The Wyoming Senate voted down Medicaid expansion today, ending the latest chapter in a multi-year effort to consider the program.

Senators voted 19 to 11 to kill the Senate File 129-Medicaid SHARE Plan.

Minutes later, House Labor Committee chairwoman Rep. Elaine Harvey (R-Lovell) pulled a separate House bill to expand Medicaid. She reasoned that no matter how the House amended its bill, the Senate would reject the measure.

One more year without Medicaid expansion means the state will not receive $120 million in federal funds for the fiscal year beginning July 2016. The Wyoming Department of Health projected that money would provide health coverage to 17,600 people, and create 800 jobs.

Since Jan. 1, 2014, Wyoming has already lost an estimated $125 million in federal funds by not expanding the program, according to advocates for the bill.

In 2012, the Wyoming Department of Health conducted a study estimating that 111 people in the expansion population would die each year if Medicaid were not expanded. That projection remains for coming years.

In its final form, the Senate Medicaid plan was written to be cost-neutral to the state General Fund by reducing up to $103 million in state-funded programs and transferring the patients to Medicaid, if an expansion were enacted.

“The bill was improved at several stages but did not achieve majority approval of the Senate,” Senate President Phil Nicholas (R-Laramie) wrote in a statement. “Many Senators campaigned on the promise to not expand Medicaid services.”

Senators voting against the bill cited concerns about adding to the federal debt. “Make no doubt about it, this saddles more debt on your children and your grandchildren,” Sen. Larry Hicks (R-Baggs) said during floor debate. “This just brings us one step closer to economic collapse in this country.”

Sen. Charlie Scott (R-Casper) criticized the measure because he believed it had no incentives to reduce utilization or control costs. He also had concerns about what would happen if the federal contributions drop below 90 percent of costs, and shared Hicks’ worries about federal debt.

“It simply increases the federal deficit,” Scott said. “The amount of money we are borrowing, that’s all going to come back to haunt us.”

Majority Floor Leader Sen. Eli Bebout (R-Riverton) said Wyoming had looked at expanding Medicaid in the past, and has been better off for not making that choice. “Now is not the time,” he said. “I think being cautious, and doing it the Wyoming way is the way we do things.”

Supporters noted their disappointment in a press conference held by the Wyoming Coalition for Medicaid Solutions. “We want to stress that we have a really broad coalition, and we aren’t giving up,” said Bri Jones, coalition member and interim executive director of the Equality State Policy Center.

As for the direction of the Wyoming Department of Health on the issue, not much will change.

“Wyoming’s policymakers have spoken on this issue,” Department of Health spokesman Kim Deti said. “We will continue to administer Wyoming Medicaid under the status quo.”

Reaction

Chesie Lee of the Wyoming Association of Churches said the demise of Medicaid expansion means thousands of Wyoming residents will continue to struggle without access to health care.

“We are extremely disappointed,” Lee said. “We were hopeful that this year legislators had the political will to act on it, and obviously they don’t,” Lee said. “It seems to me three years is enough time to figure out how to provide for them.”

The Wyoming Business Alliance has a tradition of standing firmly with conservative politics in Wyoming, including the conservative factions of Wyoming’s Legislature that opposed and ultimately killed the effort to expand Medicaid. But at its annual meeting in November the organization decided to back Medicaid expansion, because of the relief it would provide for Wyoming residents and businesses.

“Those there (at the Wyoming Business Alliance’s fall meeting) said it’s time to recognized the Affordable Care Act, it is the law of the land, it’s not going to go away, let’s take a position in favor,” WBA president Bill Schilling told WyoFile on Friday.

As for what another year without Medicaid expansion means to Wyoming, Schilling said, “For citizens and for businesses, we’re paying twice.” He said not only is Wyoming losing out on federal subsidies to help cover health care, but it’s losing on uncompensated care. “We pay twice here because the cost at hospitals here is higher than at hospitals across the country because they’re paying for uncompensated care.”

Schilling has worked closely with those in political leadership in Wyoming for more than a decade. He acknowledged a disconnect between the demise of Medicaid expansion in the face of so many businesses, industries and other Wyoming entities that came out in support of expansion. But he said there’s an explanation.

“The opinions for many legislators were already cast in stone before they got to Cheyenne, because on the campaign trail they pledged not to support Medicaid expansion,” he said. “So there was never a persuasive enough argument to offset that campaign pledge.”

