Medicaid expansion waits in the wings of the House | Local News

“I have to go through and find the things that are going to have the most beneficial impact for the state of Wyoming,” he said Friday morning outside the House chamber. “And right now, the jury is very much out on whether or not Medicaid expansion is right for Wyoming.”

Expanding Medicaid has been an emotional topic discussed both inside and outside of the Capitol for nearly a decade, as residents push for better health care options. Rallies have been organized, legislators’ inboxes are filled with constituent emails, and supporters have lined up in recent committee meetings to support the movement.

They’ve asked Wyoming to join the 40 other states in the nation, in addition to Washington, D.C., that have adopted Medicaid expansion under the Affordable Care Act. It would allow any adult in the state with an income up to 138% of the Federal Poverty Level to gain coverage, and the Wyoming Department of Health anticipates there would be 19,000 new Medicaid members by the end of the first biennium.

“When you provide coverage, they can access care in the right place at the right time,” Wyoming Hospital Association Vice President Josh Hannes testified in committee. “The evidence from other expansion states demonstrates, particularly for people with chronic conditions, they can see a primary care provider and they can pay for medications, they can maintain their health, they can go to work. Absent that, they show up in an emergency room, which is expensive, and an inappropriate place for care.”

But it is not a one-sided issue, only backed by anticipation and excitement.

Stakeholders in opposition have also made their feelings known publicly, and some Republican state representatives and senators have expressed weariness. Arguments have been made that it would jeopardize health care providers’ ability to pay for medical equipment and services, turn Medicaid into an unwieldy program and create further dependence on the federal government.

Neiman is among those who question the benefits cited by supporters and said he wants to spend the recent influx of state revenue responsibly. He said he recognizes the extractive industries are volatile, and just a few years ago, he was in the Legislature, cutting millions of dollars for programs.

The Hulett legislator said it was heartbreaking to see programs dissipate, and he has been contacted by those struggling with addiction or mental health issues who no longer have resources available.

He also voiced his doubts the program wouldn’t fall out of control, or begin to funnel money from other areas.

“If you get Medicaid expansion, it really grows, which it’s done before in other states, and it starts to pull money away from education,” he said. “Boy, I tell you, in Wyoming, you start talking about reducing the money going to education, there’s a fire to fight immediately.”

All of these factors have played a role in his decision to hold back House Bill 80, which passed 6-3 out of the House Revenue Committee and was placed on general file in mid-January. Neiman said he doesn’t want to move too quickly on legislation that would “have a dramatic impact on our state in the long term.”

He derives the power to hold bills “in his drawer” from his role as House majority floor leader. He schedules bills on general file for their first reading and could indefinitely push back bills until they are never voted on by the body.

He has until the first week of February to introduce the Medicaid expansion bill to the House Committee of the Whole, which he has let sit near the end of the schedule most days.

House Speaker Albert Sommers, R-Pinedale, has been a recent supporter of expanding the program, and he said Friday that he hasn’t discussed the bottom of Neiman’s list. He acknowledged they both have their own priorities and lists, and there is a significant number of bills up for consideration in the House.

As of Friday afternoon, there were 288 filed House bills and 12 House joint resolutions.

“We’re all going to want our good little bills out, and he’s going to have a challenge,” Sommers said in his office that morning. “… Ultimately, you have to decide how many times you want to go to the mic, and what that impact is on the list of bills. The freshman class will get comfortable with how they want to do that, and there’s no right answer. It’s the body’s will on this stuff.”

Neiman also spoke to the number of bills the body was responsible for, and he said it’s a concern that if a few pieces of legislation take up too much time, necessary bills will be killed. He said the Medicaid expansion debate could take up a day or two on the floor, or it could be over in a heartbeat. But he has had lawmakers express they’re glad they haven’t had to deal with it yet, along with some on the other side.

“I have had a few that are really adamantly wanting to get that piece of legislation out,” he said. “And I’m quite honest, I’m not against bringing it out and letting it out for debate.”

State representatives aren’t the only ones advocating for the Medicaid expansion bill to be heard on first reading. Healthy Wyoming Director Ana Marchese told the WTE they’ve been activating their grass-roots network all week to pressure lawmakers to hear the bill early next week, as well as another piece of legislation related to Medicaid.

House Bill 4 would extend Medicaid postpartum coverage for up to a year and has sat on general file for two days longer than HB 80. Neiman said he is also weighing the impact of the bill and is concerned with providing coverage for a shorter period of time, only to rip it away.

Marchese said the reasons the House majority floor leader has delayed action are only excuses.

“We’ve taken the conservative approach in Wyoming for a very long time, and we haven’t come up with another option. We don’t need to reinvent the wheel,” she said. “Medicaid expansion would bring (tax) dollars back to our state.”

She argued it also would reduce burdens on emergency rooms and rural hospitals and provide coverage to a population demographic in need. More than half of those applying for Medicaid under the expansion would be women, and the state has one of the highest national uninsured rates for women. She said this has consequences for the health of both mothers and infants.

“Medicaid expansion enrollees are often employed in lower-wage industries: restaurants, construction, hospitality, retail. Having health insurance, and being able to take care of your physical and mental health, has a positive impact on your ability to work, which means less sick days,” she added. “Healthier people go to work more, and they contribute to local economies. A healthy workforce is a productive workforce.”

Marchese also voiced her concern for where power is being held, “especially when we have one person who is deciding what bills are best for the state.” She said constituents in Wyoming know what is best for the state, and more than 66% of Republican residents support Medicaid expansion.

The majority floor leader in both chambers scheduling bills is not a new concept, and both Sommers and Senate President Ogden Driskill, R-Devils Tower, previously said they had to make similar difficult decisions during their time holding the position. They said there were bills they never let get to the floor for the well-being of Wyoming, or fear of a debate that would kill legislation under the ticking clock.

Neiman is now tasked with the same role of leadership in the House, and he said he isn’t taking it lightly. He said he loses sleep as he is pulled in different directions.

However, he said there is authority in other places. The House speaker can choose not to introduce a bill altogether, and legislators changed that this year in an effort to balance power. Two-thirds of the body can vote to take legislation out of the drawer, but both the speaker and majority floor leader have veto power in some way.

“That is very daunting,” he said. “The responsibility that comes with trying to do it right.”

He said in the wake of that pressure, there needs to be an emphasis on hearing from legislators and stakeholders. Neiman said it’s been an honor and a pleasure to work with House Speaker Sommers and the representatives, and he has appreciated their decorum.

He said they are all working together to do the best for the state, and he reflected on what a fellow lawmaker told him. His colleague told him if individuals just let legislation out of the drawer without thought, they could have broken the state years ago.

“Because of good leadership, and a willingness to make hard decisions, and to do what is maybe not as popular, but is the right thing to do,” Neiman said. “He said, ‘It’s been a blessing to the state.’”