Maybe state lawmakers who want to give Wyoming hospitals money to help cover their uncompensated care costs should quit. It seems the harder they try, the less money their colleagues are willing to appropriate.
If this trend doesn’t stop soon, the hospitals will end up owing the state money.
When Senate File 145 was introduced, it contained $10 million to be distributed to Wyoming’s 26 hospitals. The Senate reduced it to $5 million and sent the measure to the House, which briefly added $1 million Tuesday before opponents successfully passed an amendment to drop the total to $1 million.
Rep. Elaine Harvey (R-Lovell), chairwoman of the House Labor, Health and Social Services Committee, sponsored an earlier amendment that would provide $1 million to hospitals through a grant program, in addition to the $5 million the Senate OK’d. It passed the House.
But Rep. Mike Greear (R-Worland) came back immediately with an amendment that stripped Harvey’s changes from the bill, and made the $1 million grant program the only source of funds available.
Unlike the Senate’s bill, which made funds available to all hospitals, Greear’s amendment makes the money only available to the state’s smallest acute care hospitals with the largest amounts of charity care — and only if they apply for and receive a state grant.
If SF 145 leaves the House with Greear’s changes intact, a joint conference committee will need to find a compromise both chambers can accept. If they don’t reach an agreement before the Legislature adjourns, the bill will die and no additional funds will go to hospitals.
Lawmakers could have avoided this problem entirely if they had passed Medicaid expansion, which would have provided the state an estimated $125 million a year to help cover 17,600 low-income adults who are now uninsured. But the Senate rejected the program’s expansion by an 11-19 vote, and an attempt by House members to add it to the state budget bill failed, 15-41.
On Tuesday during the bill’s second reading, Rep. Bob Nicholas (R-Cheyenne) said he does not believe the vast majority of hospitals need the money. He said he began adding up the amount of new construction at hospitals in the past three years, and stopped tabulating at $330 million.
“In [Laramie County] alone it was $100 million,” Nicholas said. “The idea we have to do this because somebody is going to go out of business or is not going to care for anybody is simply incorrect.”
He maintained hospitals in Wyoming all calculate their costs differently, which leads to large variations in their total uncompensated care. “Do we really know if they’re not getting funded 100 percent of their costs?” he asked. “Of course not, because we don’t know what their cost is versus another hospital’s costs.”
Nicholas said the Wyoming Business Report in 2013 had an article about how all of the state’s hospitals are doing well and many are expanding. “They said it’s one of the great things about Wyoming, that we’re able to fund it all,” he recalled. “And yet here today people are saying we’re trying to stop [hospital] doors from closing.”
Nicholas acknowledged “one or two hospitals” do need money, and said the $1 million grant program will take care of them. Giving money to hospitals that don’t need it “is sending the wrong signal about what we want to do,” he said.
Rep. Marti Halverson (R-Etna) maintained all critical access hospitals in Wyoming and throughout the nation calculate their uncompensated care the same way, using a federal formula. Harvey said the reason there is a wide difference in the hospitals’ total amounts is because some facilities have more low-income patients than others.
Halverson blamed federal regulations as the reason why some smaller hospitals needed to expand their facilities, even though they had to spend reserves and borrow money to do it.
Rep. Mike Madden (R-Buffalo) said the state “doesn’t have enough money to be throwing it around indiscriminately.”
“What we’re doing is passing out money according to the biggest number that we can find here without any regard to whether they need it or not,” he added.
Rep. Allen Jaggi (R-Lyman) took umbrage at Madden’s comment about the state’s lack of funds, given how much the Legislature has just spent for the state’s supplemental budget needs.
“If you’re going to be scrutinizing this amount of money [for hospitals] that are providing services to people all around the state, I would like to look at the agencies we’re funding, the colleges, the university, [with] that same scrutiny,” Jaggi said.
The chairman of the House Appropriations Committee, Rep. Steve Harshman (R-Casper), continued his opposition to the $5 million for hospitals that he led on Monday during the bill’s initial reading.
Harshman said he backed Greear’s amendment because “it kind of zeroes in on the hospitals most at risk.” He also said he would like to see rural hospitals work together to centralize their services on a regional basis, but believes it won’t happen because “everyone’s worried about their own territory.”
“I just worry this bill comes in and we can say that we did something [for hospitals] because we didn’t expand Medicaid,” Harshman said, noting Medicaid costs were split 90 percent federal, 10 percent state. “That’s what these hospitals really all want, and we said no to that, and I think we’re trying to do something now that, frankly, I think makes us feel a little better.”
“This [amendment] is a solution to help keep those hospitals from closing their doors. … We have a gaping wound and we’re putting a band-aid on it [with $5 million]; we will at least cauterize that wound for those hospitals that are about to bleed out,” Greear said.