In the five years since former Gov. Matt Mead began championing expanding Medicaid in the state, much has changed – including the state’s finances and the Affordable Care Act itself.

What has not changed is that over 19,000 of the state’s poorest adults could be covered if the Legislature voted to expand Medicaid coverage to residents living below 138% of the federal poverty line. This session, state lawmakers will again have a chance to do just that.

The very day that President Donald Trump was sworn in, he signed an executive order instructing administration officials “to waive, defer, grant exemptions from, or delay” implementing parts of the Affordable Care Act, while Congress got ready to repeal and replace President Obama’s signature health law.

Under Trump’s leadership, two major changes have changed the complexion of the law: The individual mandate was repealed, and states were granted permission to add “work requirements” for Medicaid beneficiaries.

In addition to changes to the ACA, Wyoming’s financial picture continues to change – and not for the better. While some were optimistic that the current downturn is part of the normal Wyoming boom-bust cycle, it’s becoming apparent that the state’s finances are bound for a more foundational change. The state has already watched over a half billion dollars of Medicaid expansion funds float on by. Those Medicaid funds are our federal tax dollars, paying for expanded Medicaid coverage in 35 other states.

True, expanding Medicaid does come with a price tag. Wyoming would pay 10% of the costs associated with expansion, about $18 million in the first two years, according to the Wyoming Department of Health. The federal government would pick up the other 90% of the cost – approximately $162 million – under the ACA. While adding $18 million to the state’s budget is nothing to sneeze at, consider that the Johnson County Healthcare Center had nearly $10 million in write-offs last year. Statewide, hospitals have taken on more than $100 million in uncompensated care annually, according to the Wyoming Hospital Association.

The hospital association acknowledged that expanding Medicaid would not solve every cost issue, but reducing write-offs would be a good start to improving the financial outlook for small, rural hospitals.

The Legislature’s most potent argument against expansion is that federal funds might be cut, leaving the state to shoulder more of the cost. This scenario is certainly possible, and if it were to happen, the Legislature could also revisit its Medicaid commitment and even leave the program.

Fear of possible changes to the program is not an adequate excuse to continue to pass on Medicaid expansion.

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