Rep. Marti Halverson - September 2016
Medicaid Expansion is Not Good for Wyoming Citizens.
In 1965, Medicaid was designed to help poor pregnant women and their small children, the impoverished elderly and the disabled – the truly needed among us. (1)Under original Medicaid, Wyoming pays 50% and the federal government pays 50%.
Under the governor's proposed Medicaid expansion – able-bodied, working-age, childless adults can enroll, with only an income test. This has resulted in able-bodied adults dropping private insurance to enroll in "free" Medicaid. Once enrolled, they compete with the truly needy on old Medicaid.
The federal government has promised to pay 100% through 2017.
Why does the federal government want to pay 100% for this population, but only 50% for the population for whom the program was originally intended?
After 2017, their promise is vague. What is not vague is the plan to roll the new Medicaid expansion population into "old" Medicaid – at the 50/50 rate. It is a fact that the Obama administration has twice (2011 and 2013) attempted to renege on its funding promise, proposing new "blended" partnerships with the states in which the federal government pays less and the states pay more.
Under Medicaid expansion, there is no material work requirement. Premium payments or co-pays by new enrollees are not allowed by federal government. Isn't that welfare? In 2014, Wyoming attempted to work with the Obama administration to developing state-specific rules for new enrollees. To no avail. Medicaid does NOT improve health outcomes – proven. (2) Medicaid expansion is busting state budgets everywhere it has been implemented – proven. There is no statutorily fixed source of federal money – the federal share can be cut or can end at any time. The feds have no legal obligation to Wyoming to pay their share.Wyoming does not have the money to carry the load financially when federal payments decline or cease.
But once in, Wyoming cannot withdraw from expansion – no matter whether the federal government pays or does not pay. (3)Federal revenues are at all-time high, but the federal deficit will be $580 billion this year. Medicaid expansion does not use "taxpayer dollars" – it uses "borrowed" or "printed dollars". Most of the borrowing comes from Medicare - $716Billion and counting. The federal government is $20 TRILLION in debt. The federal government is broke!
If we monetize the country's debt, the USA is borrowing half of every dollar it spends – and we are quickly running out of collateral (unless you count the federally-owned public lands). Think the paltry 12% risk corridor payment to WINHealth was bad? Think of it as a sign of things to come as the federal government struggles to meet its obligations to its state partners. Enrollments in expansion states have been wildly underestimated – they have exploded past projections in every state. If Wyoming's projected enrollments are low by even 20%, our state will end up with fully 25% of its population on Medicaid. This is unaffordable and unsustainable. (4) Doctor reimbursements are low in expansion states vs. private insurance, so doctors are not taking Medicaid patients, resulting is less access, not more. Charity care debt is not falling under Medicaid expansion – it is rising as PPACA enrollees are unable to meet their huge co-pays and deductibles. Emergency room use is going up, not down, in expansion states as fewer and fewer healthcare providers are willing to accept lower reimbursements. Wyoming used to have a very generous provider reimbursement schedule. Due to our state's reduced mineral revenues, reimbursements are being cut NOW – without Medicaid expansion. Governor Mead has been asked to explain why the dismal experiences if every other expansion state will not be repeated here. He cannot. Even the famous "Arkansas Plan" expansion, under a more flexible 1115 Waiver, has been such an expensive disappointment that its legislature has formed a task force to plan dis-expansion. One justification for expanding Medicaid is that "Other states are getting the money." This is 100% false. Does anyone think that Colorado is taking on more Medicaid enrollees because Wyoming has not expanded? Nonsense. In 2016, the governor's proposed Medicaid expansion took funds earmarked for mental health and substance abuse programs. Forbes magazine has reported that the promised new healthcare jobs in expansion states have not materialized.
(1) Many of Wyoming's physically and developmentally disabled, and those with acquired brain injury, are still languishing on waiting lists for Medicaid services available in their communities.
(2) The five-year Oregon study found no difference in the health outcomes between Medicaid recipients and patients with no insurance.
(3) Legal opinion memo available on request; the author has testified across the nation and will testify in front of the Legislature if asked.
(4) A few examples of actual enrollments vs. projected enrollments: California, 284%; Illinois, 172%; Colorado, 207%.
