By Jasmine Hall and Carrie Haderlie
Wyoming Tribune Eagle
Via- Wyoming News Exchange
CHEYENNE — Attempts were made in both chambers of the Wyoming Legislature on Friday to amend the 2023- 24 biennium budget to expand Medicaid coverage to more than 20,000 residents without health insurance.
In the Senate, amendment author Sen. Cale Case, R-Lander, tried to appeal to his colleagues by sharing his own emotional experience without health care almost a decade ago. He said he lost his business in his divorce, and, with it, his health insurance. In the same year, he found out he had stage-three melanoma cancer, and the medical bills piled up.
“When you do not have health care, and you face a chronic disease, it can be a devastating event,” he said.
The introduction of Case’s amendment featured a call on the Senate Rules Committee, an objection to its decision and a long-lasting discussion on the federal program. While the Senate split 15-15 on whether to introduce the amendment to the floor, it was allowed.
“This is the time to have courage, to stand tall, to support these people,” Case urged.
But in the end, legislators voted Medicaid expansion down by a 24-6 vote.
Case brought forward the first amendment to the government appropriations bill late Wednesday evening, but the body wasn’t given the opportunity to vote at that time. He was challenged before consideration by the majority floor leader, and asked to either withdraw the addition or adhere to a Senate Rules Committee review.
Case refused, and the proposal was sent to the Rules Committee, where it was deemed unconstitutional in a 3-2 vote along party lines. Sen. Ogden Driskill, R-Devils Tower, said not only was the amendment not an ordinary expenditure of the Legislature, it was an attempt to legislate within the budget.
Although Case accepted the decision, he filed two amendments addressing the topic Friday morning through a new channel of the budget bill. While both additions were within the Wyoming Department of Health’s section of the budget, the first included an appropriation of $177 million.
Of that amount, $32 million would have been appropriated for the program if the state Medicaid expansion plan was authorized. It also gave the director of the Department of Health permission to enter into negotiations with the Centers for Medicare and Medicaid Services to obtain a state plan amendment or federal authorization for expansion of Medicaid eligibility.
Immediately after Case finished telling the chamber of his personal hardship, Sen. Tom James, R-Rock Springs, asked for the Rules Committee to reconvene again. He said the amendment was against the rules for the same reason as the last introduction, which was that it was outside of the bill’s scope.
The Rules Committee voted to allow it to go to the floor for consideration on the basis it involved appropriations in the bill, but James objected.
It became the responsibility of the Senate as a whole to sustain the objection or allow a discussion on the amendment. The vote was 15-15, and the Senate was forced to vote on expanding Medicaid.
“I’m going to vote no on the amendment itself,” Sen. Drew Perkins, R-Casper, said. “But on this, this is about procedure and how we treat each other, and everybody gets to be treated equally on this floor.”
The debate that followed was extensive, but the body ultimately decided to reject Medicaid expansion, 24-6.
“I’m brave enough to talk about this,” said Sen. John Kolb, R-Rock Springs. “I’m brave enough to say what the issue is. And the issue is, frankly, we’ve got a vehicle here that turned into a Trojan horse. We’ve got an issue that we haven’t worked through a process.”
The second amendment was not to expand Medicaid, but rather to give the governor the authority to negotiate a better match rate with the federal government. The hope was for a Federal Medical Assistance Percentage that is equal to or above the combined averages of surrounding states. It was passed by the majority.
“This is Medicaid expansion,” Rep. Cathy Connolly, D-Laramie, said as she brought her own budget amendment to the floor of the House of Representatives Friday afternoon.
Rep. Mark Jennings, R-Sheridan, immediately called for the House Rules Committee to make a decision on the “germaneness” of making an amendment to the budget that would allow for Medicaid expansion.
The Rules Committee came to a split vote, so Speaker of the House Rep. Eric Barlow, R-Gillette, ruled that the amendment was germane. His ruling was immediately challenged by Rep. Clarence Styvar, R-Cheyenne. Legislators voted 30-27 in favor of Styvar’s motion, thus refusing to hear Connolly’s amendment.
Before the vote, a debate about whether an amendment to allow for Medicaid expansion would be even be allowed ensued.
“Wyoming has a bare bones Medicaid program. Medicaid in the state of Wyoming is for waivers and that stuff. This is adding a whole new group to this that this whole body needs to agree upon,” said Styvar, who originally objected to Barlow’s ruling that the amendment should be heard. “The bills failed last time.”
Connolly said that additional federal Medicaid funding would go straight into the Wyoming Department of Health’s budget.
“It goes straight into health care financing. All it does is it increases one of the columns of federal funds, and it adds a footnote,” Connolly said. “It also will end up increasing the general fund. What could be more germane, honestly, than talking about money within an existing program?”
But Rep. Ember Oakley, R-Riverton, said she agreed that Medicaid expansion is significant policy, and that it deserved a full debate.
“We all know that we don’t have time to get that done and do the budget today,” she said, referring to the fact there were other third-reading budget amendments to consider. “There is some gamesmanship at play, but I think we are better off fully vetting big policy.”
Rep. Jeremy Haroldson, R-Wheatland, questioned the constitutionality of debating adding Medicaid expansion to the budget, but Rep. John Romero-Martinez, R-Cheyenne, said that despite constitutionality, access to health care is a civil right.
“It is clear that it is relevant and appropriate,” he said. “It is natural and logical. (Martin Luther King, Jr.) said the last civil right that we would achieve would be health care, and as the minority chair leader said, this goes directly into the Department of Health.”
Case and Connolly took it upon themselves to continue to fight for the amendments after House Bill 20, the “Medical treatment opportunity act,” was never introduced in the House of Representatives. This was due to the fact Speaker Barlow said there weren’t enough votes for it to meet the two-thirds threshold required for a non-budget bill during the budget session.
But according to poll data, 58% of Republicans and 64% of Wyomingites overall support Medicaid expansion. This backing has been shown by constituents and health care advocates through lobbying, campaigns and hosting the largest rally for the cause in the state Feb. 21.
Representatives from Better Wyoming and the Health Wyoming Coalition also said passing the legislation would provide as many as 24,000 residents with access to medical insurance. Positive impacts from this decision would include economic growth and helping businesses retain employees.
“20,000 of our citizens are crying out for help,” Sen. Mike Gierau, D-Jackson, said.
This was the last opportunity during the 2022 budget session for the Wyoming Legislature to expand Medicaid, as the government appropriations bills cross over to the opposite chambers Monday and the deadline to consider new legislation has passed.