Thread by @IAmNickReynolds

Good morning all, the #WYLeg is back. Lots of exciting stuff on the docket this morning.

In House Minerals, lots of energy bills this a.m. youtube.com/channel/UCZNA0…

I'm in House Judiciary, but am keeping an eye on Medicaid Exansion in Senate Labor.

Senate Education is also hearing their own school finance amendments. The House Education Committee has already rolled tens of millions of dollars off of their recommendations.

Gonna livetweet Medicaid here. @rothfuss is sponsoring the bill and presenting it right now. Notes 38 states (plus D.C) throughout the country have expanded Medicaid, and none have chosen to undo it.

Basics, 50% federal match but, because of the CARES Act, we could get more.

A recent policy brief by @healthywyo says we could gain $120m over the next two years under a stimulus bill being considered by the feds, covering 25k people at no cost to state.

We've deferred $500 million in not expanding since the ACA passed, he says, mostly on low-income.

This legislation would take advantage of a provision in the House and Senate version of the bill in Congress (here: wyoleg.gov/Legislation/20…) that would give states that hadn't expanded Medicaid to receive a +5% on their FMAP to the non-expansion population, Rothfuss said.

Said that it's a federal enticement trying to guide our actions, and that we haven't been bashful about taking free federal money before.

"Expansion for the next two years is a net revenue increase to the general fund of $80 million for us to expand medicaid for the next two years while simultaneously covering the healthcare costs for 24,000ish Wyomingites," Rothfuss said.

Said there is concern that we might be lowballing the estimates, but we now have 39 data points, meaning our estimates are likely better.

Said if FMAP drops below 55%, we would drop expansion. Which is a raw deal for us -- it's based off of a mean household income for the state, and ours is pretty high. Some are up to 70%.

Passing this bill would put the onus on Congress to change that and make them take action.

But this bill would leverage them -- if they don't change the formula, thousands of people who briefly gained healthcare coverage would then lose it after two years.

From how I understand it, by passing this bill, we could stand to gain tens of millions of dollars each year.

Hutchings has qs. Says she's not enticed by the federal dollars, and is nervous it will be debt-funded.

"Where in the world is this money going to come from?" she asks.

But Rothfuss notes we've paid taxes and fees to support this since the ACA was passed, and continued to.

"They are our dollars," he said. "We've just sent them elsewhere." Said these programs are deficit-spending undoubtedly, but Medicaid expansion in Wyoming will not cure or exacerbate that, and states like Texas and Florida are looking at billions of free dollars.

"That's just not the culprit when it comes to the debt of the country," he said. "There are lots of things you need to solve before you get to this."

"For the whole time I've been in the legislature, the hc circumstances has gotten worse," said Rothfuss, noting rising challenges. "This legislature has done nothing in response to those challenges... I'm looking for solutions -- I say that each year -- and am met with silence."

"If there are better ideas than receiving back the taxes we paid on legislation we may or may not agree with to support the people of Wyoming... if there are better ideas, then bring them," he adds.

Adds he gets Wyoming is reluctant to accept federal money. But that we may not be in a situation to turn down.

"We're at a time now when we're trying to stimulate the state's economy but at the end of the day.. it's going to our economy. That's helpful in an economic downturn."

If you're following along, here's the latest Medicaid expansion estimates from the Wyoming Department of Health. health.wyo.gov/wp-content/upl…

Said there could be some concern that we could potentially expand and then, lose capacity if nothing is done in the next two years. But it's unlikely that would happen.

"I see no downside," said Rothfuss.

Sen. Fred Baldwin estimates this is the seventh time that they've debated Medicaid Expansion in his time in the Legislature.

You could say this is a well-vetted proposal at this point...

Jesse Springer of the WDH says this level of resource for two years would make the state and people w/o healthcare better off for the next two years. Said that there would be a surge to address pent-up demand for healthcare services, and that costs would normalize after 2 years.

LSO staffer says there are 40 people in the queue to testify, currently. Wow.

Dasa Robinson of Enroll Wyoming says she's worked with people who were injured in crimes, domestic violence and were unable to get healthcare coverage -- costs which go directly to the hospitals.

But there's more to it.

"When you put a victim in that kind of problem of trying to make bills on top of what they've been through, it's hard to get them through that victimization," she said.

Adds there's a huge blindspot in the state's current healthcare coverage area right now.

