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Medicaid expansion

Labor panel backs two Medicaid bills

Decision ensures full legislative debate in 2014

Rev. Dee Lundberg of Casper addresses a rally of people who support expanding Medicaid in Wyoming.

Rev. Dee Lundberg of Casper addresses a rally of people who support expanding Medicaid in Wyoming.

In its 2014 Budget session, the Wyoming Legislature again will debate expanding Medicaid to deliver health insurance to more than 17,000 Wyoming residents. The chances for that debate did not look strong until Thursday and Friday of this week, when people advocating for the expansion convinced the members of the Joint Interim Labor, Health and Social Services Committee to advance two bills to the full Legislature. A rally organized Thursday by the Wyoming Association of Churches Thursday brought together about 200 people who heard speeches by Rev. Dee Lundberg of Casper and Rev. Rodger McDaniel of Cheyenne, focusing on the moral reasons for making healthcare available to more people. During the committee hearing Thursday morning, a number of witnesses testified to the need to make Medicaid insurance available to low-income adults with no children. Under the current system, Medicaid is available only to the following categories: aged/blind/disabled; pregnant women; children; and caretaker adults. All categories must be low-income. The witnesses’ testimony about the critical need for access to health insurance echoed comments made by members of the Wind River tribes who addressed the Select Committee on Tribal Relations on Jan. 7 in Fort Washakie. Tribal officials noted that Indian Health Services is under-funded. “We are funded at 45 percent of our actual need,” Richard Brannan, the director of IHS on the reservation. Lack of access to healthcare coupled with chronic disease, behavioral issues, and violence mean reservation residents have an expected life span of just 53 years – lower for men. At Friday’s hearing, Chairwoman Elaine Harvey voted for one of the bills passed by the committee, a version of Medicaid expansion based on legislation passed by Arkansas earlier this year. She said the committee has a responsibility to ensure a full legislative discussion of the issue. “I would hate to think that 12 people would decide for the whole state to not do any kind of Medicaid expansion at all,” said Harvey, R-HD26, Lovell. Advocates for the expansion now must assess the bills approved by the committee and evaluate their strengths and weaknesses.  The Budget session opens Feb. 10. Here are links to the bills: Medicaid expansions – limited benefits – 14LSO0139.C1 (Medicaid Fit) Medicaid expansion – insurance pool. – 14LSO0140.C1 (Arkansas model with modifications) The Casper Star-Tribune reported the votes on both bills: Voting in favor of “Medicaid Fit” were Sen. James L. Anderson, R-SD28, Casper; Rep. Eric Barlow, R-Gillette; Sen. Bernadine Craft, D-SD12, Rock Springs; Rep. Lee Filer, D-HD12, Cheyenne; Rep. Matt Greene, R-HD45, Laramie; Rep. Mary Throne, D-HD11, Cheyenne, and Rep. Sue Wilson, R-HD7, Cheyenne. Voting no were Rep. Norine Kasperik, R-HD32, Gillette; Rep. Lloyd Larsen, R-HD54, Lander; Sen. Ray Peterson, R-SD19, Cowley; Sen. Charles Scott, R-SD30, Casper; and Rep. Harvey. The committee voted 8 to 4 in favor of a bill, called “Insurance Pool,” that would allow the use of Medicaid funds to pay premiums for approved health care coverage offered by the federal insurance exchange. The vote for “Insurance Pool” was the same as the vote for “Medicaid Fit,” except that Rep. Harvey voted yes. Photo credit: Chesie Lee/Wyoming Association of Churches  
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Basic worker issues on table

Labor, Health panel needs attention

Interim work goes to heart of public policies affecting workers

Eyes on Medicaid expansion, unemployment insurance, and job safety

Wyoming workers need to watch what the Joint Labor, Health and Social Services Committee is doing this summer and fall. Over the next several months, this legislative panel is considering Medicaid Expansion, unemployment insurance, and worker safety – all of which go to the heart of public policies that directly affect the lives of workers and their families. During its meeting August 25 and 26 in Lovell, the committee reviewed all three matters. Here’s a quick look: MEDICAID EXPANSION: The state has the option under federal health reform law to extend Medicaid coverage to adults under 65 without children and with very low incomes (up to 138% of the federal poverty line). In the last General Session, the Legislature rejected calls to expand Medicaid, claiming that the federal government cannot be trusted to honor funding commitments in the Affordable Care Act. (Aside: Similar arguments are not made when it comes to taking federal dollars for highways and transportation, education, and other state programs that rely on federal aid.) The Joint Committee heard from the Department of Health, which recently published a report titled “The Wyoming Approach for Medicaid Expansion” laying out five potential plans to expand Medicaid. The committee did not discuss the department’s options. It instead discussed a raw draft of a limited expansion proposal that the state of Arkansas has proposed to the U.S. Department of Health and Human Services. The Arkansas plan includes the use of health savings accounts and requires co-pays for services from people who don’t have much money. “Everybody ought to have some skin in the game,” said Sen. Charles Scott, SD30, R-Casper. Scott has ardently opposed Medicaid expansion. Though Scott suggested he would oppose even an Arkansas-style expansion, other committee members expressed interest. The general support for the Arkansas plan troubled Rep. Mary Throne, HD11, D-Cheyenne. “We’re too excited about this Arkansas plan because it pleases us ideologically,” she said. It seemed to be a suggestion that the committee would prefer to score rhetorical points rather than produce more effective policies. The committee ultimately directed the LSO to draft a bill based on the Arkansas proposal. The committee also asked LSO to draft a bill based on the Department of Health’s preferred option approach labeled “Medicaid Fit.” Meanwhile, Northern Arapaho Tribal Liaison Gary Collins and Tribal Health Department Director Allison Sage asked the committee to take steps to allow the Wind River tribes to seek Medicaid expansion on the reservation through a waiver request to HHS. (The Casper Star-Tribune offers the perspective of Gov. Matt Mead and others here.) UNEMPLOYMENT INSURANCE/WORKER MISCONDUCT: The committee addressed unemployment insurance legislation that was passed during the recent session but vetoed by the governor. The new legislation seeks to define worker misconduct. Under Wyoming law, a worker fired for misconduct can be denied unemployment insurance benefits. A version of the bill passed by the House in the 2013 session was not opposed by advocates for workers. The Senate adopted amendments that significantly changed the bill. They made it virtually certain that employees discharged for inadvertent errors – such as failure to lock a door – could be denied unemployment insurance benefits. Proponents have said the bill mirrors a 1986 state Supreme Court decision that has guided state hearing officers in deciding contested unemployment insurance cases. At the Aug. 26 committee meeting, they proposed amendments stating that a worker must intentionally violate policy or take action contrary to the employer’s interests in order to be found guilty of misconduct. Rep. Throne raised a new concern, however, when she noted the bill does not include a court directive that “(i)nefficency or failure in good performance as a result of inability or incapacity” likewise shall not be considered misconduct by a worker. The committee will consider a new draft of the bill at its meeting in November. WORKER SAFETY: The committee heard a report from the Department of Workforce Services on the Safety Improvement Program. Under the program, businesses can get matching grants of up to $10,000 to start or improve company safety programs or to buy safety-related equipment. More than 45 companies have submitted applications; however, legislators questioned some of the grants, noting that they had gone to large companies with significant resources. (Laramie County School District No.2 is one of the grantees.) The Legislature needs a conversation to consider whether companies that have had a fatality in the last five years or that have been fined for serious violations should be eligible for the grants. Rep. Throne said the grants could be perceived as an “offset’’ to the state fines. It’s not clear when and if that conversation will be had by legislators.  
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