Nothing is ever really dead in the Legislature, until they turn out the lights on Day 40 and everybody goes back to where they came from.
That goes for Medicaid expansion, which looked awfully dead when the Senate killed the last active bill on the issue. And it probably is, but House members will resurrect it again when they consider the budget bill on third and final reading today.
Amendment 31 to House Bill 1 will be offered by Rep. Dan Zwonitzer (R-Cheyenne). It is basically the SHARE plan that negotiators for the Wyoming Department of Health developed with the Centers for Medicare and Medicaid Services (CMS). If the Legislature approves the plan, Wyoming would officially apply for a demonstration waiver from the CMS to operate an expansion plan unique to the state. The amendment is co-sponsored by Rep. Sue Wilson (R-Cheyenne).
In an email to WyPols late Wednesday night, Zwonitzer wrote, “The conversation/debate was needed on the House floor by the entire House.”
“I do not believe it will pass,” he added. “If it did, I see very little possibility of the Senate agreeing to it. It’s just a chance to get more debate from all elected legislators.”
On Sunday, the Wyoming Tribune Eagle reported House Speaker Rep. Kermit Brown (R-Laramie) wanted to see the members have a full debate on the controversial issue, which it hasn’t had this year. All of the action has been in the Senate, which considered a compromise bill that included a few elements of the SHARE plan, but it killed the bill in an 11-19 vote.
“At least people on our side will have a chance to speak their mind, have their say, have it considered and know whether they’ve persuaded the majority of the body or not,” Brown told the newspaper.
That’s all well and good. And if the House wanted to, it could take a populist stand (as opposed to the conservative “we hate the feds, especially Barack Obama, and we can’t trust any of them to keep their word” stand the Senate has steadfastly adopted) and put Medicaid expansion into its version of the budget bill. The House members would be heroes to the working poor.
Still, it would be an extreme long shot to bet on the Senate changing its mind about a program most of its members seemed eager to kill only a week ago.
Under Zwonitzer’s amendment, the state of Wyoming would agree to accept $54 million from the federal government to fund Medicaid expansion beginning next year. Any waiver negotiated could only be in effect for up to four years without further legislative action, and if the feds’ share of the cost ever dropped below 90 percent, the program would be discontinued.
The expansion program would include premium and cost-sharing by eligible individuals, an estimated 17,600 low-income, childless residents who cannot be helped now by either Medicaid or the subsidies available under the Affordable Care Act, or Obamacare.
A work search and training “benefit” developed by the Department of Workforce Services would be offered by the program. The Senate loaded its bill up with a “poison pill” work requirement offered by Senate Majority Floor Leader Eli Bebout (R-Riverton), who insisted that individuals in the Medicaid expansion program must work at least 32 hours per week. The CMS has never approved a waiver for any state that mandates a work requirement.
Zwonitzer’s amendment includes a provision for the state to create a $1.5 million healthcare reserve account to pay for the administrative costs of Medicaid expansion. The account would be funded by money saved through reduced costs for state agencies because Medicaid would be helping the same clients.
When the Senate killed its Medicaid bill, the House Labor, Health and Social Services Committee scrapped its plan to offer its own SHARE-based Medicaid expansion plan. Chairman Elaine Harvey (R-Lovell) explained there was no reason to work on the bill since the Senate’s overwhelming vote against its own measure would doom anything the House passed.
Harvey is also sponsoring a health-related amendment to the budget bill. Her amendment, No. 4 on the House list of proposed changes, would appropriate $5 million from the state’s general fund to the Department of Health to be distributed to rural health clinics and community-based health centers.
The funds would provide reimbursements for uncompensated care for patients with an income 100 percent or lower compared to the federal poverty level. This is part of the population that would be covered under Medicaid if the state accepts the expansion offered under Obamacare.
A bill already passed by the Senate would provide $5 million to Wyoming’s acute-care hospitals to help reimburse the facilities for uncompensated costs. The Wyoming Hospital Association (WHA) estimated the total amount of uncompensated care for its 24 member hospitals at more than $100 million annually.
The WHA said at least three smaller hospitals in rural parts of the state are at risk of closing if they do not receive immediate help to reduce their uncompensated care, and other facilities might join them.
If the House passes either or both the Zwonitzer and Harvey amendments, the Senate would need to have a concurrence vote on the changes. If it rejects those or any other amendments the House may pass on final reading, a conference committee would have to be appointed to work out the differences.