Wyoming Rejects Medicaid’s Bad Medicine

by Charles Katebi

With just two weeks remaining in the legislative session, the forces of socialized medicine were defeated, at least for now. After losing decisively in the Wyoming Senate and finding no traction in the Wyoming House, Medicaid Expansion supporters tried to ram this policy through with an amendment to the budget bill. Amendment 31 of HB0001 failed overwhelmingly, with 41 Nays and only 15 Ayes. Supporters cited the jobs it would create as well as increased federal funding for the state of Wyoming.

But the most repeated argument – that expanding Medicaid will lead to greater access to care and fewer visits to the emergency room – is likely the most erroneous.

It is conventional to assume that the simplest path to greater healthcare access is through a greater availability of health insurance. Given that Medicaid already offers health insurance to families and individuals in poverty, the federal government tried to increase access to health insurance by broadening Medicaid eligibility to a wider pool of individuals. This was the primary argument made by supporters of expansion in the Wyoming House of Representatives.

In her defense of Amendment 31, Representative Mary Throne related a story that took place during the previous attempt to expand Medicaid in Wyoming:

"I have a real life story to tell you about a friend from the Northern part of the state she shared with me the day that the Senate killed Medicaid. That afternoon there was a man in Campbell County with diabetes. Not old enough for Medicare, but uninsured. He had stopped taking his insulin because he could no longer afford it any more. Well they had to rush him to the hospital that afternoon because he was in insulin shock.

That's what happens to real people with real lives while we argue about taking money or not taking money from the federal government. It's the right thing to do. We are sent down here to do what we can with the information that we have to make the lives better of the people around us."

Her story stirs concerns. However, if Rep. Throne herself was aware of Medicaid's impact on patients and hospitals she would not want that man from Campbell County anywhere near this federal entitlement. On average, Medicaid reimburses Wyoming doctors for only 84 percent of the cost of care that they provide to its recipients. Without properly compensating providers, fewer providers are serving Medicaid patients and now, Medicaid systematically can deprive the poorest individuals of essential care.

The US Department of Health and Human Services recently conducted a survey of hospitals and clinics that accept Medicaid patients as part of an investigation into the availability of care for those that rely on the program. HHS found that more than half of these providers had ceased serving the program's beneficiaries. These providers were either no longer practicing medicine, no longer accepting new Medicaid patients, or no longer serving Medicaid patients at all. Another study from the New England Journal of Medicine discovered that children on Medicaid were being denied appointments by two-thirds of surveyed doctors. Children with private insurance were only being denied by 11 percent of doctors.

Without access to primary care and regular doctor appointments, Medicaid patients routinely suffer preventable health conditions that force them into the Emergency Room more frequently than even the uninsured. Medicaid beneficiaries on average visit the ER 40 percent more frequently than those without insurance. Economists from MIT and Harvard noticed this disturbing trend while observing the use of emergency rooms in hospitals in Oregon after the state initiated a Medicaid expansion of its own in 2008.

And if Medicaid beneficiaries in Wyoming are currently finding it difficult to access care, adding an estimated 17,600 individuals to this dysfunctional program will only put treatment further out of their reach. Wyoming is currently ranked 9^th among states with the least doctors per residents. Proponents of Medicaid Expansion in the legislature did not stop to consider whether the state's hospitals have the capacity to absorb so many new patients.

The question of whether enrolling individuals in Medicaid will improve their access to health services has been studied vigorously and the data is quite clear. By underfunding doctors, Medicaid deprives society's most needy of healthcare. The House's down vote on Amendment 31 forestalled expansion of a dysfunctional system that should be eliminated in favor of one that can better serve the interests of both patients and providers.