R.J. Kost

There were two attempts to pass Medicaid expansion in the Wyoming Legislature’s recent session, and two failures. 

But all is not lost for those who support the measure, because it is on the list as an interim topic for the Revenue Committee. Sen. R.J. Kost, R-Powell, said that means any bill will have to start in the House, because it includes income to the state. He spoke Monday about the measure and what it could mean to residents in a certain category.

That category includes about 25,000 Wyomingites who currently don’t qualify for Medicaid but can’t afford health insurance. These are the people the expansion would assist, making them eligible for Medicaid.

“I’m not knocking them, because anyone in their situation would do the same,” Kost said. “They wait until their illness is very serious, then they go to the ER.”

Because he serves as the president of the Powell Valley Healthcare Board of Directors, Kost well knows that the emergency room is the most expensive way to seek treatment at the hospital. 

“This is detrimental to the state if it has to write them off and it is detrimental to the patients because it has gotten so serious,” Kost said. 

The Medicaid expansion could allow those patients to look at their health care from a different perspective, Kost said. “We want to help them learn what to do to help them help themselves health wise.” 

The expansion essentially changes how recipients qualify for Medicaid. In every state, eligibility is based on how many are in the household, whether any of those household members are disabled, income and other factors. Under expansion, income is the single qualifying factor. Generally speaking, in states with expanded coverage, those with an income less than 135% of the federal poverty level qualify, although Alaska and Hawaii have different income limits. 

For the lower 48 states and Washington, D.C., that means $36,156 annual income for a family of four or $3,013 per month income for that same family of four.  

“Medicaid expansion would allow from 22,000 to 25,000 folks to qualify for coverage,” said Eric Boley, president of the Wyoming Hospital Association. “Most of those folks are single moms with one or two kids who are working multiple jobs,” Boley said. “This will allow them to seek health care in an appropriate setting and seek preventative care as opposed to going to the ER.” 

Fears in conservative states — like Wyoming —  are that once the expansion is in place, it is carved into stone. If the federal government should back out of its agreement to increase the amount of support it supplies to the state for expansion, legislators fear it could mean the state is left holding the bag.

“There’s this hangup, that once [a state] is in it, they can’t get out [of expanded coverage],” Kost said. “It just is not true. But there is a political hangup, because it’s turning your back on 25,000 people if you back out of it.”

The bills that were presented and failed to advance included language that states if the federal support drops, the state isn’t obligated to continue to cover the additional costs. “If the federal funding drops, we can step out of it.”

In addition, Kost points out it is better for the patients.

“They come in very sick and can’t afford to pay [the bill] and the hospital has to write that off,” he said.

Powell Valley Healthcare tallied nearly $372,000 worth of bad debt in February, for a total of $2.5 million since July. 

“And all hospitals end up having to do that,” Kost said. This increases the cost to the State Department of Health.  

If the measure is adopted, the state could benefit from healthier, more productive residents as well as the reductions in bad debt written off by hospitals. 

“Rural hospitals, especially, are really struggling,” Boley said. “They are seeing an increase in bad debt and uncompensated care.” That care, Boley said, is somewhere in the vicinity of $100 million per year.

“The state could gain money, not lose it,” Kost said.  “That money from the feds is out there anyway, whether we take it or not. “

The interim study will allow members of the Revenue Committee to learn about the proposal, both good and bad, as well as look into how best to proceed, if that is determined the best course of action. 

“We’re learning from other states how to formulate a solid Medicaid expansion for the people of the state. We’re learning from the mistakes of other [states] and learning what’s good and what’s bad,” said Kost, who largely supports the plan. “It will help people and help the state.”

No Big Horn Basin lawmakers sit on the Revenue Committee.