Friday was the day Democratic (and a few Republican) House members got a chance to tell the majority “We told you so.”
It was sweet.
Senate File 145, which would provide $5 million to Wyoming hospitals to help them recoup a small portion of their uncompensated care costs, was being debated. Republican leaders spent the afternoon bitching and moaning about how unjust it is to ask state government to throw money away helping hospitals stay in business, and how we can’t afford it.
No one cried louder or harder than Rep. Steve Harshman (R-Casper), chairman of the House Appropriations Committee, who tried to push through an amendment to reduce the amount from $5 million to $3.3 million.
Rep. Allen Jaggi (R-Lyman) reminded the House the bill began in the Senate with a $10 million appropriation that was cut in half. He said he didn’t understand why reducing it any more was a good idea.
Harshman railed that the very idea of state help for hospitals was “unprecedented.” He urged the body to be careful, because who knows how much the hospitals could come back and ask for next year?
He said it’s unfair for the hospitals not to identify which ones are most in need of help to stay open, and why their fortunes went south. “Is it poor management?” the chairman asked. “We don’t know, because it’s all confidential.”
Except it really isn’t, at least for the first part. Legislators had a handout that showed the levels of uncompensated care each hospital has, so it isn’t difficult to figure out which ones are in the most dire straits. And even if part of the reason is indeed poor management decisions, is the state really going to respond by just watching hospital after hospital close in small rural communities and make residents drive hundreds of miles for health care?
Not if these guys expect to return to their comfortable House chairs in two years.
Rep. Elaine Harvey (R-Lovell) maintained the issue of state assistance isn’t unprecedented, because the state helped hospitals purchase helicopters for life flights several years ago.
“We have done this before,” she insisted.
Harshman responded that the helicopter purchases weren’t the same thing as SF 145 asks for, so it is unprecedented. It was the legislative equivalent of yelling, “Is not! Is not!”
Harvey said the hospitals’ needs are critical — one has only 19 days of cash reserves on hand, while others have 27 days, 51 days, and two have 54 days. In fact, she said, only a single critical access hospital in the state has more than 200 days in cash reserves.
That number is important, Harvey explained, because the number of medical billing codes is increasing from 9,000 to 60,000, and inexperienced coders will cause delays. “The last time this happened, it took 200 days from billing to payment, she said.
As for the conservative GOP line that the state can’t afford the expenditure, Harvey shot back, “We can’t balance the budget on the backs of hospitals.” Strike one!
But supporters of SF 145 were only getting warmed up. House Minority Floor Leader Mary Throne (D-Cheyenne) said, “This bill is already a Band-Aid on a gaping wound. Medicaid [expansion] was the solution, and we rejected it.”
If the Republican leadership of both houses hadn’t insisted on sinking the expansion, Medicaid would have started reimbursing hospitals for some of the care they now give the Medicaid-eligible who can’t afford to pay.
Throughout the Medicaid expansion debate, opponents pretended they were seeking a “Wyoming solution” to the problem of providing health care to the working poor. The state Department of Health negotiated such a solution with the feds when it sought a waiver for a state demonstration project, but the House and Senate flatly rejected it even though it didn’t cost the state a dime.
“If we’re going to look for the Wyoming solution, then we’re going to have to spend Wyoming money,” Throne said. Strike two!
The House rejected reducing the appropriation to $3.3 million. Next up was SF 145 itself. Rep. Eric Barlow (R-Gillette) spoke in favor of the measure, and reiterated that lawmakers had a chance to take care of the problem and adopt Medicaid expansion but didn’t.
Rep. Mark Greear (R-Worland) said hospitals were responsible for putting the state “underwater $1.1 million.” He also claimed the corporate-owned hospital in his district would get $365,000 if SF 145 passes, even though it made a profit last year.
Greear said the bill isn’t the fix the state needs, but he urged moving it to second reading to keep working on it.
Rep. Donald Burkhart (R-Rawlins) was hardly in such a generous mood. “This bill is a mess,” he said. “Kill it now.”
Rep. Ken Esquibel (D-Cheyenne) said he was tired of hearing the claim the state’s budget is “under water.”
“If we wanted to we could transfer $2 billion tomorrow and cover all of the uncompensated care,” he said. “We’ve been acting more like a bank than a government.” Strike three! Game, set and match. [Insert your own sports metaphor here.]
Rep. Stan Blake (D-Green River) stuck in the final dagger: “We put ourselves in this mess, but we decided not to [expand Medicaid],” he said. “We had our shot and we didn’t take it.”
Left unsaid was an obvious truth: While Democrats consistently said “we decided,” it was the majority of Republicans who decided and blew it.
SF 145 passed its initial reading in the House with 30 standing votes when the losers asked for a division after the voice vote. But they will need more support: Passage on third and final reading requires a “yes” vote from a majority of those elected to the House. Sixty are elected, so 31 is a majority.