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Wyoming Is Safe from Medicaid Expansion – But Could it Rise Again?

     If you think health care is expensive now, wait until you see what it costs when it’s free.
             PJ O’Rourke

Choosing to expand Medicaid is like deciding to marry for the sake of a dream honeymoon when disillusionment is the likely outcome. Fortunately, seven members of the Joint Appropriations Committee rescued Wyoming from a looming and ill-conceived entitlement marriage by voting to strip Medicaid Expansion from the 2017-18 budget appropriations bill.

Governor Mead and other expansion cheerleaders appear blinkered to the facts of reality. Medicaid expansion has had unintended consequences in the states that have tried it and even the able-bodied enrollees who are the subjects of apparent concern on the part of expansion proponents would become losers. The false promise of health care security may tempt hard-pressed people into trading their right to health care choice in return for the false promises of a sclerotic and bureaucratic system. It is a common experience that as people come out of the woodwork to sign up for free care, Medicaid systems with their underpaid providers become so overloaded that access to care deteriorates.

Yet those eager for an entitlement marriage ceaselessly work to sell Medicaid expansion.

Last year a number of expansion bills failed. This year our persistent Governor launched a magic math strategy to try to convince doubters that by expanding a government program, the Department of Health would save money in its budget.

People in Wyoming can be grateful that the majority of those on the Joint Appropriations Committee (JAC) didn’t fall for the spin. Expanding Medicaid might sounds like a good idea, but a light scratch below the surface rhetoric shows a darker reality—a promise of free health care is a promise that cannot be fulfilled.

When the JAC began its discussion of the Health Department’s budget, Representative Tim Stubson from Casper made a global amendment right off the bat. He moved to strip Medicaid Expansion from budget. He gave a number of reasons.

First he said we know that Medicaid expansion will pull people from private market and according to some estimates, that number would surpass 5,000. He also said we have a fragile insurance market in this state, noting the possibility of more health insurance company bankruptcies. Rep. Stubson said he was also concerned about the mechanism and manner of the current Medicaid expansion proposal. He noted that legislation to pass Medicaid expansion has failed year after year, and trying to force it through this way fails to meet the common goals legislators have called for in the past. Those are: a Medicaid system that encourages cost containment; wellness checks; and a work requirement. None of these goals are in this proposal.

Not everyone agreed.

Representative Cathy Connolly (D-Albany) made four points. One of the concerns about expanding Medicaid is whether the federal government will continue to fund it. Rep. Connolly said that although people say they don’t like taking federal funds, we have $1.9 billion in federal funds in state agencies, and we don’t turn back those funds. She did not question the ability of a federal government, already $18 trillion in debt, to continue funding Medicaid expansion, or mention that Congress has already voted to cut back federal Medicaid funding. Also unmentioned went the fact that when federal funds stop, Wyoming taxpayers will be left to pick up the entire tab.

Rep. Connolly then said she’s heard from some of her constituents that they don’t support Medicaid expansion but has also heard from many who do. Third, the notion that able-bodied young men will get free handout is not what she hears or sees. Then she went on to use the governor’s magic math to say we need to expand Medicaid to balance our budget.

But the reality of Medicaid Expansion is this: drawing people into a poorly run welfare program does no good for anyone save the bureaucrats who run the program. It does no good for the people forced to pay for it and no good to the people who become trapped in it. Welfare destroys character and incentives; it destroys the satisfaction of living independently and making life-improving changes.

In the end, most of the JAC agreed that putting Medicaid expansion into the Health department’s budget was the wrong way to go. The vote to take Medicaid expansion out of the budget passed 7-5. Representatives Stubson (R-Natrona), Burkhart (R-Carbon), Harshman (R-Natrona), Moniz (R-Albany) and Greer (R-Big Horn), and Senators Perkins (R-Natrona) and Burns (R-Sheridan) voted to remove Medicaid expansion from the budget. Who voted to keep Medicaid expansion in the budget were Representatives Connolly (D-Albany), Hastert (D-Sweetwater) and Nicholas (R-Laramie), and Senators Wasserberger (R-Campbell/Converse) and Ross (R-Laramie).

Medicaid expansion is out of the budget—for now. In a Medicaid expansion supporter press conference after the JAC vote, Senator Steve Pappas said it is unlikely anyone would bring a Medicaid expansion bill forward this session , primarily because the 2/3 vote hurdle required for passage. However, there are three other ways Medicaid expansion could arise from the dead. First, someone can try to amend the budget bill to put it back in. Second, it can appear as a budget footnote in the Health department’s budget. Third, it can show up in a section 300. Section 300 is the budget balancer section, which usually explains where the money will come from and where it will be spent.

The people of Wyoming must scratch beneath the surface and take a good look at Medicaid expansion entitlement honeymoon proposals, because once the knot is tied, there is no way out.

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Thursday, 23 November 2017

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