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#MedEx Live Tweet Recap

Updated: Apr 20, 2021

In case you didn't follow the action with us live on twitter yesterday, here is our thread on the #MedEx debate and discussion. This is submitted to you without commentary (we'll offer that tomorrow) and only one correction: In the original thread, we mistakenly identified Sen Biteman as a Rep. We have corrected that here, but all the other syntactical, grammatical, and typographical errors remain. Happy reading!

Medicaid Expansion under consideration @WYLegislature Revenue Committee. First to testify, Franz Fuchs DOH.

Estimates 19,000 people enrolling in the first 24 months. $154M comprised of $136M of federal funds and $18M of general funds.

He emphasizes there is some uncertainty in the model. The model is based on the 36 states that have expanded.

Worth noting that these are the same slides and data that were presented to Labor/Health last week. Slides are available online.

[Sen.] Biteman asking whether projections have ever been wrong on the low end.

The model is based on the actual experience of other state. ND had lower than projected enrollment.

Rep. Sweeney referencing the report to Labor/Health. Asking for some of that detail. It shows all of the states for every state that has expanded, except for the three that had different pre-Expansion markets. They repeat that those slides are available.

Rep. Zwonitzer asking about immediate impact and long-term cost savings.

Fuchs explains that there are potential savings to government, hospitals, and private sector.

Rep Zwonitzer asks about the health and mortality effects to people. Not all numbers, he points out.

Fuchs says there isn’t any data about mortality, just anecdotal about things like smokers. Offers a comment that gets laughs that some would say smoking saves money because smokers die early and save on Medicare.

He is incorrect: there are new studies that speak to mortality.

Chairman Case asks about who is likely to enroll.

[Sen.] Biteman asks if mental health is paying for this. Fuchs explains that there is a 90:10 match.

Dept of Insurance has no position. LSO has no further fiscal beyond what DOH provided. DWS is now testifying about “dislocated” workers.

There seems to be a split in the committee: those who think Medicaid Expansion will cost more than it brings in. Those who’ve seen the recent data from the other states and are aware of the revenue and economic impact that expansion states have seen.

Rep Zwonitzer now talking about the demographic that DWS works with who are moving through voc rehab. Wondering if better healthcare might help those folks who have lower incomes. Wonders if it might make it so they would be able to have one job not two.

Rep Western asked how many of the 22,000 uninsured in Wyoming are also unemployed. DWS says there are 9716 unemployed.

Now the Liberty Group. Has three concerns: 1. “Woodwork effect” of over enrollment 2. Not an investment 3. Fosters dependency.

Rep Zwonitzer asked if he can explain the woodwork effect. Liberty Group says he’s “been told” about it from other states. Rep Connolly asks if he thinks DOH has incorrect projections. He concedes he has not seen them. [Sen.] Biteman asks what happens if we get in but can’t get out.

Liberty Groups wraps up by saying that Wyoming can put a safeguard into its CMS application.

Chairman Case discloses that he is on the board of the Liberty Group. Says his vote might go another way though.

The public policy director for the Alzheimer’s Association testifies in favor. Points out that there are 10k people living with the disease and 28k unpaid caregivers who provide 31M hours of care.

ESPC Director testifies in favor. Points out that healthcare improves economies and rural healthcare is expensive. This will reduce uncompensated care, boosts workforce productivity, increases employability.

Rep Biteman expresses skepticism about these “promises” and quizzes @ChrisMerrillWyo about rising premiums.

Now medical students! There are at least a dozen of them. Talking about what they have seen already early in their career. “It is part of the future we want for our state.”

They are all born and raised and planning to come back. “Maximize your investment in us and the state by voting yes.”

Rep Western thanking all the students. Coming back and practicing is, in his opinion, going to have a bigger impact.

Each student plans to testify.

The first student speaks about personal experience with insurance, ACA, and access to primary care and mental health services. She speaks to lost potential because of lack of access to healthcare.

Rep Hallinan discusses that as a doctor he cared for people who couldn’t pay. He speculates that the split will go to 50:50. “Your emotional thoughts are very good, but we can’t afford to expand. We have to look at the cost of things and can we afford them.” Says he will vote no.

Given the opportunity to respond, the student points out that speculating on reductions in the future is not the question on the table. She doubles down on the importance of access to care and time wasted trying to figure out ways to pay for care.

