by Charles Katebi

After seeing Wyoming's Hospital Association fight tooth and nail for Obamacare's Medicaid expansion, you'd think Medicaid expansion left hospitals in other states flush with cash. The reality is that Medicaid expansion has significantly cut hospital compensation, resulting in longer wait times and less services for the very patients it's intended to help.

Like in Wyoming, hospitals in other states assured legislators that enrollment would be low and that expansion would ultimately save money by improving health outcomes for patients. Things didn't pan out that way. Instead, Medicaid's enrollment exploded far beyond expectations, blowing huge holes in state budgets that legislators had to fill, and leaving many patients waiting for care.

To plug these holes, states aggressively cut payments to hospitals. For example, after Connecticut enrolled 64,000 more individuals than expected in 2014, Governor Dannel Malloy slashed hospital reimbursements by $192 million to address the program's growing costs.

Alaska also expanded Medicaid last July and has already become a fiscal headache for taxpayers. Now Governor Bill Walker is calling on legislators to slash Medicaid payments by $100 million between now and 2017. These cuts will hit a number of hospital programs, including ones for children and adults with developmental disabilities. When Medicaid expands to able-bodied and childless adults, it's the most vulnerable that lose out.

With such limited access to doctors, Medicaid patients often develop conditions that go undetected and untreated until it's too late. After surveying cancer patients, doctors at the University of South Florida found that Medicaid patients were 31 percent more likely to have late-stage breast cancer and 81 percent more likely to have late-stage melanoma than patients without any insurance at all.

Medicaid has always expanded at the expense of patients and hospitals. After New York State shortsightedly expanded its Medicaid program in the early 2000s, it began aggressively slashing hospital payments. Between 2008 and 2010, the state cut Medicaid's funding to the New York City Health and Hospital Corporation, or HHC, by $240 million. Faced with falling revenue and growing numbers of Medicaid patients, the HHC cuts its workforce by ten percent.

These Medicaid-induced job cuts have proven to be downright fatal for patients. In 2011, a 33-year old pregnant woman died from a cerebral hemorrhages at the Woodhull Medical Center in Brooklyn after no one noticed she was having seizures. According to court testimonies of four doctors, the hospital was far too understaffed to provide adequate healthcare to patients.

In recent years Medicaid had grown so out of control that states across the country were slashing hospital reimbursements. An extensive review of state Medicaid programs by the Kaiser Family Foundation found that 28 states cut or froze hospital payments in 2011 and a total of 40 states restricted reimbursements in 2012.

Yet despite Medicaid's untenable fiscal situation and harmful impact on patients, 31 states expanded Medicaid yet again under Obamacare, putting hospitals and patients further at risk. A report by the Kentucky Hospital Association estimated that the state's hospitals lost $1 billion as a result of Medicaid expansion, and expects to lose a total of $7 billion by 2024. With these looming cuts in mind, hospitals are scaling back. A hospital survey found that Kentucky's hospitals have shed 7,700 positions since Kentucky expanded Medicaid in 2013. In addition, four out of ten hospitals have cut back whole divisions, including wound care clinics and surgery departments. And two hospitals have shut their doors entirely.

With fewer hospitals and doctors available, Medicaid's patients have to wait longer for treatments as their health deteriorates. A 2014 survey by Merritt Hawkins found that Medicaid patients have to wait 17 days on average to be treated by a doctor. But in some cities, they could wait as long as six months. Is this the kind of healthcare we want for Wyoming?

Wyoming's patients and providers should breathe a big sigh of relief after legislators rejected Medicaid expansion. Wyoming's Medicaid program pays hospitals some of the highest reimbursement rates in the country because we prioritize care for the vulnerable and indigent, rather than treating all comers alike. Expanding Medicaid's coverage to able-bodied and childless adults only leads to less healthcare access for everyone.