Nate Martin

Wyoming lawmakers have long argued that the state cannot afford to update its Medicaid program to cover low-income residents. They say it’s just too expensive.

It would be a “waste of time” for the Wyoming Legislature to consider, said Sen. Bo Biteman, R-Ranchester, last spring, because “we can’t afford it right now.”

Thirty-eight U.S. states have modernized their Medicaid programs under the Affordable Care Act to extend health insurance coverage to low-income residents. In doing so, these states have received hundreds of millions of dollars in federal healthcare funds and have seen their residents’ health and local economies improve.

But not Wyoming. Even though the federal government would cover 90% of the cost of extending Medicaid insurance coverage to some 24,000 low-income residents, Wyoming lawmakers claim that the state’s budget is simply too tight for us to cover the other 10%, which according to the Wyoming Department of Health would be about $10 million per year.

“We still have to pick up 10% of the tab — 10% of a big number is a big number,” Biteman said.

This is a weak argument to start with: A $10 million investment to receive $90 million is a good deal, plain and simple.

Now, however, a proposal before the U.S. Congress could make the “Wyoming can’t afford to update Medicaid” argument completely bunk.

As part of a COVID-19 relief package that Congress will likely pass, states like Wyoming that have yet to update their Medicaid programs under the ACA can choose to do so and receive a huge injection of federal funding.

In Wyoming’s case, the state would receive about $120 million. That’s on top of what we would normally receive by updating our program like most of the rest of the nation. 

In other words, it would be enough to cover Wyoming’s portion of a 90/10 Medicaid cost split for 12 years.

Or, Wyoming could cover two years of the cost of updating its Medicaid program, and then have $100 million left over to help pare back cuts to schools, healthcare, and other critical public services that are proposed in the Wyoming Legislature’s current budget.

In any case, if Congress passes the COVID-19 relief package with this Medicaid provision in it, no Wyoming lawmaker will be able say, “We just can’t afford to update our Medicaid program” without it being a flat-out lie.

Under the Congressional proposal, states that newly update their Medicaid programs under the ACA will receive for two years a 5% increase in their Federal Medical Assistance Percentage (FMAP) rate. In basic terms: Medicaid costs are split between the state and the federal government. When states chip in funding for Medicaid, the federal government chips in some, as well. The Congressional COVID-19 relief package would have the feds chip in more — in Wyoming’s case, $120 million more — to states that update their Medicaid programs to cover low-income residents.

Congress is likely to pass some form of the COVID-19 relief package by mid-March, when the Wyoming Legislature is still in session. If the relief package includes this Medicaid provision, which seems likely, state lawmakers could vote to update Wyoming’s Medicaid program, extend health insurance coverage to tens of thousands of low-income residents, and completely cover the cost for more than a decade.

Of course, plenty of Wyoming state lawmakers are happy to turn up their noses at free money for healthcare. The Legislature has for years been content to maintain Wyoming’s outdated Medicaid system, under which the state pays 50% of the costs and extends coverage only to people with disabilities or other severe obstacles to obtaining insurance.

Meanwhile, tens of thousands of Wyoming workers don’t have access to affordable healthcare, because their jobs don’t provide it. Our hospitals and health clinics lose millions of dollars each year providing treatment to uninsured people who can’t pay. This contributes to Wyoming’s wildly high healthcare premiums, which discourage businesses from locating here, encourage young people to leave the state, and generally hurts Wyoming and the chances of improving our economy.

COVID-19, of course, has only made matters worse.

It’s one thing for state lawmakers to sneer at free money for government healthcare when times are good. But times are not good. More and more people are losing their job-based health insurance. Meanwhile, the state faces a budget crisis that has the Legislature poised to dramatically cut funding for our local health programs and clinics, stripping bare Wyoming’s already skimpy healthcare system.

Wyoming’s refusal to update its Medicaid program has long been an obvious mistake, whatever lawmakers’ corny excuses. If Congress offers us $120 million to update it, at least state legislators will no longer be able to claim that Wyoming can’t afford it.

(Nate Martin is the executive director of Better Wyoming, an organization that offers “fresh alternatives to the stagnant ideas that have long dominated state politics.” Martin was born in Rock Springs and lives in Laramie.)