Their faculty adviser is testifying about the cost to the state in addition to the cost to the individual. Speaks to people who move away for access to care. Aging physician workforce. Listen to the needs of younger docs and newer trainees.

“We are at the limits of donation based primary care.”

“This is a long-term economic issue.” Rep Sweeney concurs. Asks if the students are getting extra credit.

Sheila Bush with Wyoming Medical Society. The cost of preventative care and the cost of emergency services. Also the economic impact of docs.

Wyoming Medical Society is in strong support.

Recruitment is more and more difficult. 36 states + DC have expanded. We are competing with them.

Physicians bring jobs and support the tax structure of the communities they move into. Expansion creates stability and predictability in the healthcare system. Creates the means for recruitment and hiring.

Josh Hannes with Wyoming Hospital Association. Speaking about the offsets and reductions in costs in Expansion states.

The room continues to fill. SRO

More kids than cowboy hats.

There is a discussion of the WHA handout for the benefit of the public. It describes what MT did to create savings.

We had an entire thread about the powerful testimony Marcie Kindred. No cell service in the room and the tweets failed.

We want you to know that her testimony was personal and powerful. She said she was here to humblebrag about her four beautiful boys. She introduces Orson. He’s 2. They have matching glasses. He says hi.

She talked about her oldest son. “He wants to be a bull rider and business owner,” she said, “and I can’t think of anything more Wyoming than that.”

She tells the committee that three of her boys were born on Medicaid and fed on WIC and SNAP. She says her hands are sweating and she wore her best outfit. She says she knows what people say about people who use government support.

She thanks the network of people who “reached back to pull me forward.” She says Medicaid Expansion is part of how we can take care of each other in Wyoming.

Next up: Mr Allred who is vocally opposed. He says that all states have underestimated enrollment. That it is socialized medicine. He believes that Canadians spend 75% of their income on taxes and wait five years for new knees and hips.

Rep Connolly and Sen Case dispute his figures and encourage him to use accurate data.

Sen James testifies that doctors don’t want this. Sen Case points out that the Wyoming Medical Society represents the doctors and they want Expansion.

The nurses association testifies unequivocal support as the largest provider group.

Another speaker is opposed and indicates a belief that it will bankrupt the state and raise his taxes.

Jan Cartwright of the Wyoming primary care association testifies in support. Explains that this would cover uninsured people.

It is 9:56 and Sen case says they’ll take one more comment.

Phyllis Sherard of CRMC steps up to testify on behalf of Medicaid Expansion. Encourages them to read the hospital cost study.

She says the last three pages will show that outmigration is substantial and sending the competitive advantage out of state. Says the answer to bringing cost down requires political will and changing the system. Urges a yes vote.

Rep Zwonitzer moves the bill, Rep Sweeney seconds. Rep Zwonitzer points out that we as Wyomingites are already paying for other states. Rep Connolly says she believes we’re at a new place and cites the compelling testimony of the students as part of the shift.

Rep Connolly talks about the job loss 4,000 and population loss 1,000. There is not a 1:1 correlation for people losing jobs and leaving. People stay. People who have lost jobs need healthcare. This is an opportunity to keep our neighbors in the state.

Still standing room only.

Rep Blackburn pushes back. Says maybe partners have insurance. Maybe they’re retiring. Maybe they have a second job. Maybe they’ll start a business. Says he’s encouraging a no vote.

Rep Sweeney discussing ballot initiatives in NE, ID, and UT. Urges no work requirement. Discusses 1115 waivers for CMS: they will be crafted ahead of time. Reads data that state that overall Medicaid spending and enrollment have evened out and are stable.

Rep Sweeney says he was opposed in the past but the time has come.

Rep Laursen says it goes against his principles and discusses the deficit. “We can’t afford it, the Feds can’t afford it.”

Rep Zwonitzer asks if any amendments would move no votes. No one bites.

Sen Baldwin comments that he wishes WHA discusses uncompensated care more. He points out that hospitals are in the edge. It is important to see the face of the people who would benefit. He is persuaded that now is the time.

Chairman Case calls the question.

8-5 it passes out of committee.

For those of you keeping score at home: Senate Baldwin - aye Biteman - no Case - aye Driskill - excused Ellis - aye House Blackburn - no Connolly - aye Dayton-Selman - aye Hallinan - no Laursen - no Roscoe - aye Sweeney - aye Western - no Zwonitzer - aye

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