“In my opinion, I don’t see a likely prospect for Medicaid expansion to come up for another year … because the legislature has been debating this for about four years and there doesn’t seem to be the movement to go forward.”

The demise of Medicaid expansion was unwelcome news for the Wyoming Hospital Association, as well.

“I am worried that our fragile hospitals that are struggling to stay solvent will either fail or will have to cut services in order to keep their doors open,” Wyoming Hospital Association president Eric Boley told WyoFile via email. “In fiscal year 2013, Wyoming acute care hospitals provided more than $100 million worth of uncompensated care and this is the actual cost of providing that care, not what the uncompensated charges were.”

Sarah Gorin, executive director of the Downtown Clinic in Laramie, said people in need of basic health care will continue to depend on safety-net services that are available — although those are limited.

“Thousands of people across Wyoming will continue to be sick and unable to work due to lack of access to basic primary care, and all Wyomingites will continue to pay higher health care costs than would otherwise be the case,” Gorin said.

Harvey spoke on withdrawl of House Medicaid bill

Minutes after the Senate rejected its bill, House Labor Committee chairwoman Elaine Harvey (R-Lovell) told her committee that it would not consider Medicaid expansion. She pulled HB 245 from consideration, giving her reasoning as follows:

I would like to announce that the Senate defeated Senate File 129, 11 to 19. What that means for our discussion today is that if they spent well over a week discussing and cussing and amending and changing — they amended out all of the committee suggestions, they amended in all of the SHARE Plan, they amended out all of the SHARE Plan, they amended the work requirement into it — I guess what I am trying to say is with all of the Senate’s work, they still fundamentally believe this is not the right thing for Wyoming. I could continue on with this meeting, continue with the hearing. We could go through an exercise in futility, which would be amending this bill to a point where this committee is satisfied with it, but at this point, I don’t see the point in it. Because whatever we do and the amount of time that we spend on the floor of the House discussing this bill, it won’t pass the Senate, no matter what plan we come up with, or no matter what we do to the bill. I think that we heard from people in testimony that there is a lot of interest in finding a solution and I believe that we should continue to look for one. But I think at this point, I am going to pull this bill. We will not continue the hearing, and Wyoming will go another year without Medicaid expansion. I don’t want to waste your time. I don’t want to waste the time of my committee members. I don’t want to put the vote out on the floor of the House and expose people to election troubles over this.I think that this is something that a lot of us have put a lot of thought, a lot of effort, and certainly many, many, many hours, days, weeks. I appreciate the committee. I appreciate your efforts. Everything you have done, all of the effort you have put into this. Rep. Wilson (R-Cheyenne), thank you for keeping the issue alive, and our goal was, if the Senate vote was closer, we would have continued on, but with them resoundingly defeating the bill, there is no point in moving on. It’s not going to happen. So I would hope that you in the audience would continue to work on this issue. I think that we all need to work together. Wyoming does have a problem. We have people that are not being taken care of, and we need to find a solution to that. And with that, this meeting is adjourned.

The Vote on Senate File 129-Medicaid SHARE plan

Nays:

Sens. James Lee Anderson (R-Casper), Paul Barnard (R-Evanston), Eli Bebout (R-Riverton), Bruce Burns (R-Big Horn), Leland Christensen (R-Alta), Hank Coe (R-Cody), Stan Cooper (R-Kemmerer), Dan Dockstader (R-Afton), Ogden Driskill (R-Devils Tower), Gerald Geis (R-Worland), Larry Hicks (R-Baggs), Dave Kinskey (R-Sheridan), Bill Landen (R-Casper), Curt Meier (R-LaGrange), Drew Perkins (R-Casper), Ray Peterson (R-Cowley), Tony Ross (R-Cheyenne), Charlie Scott (R-Casper), Jeff Wasserburger (R-Gillette)

Ayes:

Sens. Jim Anderson (R-Glenrock), Cale Case (R-Lander), Bernadine Craft (D-Rock Springs), Fred Emerich (R-Cheyenne), Floyd Esquibel (D-Cheyenne), John Hastert (D-Rock Springs), Wayne Johnson (R-Cheyenne), Phil Nicholas (R-Laramie), Stephan Pappas (R-Cheyenne), Chris Rothfuss (D-Laramie), Michael Von Flatern (R-Gillette)

Official vote report is here.