Saturday, June 13, 2015

$100 million WYO budget cut w/o pain

I beg your indulgence for one more column on Medicaid expansion. If you’re tired of reading about Medicaid, it may be because you are not one of the 17,600 denied health insurance for the last three years when you could have been insured. Either that or you don’t mind being taxed more than necessary.

Declining oil and gas revenues have given rise to a renewed conversation of just how fiscally irresponsible it is to turn down Medicaid expansion. Governor Mead has floated the prospect of serious budget cuts and the elimination of entire programs in order to balance the budget.

As the Governor searches for savings, he should consider the massive savings available in the 100 million dollar appropriation for mental health and substance abuse services even without Medicaid expansion. This savings is in addition to the nearly 50 million dollars the Department of Health predicts could be saved by expansion.

Although it’s always about the money, the legislature shouldn’t ignore the human costs of their decisions. People without health insurance become sicker faster and die earlier than the insured. Dr. Sherry Glied, Columbia University public health professor, said on PBS, "The people most at risk today are those who have no health insurance at all. They're at risk of not getting regular care when they need it…of not catching real problems before they get serious enough to not be treatable…of not getting the best treatment when they actually do get sick."

But, let’s talk money. They tout themselves as “fiscal conservatives.” Their votes on this issue betray those claims. Call them the “neo-fiscal-conservatives,” politicians who put their narrow political agenda above their promises to take care of the taxpayers.

How did it happen that state legislators are able to deny the health care to Wyoming citizens that other states enjoy? Why are Wyoming lawmakers allowed to spend millions of your tax dollars needlessly while sending millions more to pay for health care in other states?

Obamacare was written to assure nearly all Americans would have health insurance. Those who couldn’t afford private insurance would be covered under Medicaid. Those who made too much to be Medicaid eligible but too little to afford private premiums were to be covered under expansion of Medicaid. The original law required all states to expand Medicaid for those folks.

When the Supreme Court upheld the constitutionality of Obamacare, it also ruled that Medicaid expansion could not be mandated. States like Wyoming, whose political leaders opposed Obamacare, chose partisan politics over the enormous tax savings expansion offers.

Legislators and the Governor have overlooked another huge tax savings available even without expanding Medicaid. It’s a savings that would be significantly magnified if the legislature voted for expansion.

Wyoming spends nearly 100 million dollars each biennium for mental health and substance abuse treatment. As the author of the study that resulted in huge increases in public funding of these services, I know that while the size of that appropriation was once necessary, it is no longer.

Here’s why. Before Obamacare, most people needing mental health and addiction services were either uninsured or woefully under-insured.

Obamacare improved the Mental Health Parity and Addiction Equity Act of 2008. As a result, insurance companies are now required to offer the same amount of coverage for mental health and substance use disorders as they would for medical or surgical procedures. Plans must cover medications, emergency care, outpatient, and inpatient services.

Today, nearly all of those who once could not afford mental health treatment without huge taxpayer subsidies are, or should be, insured. Medicaid expansion would make massive state appropriations unnecessary.

The Wyoming legislature should do what even Governor Mead now sees as fiscally responsible and expand Medicaid. Even if they don’t, they should review the huge expenditures for mental health and substance abuse services and ask how much of that 100 million dollar appropriation is now unnecessary as private insurance provides coverage.

In times of declining revenues, as the 49’ers said, “thar’s gold in them thar hills.”

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