access to the health care system.

Sen. Michael Von Flatern (R-Gillette), the sponsor of SF 129, reminded his colleagues before the vote that the bill would bring $120 million in federal funds into the state, create an estimated 800 new jobs, and “most importantly, take care of 17,000-plus people who now fall through the cracks [of the health care system].”

No state money would be expended next year, Von Flatern stressed. Any cost to the state would be paid for by reducing and eliminating programs that would be no longer needed because the recipients would now be on Medicaid. The entire plan was “revenue neutral.”

This marks the third year in a row the Legislature rejected Medicaid expansion, which means that even if it does approve the program in the future, it cannot take advantage of the feds’ offer to pay for 100 percent of the first three years of expansion.

Even if legislators come back in the 2016 budget session and are able to get the two-thirds support necessary to introduce the bill — which is an incredible hurdle unlikely to be achieved — Medicaid expansion would probably not start until Jan. 1, 2017.

Please keep in mind that’s the BEST scenario possible. If the lawmakers who opposed Medicaid expansion get re-elected, it will never happen.

In addition to not doing its duty to help the state’s neediest, the Senate’s Republicans — at least 19 of them — gave a middle-finger salute to Gov. Matt Mead, who finally came out in favor of some form of expansion for the first time this year. Mead said he preferred the SHARE plan, but would sign any plan the Legislature passed.

In his State of the State address to open the legislative session, Mead said Medicaid expansion must happen this year, because it can’t be put off any longer. He implored them to act. Nearly begged.

The Senate’s actions, taken right after a Republican caucus on the issue before the vote, showed conclusively that its crass leadership doesn’t have any respect for anyone, even the leaders of their own party.

Sen. Charles Scott (R-Casper), to absolutely no one’s surprise, stood and spoke against SF 129. He was the leading opponent the past two years, and he briefly climbed on board in favor of expansion earlier this session when his Labor, Health and Social Services Committee approved a bill he sponsored that created an expensive, unwieldy system with health savings accounts.

After his fellow senators stripped his plan from SF 129, Scott became the same vociferous Medicaid expansion opponent he’s always been.

Scott maintained there were no cost controls in the bill, which simply isn’t true. There was a trigger mechanism that stated if the federal government ever paid less than 90 percent of the cost of the expansion, Wyoming would automatically drop out of the program.

He also said the co-payments by the poor to their own health care were so small they weren’t even worth the trouble of collecting. If that’s true, why did he and other opponents of the bill last year insist the working poor had to make co-payments to get “some skin in the game”?

Then Scott peppered his speech with his standard claim that the nation has a health care problem because the poor “overutilize” health care services by actually seeking medical treatment. He blamed Medicaid for that, adding that when the poor “get tests and other procedures they don’t need, you’re doing more harm than good.”

Scott said expanding the program would not solve the problem Wyoming hospitals face of collectively having an estimated $200 million a year in uncompensated care. He said putting low-income, childless adults on the program for the first time would only reduce uncompensated care by 6 to 7 percent.

But other states have reported reductions of 30 to 40 percent since expanding Medicaid when it became available through the Affordable Care Act, derisively called “Obamacare” by opponents.

“We know from past experience that the federal government is going to back off its promise [to pay at least 90 percent after 2020].” Really? We know that for certain? Without ever saying how he arrived at his figures, he said the state would need to come up with an extra $60 million a year to pay for the program. Scott said the state could only make up that money by cutting higher education or raising taxes.

The idea the feds will renege on their fiscal promises because of its large national deficit is truly a red herring, because Wyoming would automatically end Medicaid expansion here, so it won’t need an additional $60 million annually. Further, while Senate Republicans see the national and state economies headed into a tailspin, there’s no indication that the economic growth the nation has experienced in the past year won’t continue to improve.

Sen. Chris Rothfuss (D-Laramie) said Wyoming has abandoned 17,600 low-income, childless adults for three years by not expanding Medicaid, and SF 129 represented the state’s best effort to actually help them.

