Medicaid expansion advocates share their stories with Wyoming lawmakers

Feb. 22—CHEYENNE — Zina Regan started having stomach issues around seven years ago. She went to the doctor in Riverton, where she lives, but was turned away because she was uninsured and unable to pay out-of-pocket costs.

Eventually, it got so bad that she stayed in a bathtub with hot water for 90 days, living off ibuprofen and Tylenol, she said.

The only way she could receive care is if it became an emergency. It soon got to this point, so her daughter took her to the emergency department at the hospital in Lander, 25 miles from her home.

There, they conducted a CT scan and found that she needed emergency surgery and should be transported to Casper.

Initially, they planned to fly her because it was an emergency. When they learned that she didn't have health insurance, they drove her in an ambulance instead, Regan's daughter Yolanda Snyder said. The surgery lasted more than seven hours.

The doctors discovered she had diverticulitis, which is when small, bulging pouches develop in the digestive tract. A pouch burst and put a hole in her colon, so they removed a foot of her colon.

Zina woke up from the procedure with a colostomy, an operation that creates an opening from the large intestine to the outside of the body through the abdomen so that solid stool and gas may leave the body through the passage. She said the hospital staff couldn't reverse it because she did not have the insurance to cover it.

It wasn't until three-and-a-half years later, living with the colostomy, that Snyder found a doctor that would reverse it. The surgery was reversed, but Zina had gotten an infection.

"If it wasn't for [that doctor], I'd still have my colostomy. And my skin was tired. It was breaking out; I had sores, open sores," Regan said.

The infection left a large wound in her abdomen. She was on a vacuum-assisted closure machine for nine-and-a-half months, which pulls fluid from the wound over time to help reduce swelling and can help clean the wound and remove bacteria.

But she still had a hole in her pelvic area that took longer to heal — two years. Because the incision took so long to heal, she developed incisional hernias, which occur when intestine, organs or other tissue protrude.

Now, she has five hernias along her abdomen.

"They're painful," she said. "I haven't been able to do anything the last two years. I can't lift, I can't bend, I'm not supposed to reach, I can't do laundry. I can put the clothes in the washing machine, but I can't bend over to pick them up because it's too painful."

Regan has had to pay thousands of dollars worth of out-of-pocket expenses to cover her medical procedures. A month ago, she had a lien put on her home that would take it from her unless she paid off $20,000 in medical expenses.

"If I paid that off, there'll be somebody else applying to do it again," she said. "... My great-great-great-grandkids probably wouldn't be able to pay it off."

She said she believes this could have all been avoided if she had received proper care early on, but she didn't qualify for Medicaid because she had no dependents.

"If I could have gotten Medicaid from the state, I wouldn't have had to have surgery," she said. "A strong antibiotic would have cured it."

Wyoming's Medicaid situation

Wyoming is one of 10 states in the country that has yet to vote in favor of Medicaid expansion since that became an option in 2014.

Currently, the program covers medical expenses for those below the poverty level, which was $14,580 for individuals and $24,860 annually for a family of three in 2023. The cost of the program is split evenly between state and federal funds.

Medicaid expansion would cover adults under 138% of the poverty income level, which would be $20,120 for individuals and $34,306 annually for a family of three.

The Wyoming Department of Health estimated in 2022 that this expansion would cover around 19,000 Wyomingites over the first two years. As it stands without expansion, it is equivalent to if every person in Sheridan didn't have coverage.

For those newly covered residents, federal funds would cover 90% of the cost, while the state would be responsible for 10%.

American Cancer Society Cancer Action Network (ACS CAN) government relations director Kristin Page-Lei said Medicaid expansion is the right move for the state.

"It's basically the working poor who don't have access to private health insurance right now. Maybe it's just a little too expensive for them, and they make just enough that they don't qualify for basic Medicaid," she said. "So, this bridges that gap."

"Because Wyoming is not taking it, other states get those funds to care for their folks. But Wyomingites are federal taxpayers, too. So, they should have the ability to have this."

She said expansion wouldn't just benefit the 19,000 residents in that gap, but other sectors, as well.

ACS CAN said that it would create 1,900 new jobs across the state. It would also incentivize more providers, including behavioral and mental health, to come to Wyoming which currently has the third-highest suicide rate in the country.

Neighboring state's success

In 2015, Montana passed Medicaid expansion. A 2023 study from the Montana Healthcare Foundation found that the number of uninsured has fallen by 45%. Around 30,000 more Montanans now have access to mental and behavioral health care, as well.

In Laramie County, there is currently no access to behavioral health care for youth.

"If you have more people who can afford to pay for it — youth, but also the parents of those youth — then it's going to attract more providers into the field," Page-Lei said. "So, it's a no-brainer."

The Montana Healthcare Foundation report also found positive economic impact. It found that the roughly $100 million in annual state expenses for the program are largely offset. Around $51 million in revenue related to the estimated $475 million in personal income was generated by Medicaid expansion. Budget savings attributable to expansion also offset an estimated 60% to 80% of the state's share of the expansion's cost.

The state of Wyoming pays for 100% of health care costs for incarcerated people in Wyoming. Page-Lei said that other states have saved money by getting people the proper care they need before they are incarcerated for things like substance abuse, deterring further state expenses.

"It shouldn't depend on our ZIP codes to determine how successful we are in our journey with health care," Page-Lei said.

Pushing for change

On Thursday, around 20 volunteers of ACS CAN, including Regan and Snyder, went to the state Capitol to meet with lawmakers and share their story. Medicaid expansion wasn't under consideration as a standalone bill during this year's legislative session, but advocates are pushing for change in 2025.

The volunteers waited in hallways for lawmakers to pass by so they could share testimonials and information on their support for Medicaid expansion.

Bills seeking to expand the program have come up nearly every year since expansion was introduced, but have been shot down every time. Critics of the program often say that it is not their responsibility to pay for others' health care, and they don't want to increase their taxes.

ACS CAN launched a program to advocate for Medicaid expansion in Wyoming called "This Is WY: Voices from the Health Coverage Gap." On Wednesday, they premiered a short film featuring testimonials of those who have suffered from lack of health care from across the state, including Regan's story.

"If I can help anybody out there not to go through what I went through, I would do it 1,000 times," Regan said.

Noah Zahn is the Wyoming Tribune Eagle's local government/business reporter. He can be reached at 307-633-3128 or nzahn@wyomingnews.com. Follow him on X @NoahZahnn.