President Joe Biden sweetened the deal for Medicaid expansion in Wyoming (and other states that have yet to expand it) with COVID-19 “stimulus” dollars. According to Wyoming lawmakers who have historically resisted expansion, that money “really changed some hearts and minds in the Legislature.” The Wyoming House has now passed an expansion bill, and the matter is now before the Senate.
Here’s what that bribe didn’t change: It didn’t change the fact that Wyoming has a physician shortage. According to Eric Boley, president of the Wyoming Hospital Association, it’s “almost impossible” to recruit family practice physicians to Wyoming’s rural areas. “My facilities are having to pay, in some cases, the 95th percentile for salaries, with sign-on bonuses and really lucrative living expense packages,” he explains.
Nor do the COVID-19 funds increase Wyoming’s Medicaid reimbursement rates, which will limit the number of existing doctors who can afford to accept new patients. Unless Wyoming lawmakers bite that fiscal bullet and permanently raise reimbursement rates across the board, expanding Medicaid will increase only demand—not supply.
The truth is that coverage doesn’t equal care. If Wyoming takes the bait and expands Medicaid, it will crowd out the truly needy young mothers, children and disabled with newly enrolled able-bodied adults.
One Wyoming lawmaker says the state has no other choice.
“I voted ‘no’ multiple times on this same issue,” Wyoming Republican House Speaker Eric Barlow said, “and I’m going to vote ‘yes’ this time, because I haven’t seen any other solution. Nobody’s brought anything forward, and I’ve looked myself.”
He’s wrong. There are alternatives to Medicaid expansion that will provide care—not just coverage—and won’t break the bank.
Let’s look at the case NBC News led with when it when it reported on the Wyoming House’s vote: A woman couldn’t afford her insulin. That’s an important issue, and it doesn’t just affect Wyoming residents, it affects Texans, too.
That’s why the Texas Legislature is taking a targeted approach, with a bill that would establish a safety net for Texans, offering affordable medications to the uninsured. The bill, authored by state Rep. Tom Oliverson, a medical doctor himself, is modeled on a successful program being used in Utah.
It simply doesn’t make sense to expand a massive, cumbersome and deeply flawed Medicaid program. More targeted assistance would have a far greater impact on public health—and our fiscal well-being.
Other innovations, such as broader use of telemedicine in the vast windswept plains and mountains of Wyoming, and incentivizing Federally Qualified Health Centers to care for its rural communities, could remake the state’s health care system.
Medical cost sharing organizations are another alternative. Medical cost sharing provides a less expensive non-insurance market based alternative for non-traditional workforces such as contract workers and the unemployed could benefit. Medical cost sharing is already legal in Wyoming, but lawmakers could explore ways to help it grow.
Texas, like Wyoming, is often criticized for choosing to not expand Medicaid. But the decision is based, in part, on higher-than-expected Medicaid costs and research showing that overall health outcomes have not improved for expansion populations.
Instead of expanding an ineffective, bureaucratic program, Wyoming lawmakers should look to state-based initiatives targeting access to health care.
Like Texas, Wyoming can seek solutions for affordable drugs, affordable health coverage, price transparency, and other options that put patients in charge of their own health care decisions, and that give them peace of mind.