Archive | February, 2014

Medicaid expansion

Wyo House leans into expansion

Endorses Medicaid waiver process for 2015

Millions in 2014 funds left on table but 18,000 may see insurance in 2015

Wyoming may yet find a way to take advantage of federal Medicaid funds to bolster the state’s health care system, put millions of federal dollars into communities across the state, and improve the quality of life for 18,000 residents currently without health insurance. But not til next year.
Rep. Barlow, HD3, R-Gillette, offers his Medicaid expansion amendment to the budget bill.

Rep. Eric Barlow offers his Medicaid expansion compromise to the Wyoming House Feb. 21, 2014

Rep. Eric Barlow won voice vote approval for an amendment to the state budget for the 2015-16 biennium that directs Gov. Matt Mead to work with the federal government to design a Medicaid expansion program. It requires legislative approval in the 2015 session, meaning the state will leave on the table more than $50 million in federal funds that would have been poured into the economy in 2014 and early 2015 had the Legislature authorized the standard Medicaid expansion offered each of the 50 states. But Barlow said he wants Medicaid expansion on Wyoming terms. “This is a Medicaid expansion amendment,” Barlow told the House. It calls for developing a Medicaid insurance program for low-income adults without children, a population ineligible for coverage under the current federal Medicaid program. The federal Affordable Care Act (ACA) authorizes expansion of Medicaid to cover additional categories of low-income people. Under the ACA, the federal government will pay 100 percent of the cost of insuring the new enrollees in 2014, 2015 and 2016, with the subsidy decreasing to 90 percent between 2017 and 2020. “This is a demonstration waiver,” Barlow told the House. “It will be on negotiated terms, not government terms.” The Barlow proposal calls for imposing premiums up to 2 percent of an enrollee’s income and requiring co-pays for some health care services. “Skin in the game,” Barlow said, taking the House through each page of the amendment, noting incentives that encourage healthy behavior. “More individual responsibility,” he said, by pushing people to deal with substance abuse, tobacco use, and other health issues. He noted that “nothing goes forward until the next Legislature meets in 2015,” because the amendment requires the governor to obtain legislative authorization to move ahead with the program next year. “There is no automatic expansion,” he said. “There is no appropriation (for Medicaid expansion) in this budget bill.” Rep. Bob Nicholas, HD8, R-Cheyenne, was one of three Republicans who stood to support the amendment. “It gets us heading in the right direction for all of us,” Nicholas said. Rep. Albert Sommers, HD20, R-Pinedale, said the idea means the Legislature will have a detailed proposal that can be evaluated next year. Jackson Rep. Ruth Ann Petroff, HD16, said she wanted to be able to return home and be able to tell constituents that legislators “tried to do something” on Medicaid expansion. There were opponents but only Rep. Kendall Kroeker, HD35, R-Casper, said, “You can take a bad idea and look at it a million ways, it’s still a bad idea.”

Voice vote

The amendment passed on a voice vote. Because it contained no appropriation, House rules did not require recording individual votes on the Barlow amendment. The House approved the budget bill 45-13. It now goes to conference committee where legislators from the House and Senate will attempt to work out differences in the budget bills passed by each chamber. Barlow’s amendment could be lost or saved in a conference committee compromise. The Senate rejected two Medicaid expansion proposals earlier Friday.

Here’s the vote on the budget bill, House Bill 1:

Roll Call

Ayes:  Representative(s) Barlow, Berger, Blake, Blevins, Blikre, Brown, Burkhart, Byrd, Campbell, Cannady, Coleman, Connolly, Eklund, Esquibel, K., Filer, Freeman, Goggles, Greear, Greene, Harshman, Harvey, Hunt, Kasperik, Kirkbride, Krone, Larsen, Lockhart, Lubnau, McKim, Moniz, Nicholas B, Northrup, Patton, Paxton, Petroff, Semlek, Sommers, Stubson, Teeters, Throne, Walters, Wilson, Winters, Zwonitzer, Dn. and Zwonitzer, Dv.. Nays:  Representative(s) Baker, Davison, Halverson, Hutchings, Jaggi, Kroeker, Loucks, Madden, Mader, Miller, Piiparinen, Reeder and Watt. Excused:  Representative(s) Gay and Gingery. Ayes 45 Nays 13 Excused 2 Absent 0 Conflicts 0

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Medicaid expansion

Senate vote on first Medicaid expansion amendment

Amendment 3003 failed on 9 – 21 vote

Sen. Chris Rothfuss, SD9, D-Laramie, today offered an amendment to the state budget bill that would have authorized a staged expansion of Medicaid. The state would have expanded Medicaid under standard rules for the first year. Over the next year or so, it would have required the executive branch to negotiate a waiver with the Center for Medicaid Services that would have established an expansion program designed specifically for Wyoming. The Amendment failed. Here is the vote: Aye: Christensen, Craft, Emerich, Esquibel, Hastert, Johnson, Rothfuss, Schiffer, Von Flatern. No: Anderson, J.D. (SD2), Anderson, J.L. (SD28), Barnard, Bebout, Burns, Case, Coe, Cooper, Dockstader, Driskill, Geis, Hicks, Hines, L There will be votes today in the House and Senate on other amendments to authorize the expansion that will make Medicaid insurance available to thousands of low-income Wyoming residents without children. Individuals in this population currently do not qualify for Medicaid services no matter how low their income.

Senate kills second expansion attempt on voice vote

Late Friday afternoon, the state Senate defeated on voice vote a second attempt to pass a second version of Medicaid expansion that would have delayed insuring Wyoming’s very low-income adults without children until 2015. Sen. Rothfuss brought the amendment, only to see it quickly dispatched.   This post was updated at 4:24 p.m. Feb. 21, 2014.
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