Wyoming Dr. Give 14 Reasons To NOT Expand State Medicaid

Once again a Medicaid expansion bill is before the Wyoming legislative body.

To ensure that we are getting both sides of the Medicaid expansion argument, a Wyoming doctor has laid out 14 reasons that he opposes expansion and why Wyoming should avoid it.

1. Medicaid Expansion has no "volume knob". Once expanded, Wyoming has to allow any eligible applicant into the program, including people who move here from other states for the lower cost of living, a pattern we already see in clinics across the state. There is no dipping one's toe in the water of Expansion, it's all deep end.

2. Every other Expansion state has underestimated the number of program recipients by 100% to 300%.

3. People can "make themselves eligible" just by quitting work. Businesses can drop their healthcare insurance plans. Both tactics increase the number of Expansion recipients. If you think COVID money makes it hard to fill jobs, wait til you give out free healthcare.

4. Other Expansion states have been forced to divert funds from other departments, transportation, education, and law enforcement, to offset the unexpectedly high costs of Medicaid Expansion, despite the federal matching incentives.

5. Across the nation Medicaid, on average, reimburses 86 cents on the cost dollar, not the price of the healthcare service, the actual cost to the provider. This means that each Medicaid care event causes a loss to the hospital, clinic, or provider.

6. Except when it doesn't pay that much. Wyoming Medicaid pays about $24 for a day of inpatient hospice care. Know any nurses willing to work for a dollar an hour?

7. The cost to our state healthcare system of uncompensated care for 19,000 people in Wyoming is less than the cost of under-compensated care for 57,000 people as the latter group is incentivized to use more care as it is essentially free to them. But not free for Wyoming or its hospitals. Every $1000 of Medicaid spending is a $140 loss to a healthcare provider in Wyoming, see above.

8. Medicaid Expansion makes it harder for current Medicaid recipients to get care as they have to compete with more of the new program recipients for care as many clinics ration how many Medicaid recipients they will see per week or month.

9. For the 132 million working people in the United States, Medicaid costs them directly and indirectly over $5000 a year. This is in addition to $885 a month to support Social Security and over $6200 a year for Medicare. Medicaid Expansion drives this number higher.

10. Medicaid Expansion has not demonstrated a pattern of saving fiscally distressed hospitals in other states.

11. The Wyoming Department of Health has published estimates of needing 2000 more employees to implement Expansion while the Wyoming Hospital Association estimates that our state's hospitals lose $120 million annually for uncompensated care. Ironically the cost of 2000 new employees is less than the cost of giving direct support to the hospitals for losses with no federal strings attached and no pension costs.

12. Statewide population studies (Oregon, specifically) have not shown an improvement in the health of Medicaid Expansion recipients after they were placed in the program.

13. Medicaid Expansion has no off switch. Once a State expands, there is no means to sunset the program or its costs.

14. This leads to the logical outcome, a vote to Expand is a vote to increase taxes and enact a Wyoming State Income Tax.

Ask a room full of nurses, or doctors their opinion about this program. Their answers might surprise you.

As a Wyoming citizen, practicing doctor, and retired Army Colonel I feel compelled to give you honest advice as an industry subject matter expert who has practiced for over 30 years. I am not paid by anyone to tell you the truth that this is both a bad and unsustainable policy. There are other ways to make healthcare affordable that cost the State of Wyoming nothing.

And, yes, I do see Medicaid patients, while I still can.

Respectfully,
John Mansell, MD
Gillette