The Medicaid Expansion bills are beginning to be introduced in the legislature. So far, there are four bills with various provisions. I’ve attached a chart to help navigate the differences.
To recap, Medicaid is available to citizens in certain categories of disability, age, pregnancy, and a few other qualifiers. It is available to families who make less than 133% of federal poverty level who have school-age children and families who make less than 145% of federal poverty level with younger children.
When the ACA (Obamacare) passed, the Act expanded Medicaid to people earning below 133% of federal poverty level, whether or not they had children. The ACA also required people to have insurance if they didn’t qualify for Medicaid and it created an online marketplace where citizens can shop for insurance and, depending on household income and number of family members, can qualify for a subsidy to purchase insurance.
The ACA was challenged in the US Supreme Court, resulting in a ruling that most provisions of the ACA met constitutional muster, but the court ruled that the federal government could not require states to expand Medicaid. For states that did not accept full Medicaid expansion, this left a sort of “doughnut hole” of people who earned too little to qualify for the subsidized health insurance, but who did not meet criteria for Medicaid.
Arguments in favor of expansion include that the federal government pays 100% of the cost for the first couple of years and 90% after that. Additionally, Medicaid would cover services for some people who are currently receiving state-funded services, so Wyoming would actually save – I’ve seen various numbers – but likely $50 Million a biennium. There are estimated to be 17,000 for people who would qualify for the expansion. This would reduce the burden on our rural hospitals, some of whom are in truly desperate financial condition.
Arguments against include that the ongoing funding is not guaranteed and that once our citizens sign up for the program, it would be extremely difficult to pull the program back, meaning Wyoming could have a huge, possibly unmanageable, price tag down the road. It is argued that a fair percentage of the number of people who would qualify for the expansion are currently insured, so would be taking a cost that is currently being covered by individuals and employers and putting it on the federal government, who cannot afford it. Additionally, some detractors believe there would be an incentive to stay in a low paying or part-time job in order to qualify for this benefit.
The chart below lists the four bills that have been drafted to be considered during the legislative session. Senate File 88, the one on the far left side of the chart, failed introduction in the Senate. The remaining three will have introduction votes in the next two days.