Josh Hannes and Eric Boley of the Wyoming Hospital Association say they've been working this topic for nearly a decade. Level of income to qualify for this would be about $24,000 for a family of two and, if expanded, this would mostly cover single mothers with children.

Said this population (which comprise 60% plus) either don't make enough to qualify or can't afford the premiums of the other ACA plans they do qualify for.

That has impacts.

"If they don't have insurance, the front-door to care becomes the emergency room," Hannes said.

Hospitals typically provide $100m+ in uncompensated care every yr, which takes away from equipment, upgrading facilities, or paying staff.

Notes that states that have expanded haven't done away with it and it's not only "the right thing to do," but we can afford it now.

Boley said there has been a constant fear the government could change, but notes through two administrations, "The government is invested in this, and we keep turning away from this opportunity to help out our neighbors."

Said it's an unfounded belief they could change course.

"This isn't giving a handout to people," he said, "it's giving a hand-up."

Notes that with downturns in energy, "We're dealing with a different population than we were seven or eight years ago," and they need help now to get back on their feet.

Sheila Bush, Wyoming Medical Society, reiterates the society is in support of expansion and, while healthcare in this country "isn't perfect," expansion has helped to improve situations for patients. Ultimately leads to lower costs and burdens by shifting people to primary care.

"It's a way to have patients create an established relationship with a provider when they can address those problems when they occur," she said. "Our system isn't developed to allow the working poor to address those conditions. It incentivizes them to wait."

Sen. McKeown asks "when does it end?"

Says in 2008 he bought a grocery store and offered health insurance and then the ACA came along, and he couldn't offer health insurance.

"While I think this is a great plan, my question is what are the strings that are attached?" he asks.

Said he doesn't want socialized medicine. "Are we going to have federalized hospitals?" he asked.

Bush said this is "one small step" toward something bigger, and is in no way going toward socialism.

"With the resources we've been given, how do we hold our state together in this crisis, how do we support healthcare. Is it perfect? No. But it's the best answer for us.

McKeown said he's not against that spirit or the bill, but calls it a "slippery slope."

"At what point do we say enoughs enough?" he asks.

But Bush said the current system has already forced our hand -- having to cope with an already inefficient and clunky system.

"This is a means to start to fix it. It may be a roundabout way and it may run counter to core beliefs, but I do believe it's there," she said. "It's already a system where we pay for those services. This is just a way to do it in a more affordable and humane way."

Nate Martin of @BetterWyoming sharing his own personal experience of watching family make the choice between food and medicine. "I've been watching this happen for the rest of my life in Wyoming," he said.

Said you can have ideological stances against it, and he gets those. But it's about perspective.

"I don't want socialized medicine," said Martin. "But if you don't have insurance, you want something."

"it's not the perfect solution, it's not the end game, but people are dying right now," he said. "Those 24,000 people are the people who have to choose between getting sick or putting food on the table."

Said every time they turn down Medicaid expansion, it says "I got mine."

Bouchard says he "gets the push," but named one instance of a Medicaid fraud case that made him nervous, and that he doesn't like the ACA.

"I just don't want top-down medical care anymore," he said.

Named a bad experience he had with a doctor, but not sure how it relates.

Says we're throwing money at a problem, doing nothing to control costs.

"We have a lot of power to stay at-level here and fix things, but we're not doing it," he said.

Martin said we're not actually throwing money at it. We're paying and getting nothing back.

Public comment over. Rothfuss now pushing the committee to at least hear it on the floor. Noting the current HC system has a lot of flaws we will struggle with.

But...

"We're taking a principled stand against the poor hand that's being given to us with the feds -- not with our own access but with the lives of 25,000 Wyomingites that don't have the luxury of sitting here today having this chat," Rothfuss said.

"Those are the lives we're playing with, and we've offered them nothing for the last decade."

Bouchard says he's heard a lot of people wanting "socialist healthcare." Said that everytime the government is involved, healthcare gets worse, and doesn't want to go there.

Said they could look at what our healthcare costs really are. But that today's convos were a "red flag."

Sen. Furphy, who served on a hospital board for eight years, said they worked hard to control healthcare costs. But those went "far beyond" what this bill sought to address, and dealt with a lot of uncompensated care in their system, putting pressure on the hospital and insurers.

"We for now need to take care of these 24,000 people who have no care in our state," he said. "If it becomes too onerous, we can back out of this."

Pushing for this to at least go to the floor.