Medicaid Expansion Report from State Puts Revenue at Issue – Important Questions Remain Unanswered

The Department of Health released their final report on Medicaid expansion in Wyoming and enrollment cost projections. Medicaid already covers hundreds of poverty-stricken individuals in our state. But, the Revenue Committee in the Wyoming Legislature would like the full body to consider expanding Medicaid to non-disable, childless adults, over the poverty threshold.

But since this bill comes at us out of the Revenue Committee, let's talk revenue. This committee is producing a financial detriment to the State of Wyoming, not a revenue maker. The Department of Health estimates that Medicaid expansion will cost the state at least $18 million in the first biennium and could cost as much as $30 million (described in the report as the "non-negligible probability"). This doesn't make us revenue at all, it costs the taxpayers. The reason? So the self-described "working poor" can have access to healthcare cheaper than they would through the open market.

But the report by Department of Health shows that in states that expanded Medicaid, "…physical health markers did not improve by any statistically-significant degree." Also, "there was no statistically significant evidence that Medicaid expansion changed employment status, earnings, or receipt of government cash benefits (e.g. TANF, SSI/SSDI). This research demonstrates that Medicaid expansion would be a hand-out not a hand-up to get individuals out of poverty and health situations. This would only be a huge state financial burden, controlled by the federal government and not contributing notable benefits to our citizens, but at the significant cost of taxpayer dollars.

Another troubling aspect of Medicaid expansion is the tie to the federal government at play. Make no mistake, Medicaid expansion is a program of the Affordable Care Act ("ACA"), that we all know from experience – thanks Obama, it's not affordable at all!

Small businesses united in opposition of Medicaid expansion. With 300,000 business members nationwide, and 2,500 just in the state of Wyoming the National Federation of Independent Businesses ("NFIB") membership ranges from health care providers, to mechanics and oil field workers, and even in high tech manufacturing. But the message they are all sending is clear – they do not support Medicaid expansion because the federal reimbursement could end in the near future and the certainty of yet another state obligation for services to employable, able-bodied, childless adults will require business owners and taxpayers to foot the bill.

The report is clear that, "…the federal match could be as low as the usual 50%". The state of Wyoming can't even come up with the 10% needed in 2020 without cutting mental health and substance abuse treatment programs that were already slashed significantly in the Matt Mead era. What critical programs would be cut after that to accommodate an additional 40% and is it worth those cuts to ensure able-bodied, childless adults above the poverty cutoff get free healthcare? The report discusses the profile of an average Medicaid expansion recipient saying, "the vast majority of people [Medicaid expansion recipients] are high school graduates, and that most 56% have at least some college education". Additionally, about half will be in the workforce and half will be unemployed.

This decision could jeopardize the stability of a Wyoming economy. In a time where we should be helping small businesses take off to organically diversify our economy, we should not be burdening them more. For this reason, healthcare coverage is in the top 3 issues NFIB monitors pursuant to their membership polls and surveys.

One of the biggest problems from a revenue standpoint is the conceded "uncertainty" by the Department of Health analysts. It is known that the subsequent biennial appropriations will be necessarily larger than the first. The statisticians say, "we anticipate approximately 19,000 new Medicaid enrollees by the end of the first biennium". A big unknown is the possible projection that 32,000 people could be enrolled at the 24-month mark. Also predicted, is that 50% of the Medicaid expansion recipients would be employed! As the report notes, "experience from other expansion states has shown that actual enrollment has often exceeded original projections."

Some doctors and small businesses express concern over the lower Medicaid billing rates that will flood their business, increase waits for care times, and change the very way they do business and the amount of money they can make. Medicaid rates are lower than commercial rates, and that is undisputed.