“It’s our obligation as leaders of this state, as representatives of the people, to try to find a solution to this problem we have,” Rothfuss said. “It’s not our obligation to figure out what’s going to happen five years from now.”

Before she killed House Bill 245 by laying it back for the session because of the Senate’s obstinance on the issue, Harvey also spoke about the need to keep working on Medicaid expansion.

“We all need to work together,” she said. “Wyoming does have a problem. We have people that are not being taken care of. We need to find a solution to that.”


THE VOTES

Ayes: Senator(s) Anderson J.D., Case, Craft, Emerich, Esquibel, Hastert, Johnson, Nicholas Pres, Pappas, Rothfuss, Von Flatern

Nays: Senator(s) Anderson J.L., Barnard, Bebout, Burns, Christensen, Coe, Cooper, Dockstader, Driskill, Geis, Hicks, Kinskey, Landen, Meier, Perkins, Peterson, Ross, Scott, Wasserburger

5 COMMENTS

  1. Well, that’s what happens when the state elects worthless scum. No one in Wyoming should be surprised. It’s not as if any recent election was close. Stupid voters deserve what they get. i’m sure some of the 111 who will die in the next year due to lack of medical coverage voted for these senators and these soon-to-be-corpses hate, hate, hate Obamacare. I’m throwing a party each time one of them dies.

  2. I’m pleased at the outcome. We like to discuss Medicaid as a “revenue neutral.” Of course, this is looking at it from the myopic perspective of the state level. That $120 million is paid for by someone – whether through federal taxation or, more likely now, an increase in the $18 TRILLION national debt. We are mortgaging our childrens’ and grandchildrens’ future for the wants and needs of today.

    And “revenue neutral” at the state level assumes the feds will pay its share. The concept that the state will bail if the feds fail to pay is laughable. Once a social program is given to 17,000 people, taking it away will be almost impossible. Make no mistake, this is permanent, whether the feds pony up or not.

    I am also skeptical that denial of this will cause 111 deaths in Wyoming. Forgive me if I don’t put much faith in the DOH which has a vested interest in pushing the medicaid expansion. While preventative care might suffer, acute care is given at any ER in Wyoming, regardless of payment (or non-payment) method.

    And finally, yes, utilization matters. When you look at our incredible healthcare costs, much of it is driven by the fact that the current insurance setups take customer choice and control out of the equation. A good – like healthcare – which is effectively free to the consumer will always be overutilized, driving up costs for us all. This is why adding in things like HSAs are so critical to a successful program. Consumers need to drive at least part of the equation, and they don’t with a pure medicaid setup.

    Sometimes it takes more guts to say “no” than to say “yes”. I appreciate the Senate’s ability to say “no” when our country is facing $18 TRILLION in debt. Sanity has to start somewhere.

  3. Yes, by all means, let’s balance the budget on the backs of the poor. Forget about military misadventures and military expenditures in general, taxing the wealthy and businesses, and bailing out banks without nationalizing them, since those entities can defend themselves. But, the poor, now that’s another story … they’re and easy target, and defenseless. And, all your 17th Century free-market nonsense is out of date. Adam Smith wrote for a whole different time and set of circumstances, a whole different economy in fact, yet conservatives are so in love with the past that they still peddle his economics as reality. You also fail to mention that the U.S gross domestic product is around $16 trillion.

  4. I have been following the Wyoming and national healthcare debate for at least three years and am consistently pushed back to a question of rights. Is being healthy a right or a privilege? It just feels wrong for our society to only provide healthcare for the financially secure and deny health because of insufficient financial status. I can easily find a relationship between health and freedom. Personally, I consider health to be an inalienable right. We are a wealthy nation so it certainly cannot be an issue of cost. It seems to me it is an issue of realigning our priorities.

  5. I think it is time that we (the people in America) have a real debate as to whether health is a privilege or a right. It seems wrong to me that health should be determined by economic status. It seems right to me that health is an inalienable right and healthcare is available to all people. In my mind there is a relationship between being healthy and being free. Therefore, because we are a wealthy nation it is not a question of how we pay for it. It is a matter or rearranging our priorities.

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