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An uninsured patient visited Dr Gregory McCue’s office in Cody, Wyoming, this week and explained that she could not afford insulin to treat her diabetes. McCue worries that the next time she returns to Cody Regional Health it could be expensive and potentially life threatening.
“This patient,” said McCue, “will end up in the hospital and it will cost us $ 5,000 for a two-day stay instead of the $ 200 to $ 300 per month it would have cost for her insulin. And since you can’t get the blood from a turnip, it’s unpaid care that gets passed on to the hospital and the state.
It’s a weekly event for him in Wyoming, he said, because the state hasn’t expanded Medicaid, an option that could provide health care to thousands of workers in the state.
But that may soon change.
Republicans who have long opposed the measure and Democrats who have long supported it at Wyoming House on Wednesday gathered to embrace the Medicaid expansion, potentially signaling the start of a nationwide change that could provide health care to those within the coverage gap.
Expanding Medicaid has been an option available to states since 2014 through the Affordable Care Act, commonly known as Obamacare, but Wyoming and 11 other states have refused to accept the federal government’s offer. About 2.2 million people, who earn too much for Medicaid and too little for Obamacare grants, fall into this coverage gap nationwide, according to the Kaiser Family Foundation.
In those who refused to expand Medicaid, ruling Republicans argued that their states could not afford to continue with the measure and that their opposition had become more ideological over time. Their positions ignored ample evidence that states that developed failed to shoulder additional burdens and increased coverage saved American lives.
However, the conversation around Medicaid expansion appears to be undergoing a new and dramatic shift in some of the recalcitrant states. At the heart of this change is the Biden administration’s offer, through its Covid-19 relief bill, to increase two-year federal dollars to states that are adopting expansion for the first time. The funding is expected to cover state Medicaid costs for this period.
“It’s the stimulus funds that are really the motivation,” said Sen. Chris Rothfuss, the Wyoming Senate Minority Leader who helped draft the bill en route to the legislature. “I think it really changed some hearts and some minds in the Legislature.”
The window is small for the bill to go through Wyoming. The state Senate has a week to approve it before the end of the session, and Republican Senate leaders canceled an effort in the chamber earlier this month. The fact that this is a conversation with Republican support is significant and the state aid could be massive.
In Wyoming, the Medicaid expansion combined with the boost from the American Rescue Plan means $ 120 million over the next two years and, according to the state’s own estimates, would provide health care coverage to more than 24,000 people. The state has 67,900 uninsured residents, according to data released by the Department of Health and Human Services.
“I have voted ‘no’ several times on this same question,” Wyoming Republican House Speaker Eric Barlow said on the floor of the Legislature on Wednesday, “and I will vote ‘yes’ this time around. , because I haven’t seen any. other solution. Nobody offered anything and I looked at myself.
Beyond Wyoming
It wasn’t just in Wyoming that advocates and heads of state began to see the landscape change when it came to healthcare. Many have noted that Alabama Gov. Kay Ivey’s office said she was “open to discussion” after she and GOP leaders long opposed the expansion, but there is also a new movement among some Republicans in North Carolina, Texas and other states – something many once thought impossible.
North Carolina Republican State Senator Kevin Corbin on Friday announced on Facebook that he was working with Senator Jim Burgin, the chairman of the state’s Senate Health Care Committee, “to present a draft bill in the next two weeks that examines how to expand health care coverage for working families in North Carolina. “This is one of the first public announcements from Republicans in the North Carolina Senate that reported that they were working on some form of health care expansion.
Corbin did not respond to a request for comment, but Republican leaders in the North Carolina Senate said his bill was unrelated to federal incentives to expand Medicaid and could not be considered a traditional expansion of Medicaid.
According to two people familiar with the recent negotiations, however, concrete conversations between Republicans in the North Carolina Senate about expanding Medicaid legislation have progressed more than ever – just ahead of the deadline for filing the North Carolina bill. April 6 in the Senate. But the incentives from the US bailout weren’t the only thing moving the needle, they said.
The office of North Carolina Senate Majority Leader Phil Berger denied such conversations were underway and said Senate leadership had no intention of supporting traditional Medicaid expansion.
“We have over 400 studies showing why expanding Medicaid is a good thing,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University. “It didn’t destroy the budgets of the states that did it, it supported their budgets, it reduced mortality, it improved health outcomes, it supported hospitals – the evidence is mounting . And saying “no” is getting more and more difficult. “
Seven members of the Texas Republican House, meanwhile, signed their names on a bill, drafted by Rep. Julie Johnson, Democrat, that would expand Medicaid. This effort could net billions of dollars for the state with the highest uninsurance rate in the country, according to data from the Department of Health and Human Services, and provide health care coverage at $ 1. 5 million Texans.
“This is the first Republican co-sponsored bill we’ve had since 2013,” said Anne Dunkelberg, who oversees healthcare policy for the Every Texan public policy think tank. “So this is a very big problem.”
While Texas Gov. Greg Abbott and Lt. Gov. Dan Patrick, both conservative Republicans, are unlikely to support a Medicaid expansion bill – which would likely kill the measure – some expect that he sets up a political battle within the Republican Party of the State and the ball. in a major stake in the presidential race of 2022.
In Texas, 69% approve of the expansion of Medicaid, according to a poll conducted late last year by the Texas-based Episcopal Health Foundation.
Abbott hasn’t made a clear statement on the expansion since President Joe Biden’s US bailout was adopted, which some say is revealing, but he has been a harsh critic in the past. Ed Emmett, a Republican who served until 2019 as a judge in Harris County, the state’s largest county, recalled that the Medicaid expansion was a no-beginner in meetings with Abbott.
“Every time a meeting has been arranged with the governor or his office, I’ve been told that if you bring up the expansion of Medicaid, the meeting is over,” he said.
And governors can function as effective bottlenecks for any Medicaid expansion effort.
Mississippi Governor Tate Reeves, a Republican, said earlier this month that his “position has not changed. I am opposed to the expansion of Medicaid in Mississippi. The move prevents more than 200,000 people in the state from receiving health care coverage, according to the Kaiser Family Foundation.
The office of Republican Florida Governor Ron DeSantis has spoken out against it, denying health care coverage for an estimated 800,000 people. Spokesman for South Carolina governor Henry McMaster told the Washington Times that the governor “is not for sale” and would not support the expansion of around 300,000 residents. South Dakota Governor Kristi Noem also signaled her continued opposition, which would leave around 50,000 people in the state without coverage.
In Georgia, Governor Brian Kemp is trying to wage a war with the Biden administration over Medicaid work requirements – an issue the Supreme Court may soon consider.
Kansas and Wisconsin, meanwhile, have Democratic governors who support the expansion, but Republican legislatures that have historically opposed it.
It remains to be seen whether the latest Covid-19 relief bill will further influence Republicans across the state to consider the possibility of expanding Medicaid.
Some heads of state and supporters have said the expansion may not happen in those states this year, especially given the short legislative windows, but there is renewed optimism given the promised federal aid. is not limited in time.
“I think we’ll start to see stronger debates in other states as well,” Alker said. “And of course if a few states like Wyoming move, it creates momentum and things could really heat up.”
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