New reports highlight benefits of Medicaid expansion for Wyoming workforce

May 23—CHEYENNE — With Medicaid expansion back in the state's spotlight this year, a pair of new studies released last week highlighted the potential benefits that could come to Wyoming workers, as well as the state's employment numbers, if lawmakers decide to opt into the federal program.

One of them, conducted by the Commonwealth Fund and George Washington University's Milken Institute School of Public Health, projected that Medicaid expansion would create 1,900 jobs in Wyoming, with about two-thirds of those coming in the health care industry. The study's lead author, Leighton Ku, said the new employment opportunities would come as a result of more than $100 million in additional federal funds coming to the state.

"The first place that those hundreds of millions of dollars go to is to hospitals, doctors' offices, pharmacies, health care providers ... what all these places do is a majority of the money goes to pay their employees," said Ku, a GW professor and lead author of the report.

That money for employees then creates a "multiplier effect," as Ku described it, with additional spending generated throughout the state's economy. His report estimated the state could see as much as $4 million in additional local revenue in the first year of expansion.

"When you help pay for another nurse, that nurse has a salary, that nurse now is going to use that to pay her rent, to pay for groceries, to pay for all the needs that people have," Ku said. "So, therefore, a little bit more money is flowing into the economy that goes into real estate, into grocery stores, into all the sorts of things that we do."

In addition to its potential for new health care jobs, Medicaid expansion, which is backed by the Wyoming Medical Society and the Wyoming Hospital Association, would largely benefit uninsured workers in the hospitality, food service and retail industries, according to another report from the Georgetown University Center for Children and Families released last week. An estimated 57.1% of Wyoming's low-wage, uninsured workers come from those industries, according to the report, though its employment numbers are based on 2019 data.

"This data is pre-pandemic, and when you think about what happened during the pandemic and how hospitality got hit really hard, this data suggests it's only gotten worse for these low-wage workers," said Joan Alker, the report's co-author and a research professor at the Georgetown University McCourt School of Public Policy.

"Some of them may not have a job anymore," she added. "We may have more uninsured workers in these categories, so that was really something that has jumped out across the board, and in Wyoming, that top-line number in the hospitality industry is even higher than what we've seen in other states."

The Wyoming Department of Health estimates that 64% of the population eligible under Medicaid expansion, which covers residents at or below 138% of the federal poverty level, are currently uninsured, and roughly 60% are presently employed, according to its report from February.

The uninsured populations in Wyoming are especially sizable in rural areas, with Niobrara, Big Horn, Washakie, Fremont and Lincoln counties all reporting uninsured rates over 20%, according to the Georgetown report. That trend of rural areas with higher uninsured rates is common across the 12 states that have declined to expand Medicaid, Alker said. Statewide, the report found that Wyoming's uninsured rate was 13.9%, slightly above the nationwide rate of 11%.

Medicaid expansion could bring other benefits to Wyoming's most rural areas, where many local governments are trying to find sustainable funding models for ambulance services. Last week, the Riverton Ranger reported that prospective ambulance providers have been "very interested" in Medicaid expansion as a route to stabilize payment streams.

It remains to be seen whether the Wyoming Legislature will consider Medicaid expansion during a possible special session this July, following a vote this month by the Joint Revenue Committee to sponsor an expansion bill either for the special session or its budget session early next year. This year, the push for expansion has gained added momentum, as federal incentives in the American Rescue Plan would boost the federal match to the state's traditional Medicaid program and net the state an estimated $34 million in the first two years of expansion.

The decision on when to consider it will ultimately be left to legislative leadership. A request for comment from House Speaker Eric Barlow, R-Gillette, had not been returned by a reporter's deadline.

Debunking myths

Of course, Medicaid expansion has long been opposed by a majority of Wyoming lawmakers, and despite passing out of the House of Representatives for the first time this year, the proposal then failed in a Senate committee by a 3-2 vote.

During the Joint Revenue Committee earlier this month, wide-ranging claims about Medicaid expansion's negative effects on hospitals and state budgets were made by lawmakers and some others who gave testimony. Some of the statements eventually drew a rebuke from committee co-chair Sen. Cale Case, R-Lander, who has supported Medicaid expansion.

"It is disappointing to me, as a long-term member of this Legislature, to hear so many falsehoods from the same people over and over," Case said. "I have never experienced it quite like this, and it kind of is a sign of our times, where people, they get something on the internet, then you see the same thing from five different people, but it still doesn't make it true."

Both in the committee meeting this month and in the Senate committee meeting when the proposal was defeated in March, some argued that Medicaid expansion would lead to residents being more dependent on the government and less likely to pursue employment. Ku and Alker, both of whom have extensively studied Medicaid expansion's impacts on other states, said that assertion is not backed up by research.

"There's no evidence that states that expanded Medicaid saw increases in their unemployment rates," Ku said. "If anything, Medicaid expansion creates jobs, because there's more money, there's a sort of a new influx of federal funding that, in the end, goes to health care providers, goes to grocery stores, goes to construction companies, etc."

Alker agreed, noting that many of those who are uninsured and unemployed tend to have other responsibilities.

"For those who are not currently in the workforce, it's often because they're caregiving, they may be parents, they may be taking care of a relative, or because they themselves have a chronic condition and are unable to work," Alker said. "When folks have access to health insurance, particularly those who might have chronic conditions like hypertension or diabetes or depression, this helps them to be able to work (and) supports their ability to work by accessing the treatment they need to control those chronic conditions.

"Many folks are working out there in restaurants, in sales, in industries that are not providing insurance to their low-wage workers," she added. "That's just the bottom line, so they really don't have an opportunity to get health insurance through their job and want to make sure they can keep their job. That's where Medicaid expansion would help support that."

Another frequent point made during committee meetings is that Medicaid expansion can harm state budgets. This month, the Montana Hospital Association's president wrote a letter provided to lawmakers refuting that point based on his state's experiences, and Alker and Ku agreed that, if anything, expansion has boosted state budgets by reducing costs related to uncompensated care.

Ku also noted that Medicaid expansion has reduced the risk of rural hospitals being forced to close down in states that have opted into the program.

"What happens when a rural hospital closes? It doesn't just hurt Medicaid beneficiaries. It hurts everyone in that community, because even people who have private insurance now have a harder time getting care," Ku said. "This notion that somehow Medicaid expansion hurts hospitals — why would the hospital association be for it if it hurts them?"

Tom Coulter is the Wyoming Tribune Eagle's state government reporter. He can be reached at tcoulter@wyoming or 307-633-3124. Follow him on Twitter at @tomcoulter_.