Research & Commentary: Wyoming Medicaid Expansion

Published January 15, 2014

After voting in 2013 not to expand Medicaid, the Wyoming Legislature is now considering three possible alternatives to simple Medicaid expansion in Wyoming. Each plan would use federal dollars to extend assistance to more people, creating new costs the federal government may not always be able to cover, leaving state taxpayers on the hook for the new liabilities. 

The first two plans are modeled on the Medicaid “premium assistance” program first introduced in Arkansas. Under the Arkansas model, Medicaid funds are provided for those newly eligible for Medicaid to purchase private insurance through the federal insurance exchange. 

The first proposal, by state Rep. Elaine Harvey, would utilize Medicaid funds, emulating Arkansas’ approach. There are federal requirements such a plan must fulfill. First, the state would have to file for a waiver of existing Medicaid rules and conduct state and federal public hearings. Second, the private insurance options could not cost more than traditional Medicaid. 

The second proposal, championed by state Sen. Charlie Scott, also involves a Medicaid expansion based on the Arkansas model, but it adds several restrictions. This plan would include new work requirements for recipients and require them to contribute to the cost of their care. Proponents argue the payment and work requirements add a sense of ownership and make individuals more likely to monitor how they use their insurance dollars, thus controlling costs and utilization. 

Arkansas’ “premium assistance” model has several shortcomings. First, despite the private market feel of the program, it is still an expansion of Medicaid, where multiple aspects of the insurance plan, such as cost-sharing, are dictated by the federal government. The beneficial aspects of real free-market competition are lost. Second, once expansion occurs, it will be extremely difficult to roll it back. Critics note there is no guarantee the federal government will allow the program to continue once it is up for renewal, and the feds could replace it with a less market-based system. 

The third option, supported by Gov. Matt Mead and recommended by the Wyoming Department of Health, would use the state’s existing Medicaid infrastructure but offer more limited health care benefits while requiring increased cost-sharing. The program, Medicaid Fit, would require recipients to contribute to the cost of their care through deductibles and copayments. Medicaid Fit would not require a waiver from the federal government. A study by the Wyoming Department of Health projected Medicaid Fit could save the state $47 million

Instead of expanding a flawed model that is very costly to taxpayers, delivers subpar health care, and shifts more power to the federal government, state lawmakers should focus instead on reform options, like those piloted in Florida, which reduce costs and offer better care to patients in the existing system. 

The following articles offer additional information on state Medicaid expansion.

Ten Principles of Health Care Policy
This pamphlet in The Heartland Institute’s Legislative Principles series describes the proper role of government in financing and delivering health care and provides reform suggestions to remedy current health care policy problems. 

Research & Commentary: Wyoming Health Insurance Exchange and Medicaid Expansion
In this Heartland Institute Research & Commentary, Kendall Antekeier examines health insurance exchanges and Medicaid expansion. “Many states already have decided against expansion,” she writes. “Wyoming would be wise to resist ceding more control of its Medicaid program while further expanding a system that is already fiscally unsustainable.” 

Wyoming Legislators: Please Reject Arkansas
Christie Herrera, vice president of policy at the Foundation for Government Accountability, examines the Arkansas Medicaid expansion model and offers 10 reasons why Wyoming should reject it. 

Medicaid Expansion: The Wrong Option for Wyoming
Bob Williams of State Budget Solutions argues Medicaid expansion will not improve the health of Wyoming residents and will not deliver on the promise of cost savings. For those simple reasons alone, Williams concludes, Wyoming should “just say no” to Medicaid expansion. 

Joint Committee Considers Medicaid Expansion Options in Wyoming
Megan Comlossy of the National Conference of State Legislatures discusses the three proposed alternatives to expanding Medicaid in Wyoming now being considered by an interim legislative committee. Comlossy examines each position and notes none of the proposals’ supporters seem completely sold on such an expansion. 

Does Your State Benefit from the Medicaid Expansion?
This interactive map, built on numbers from the left-leaning Urban Institute modeled forward by the right-leaning Heritage Foundation, presents the amounts each state is expected to have to come up with under the Medicaid expansion over the next ten years. 

Research & Commentary: The Medicaid “Cure”
Kendall Antekeier of The Heartland Institute examines the Medicaid Cure, a pilot program established in five large Florida counties by Gov. Jeb Bush, a premium support model in which 290,000 Medicaid recipients are given a range of premiums and plans from which to choose. 

A Medicaid Cure: Florida’s Medicaid Reform Pilot
The Foundation for Government Accountability provides insight into the success of Florida’s Medicaid Cure pilot program, stating, “When the patient is the priority, government and HMO bureaucrats are finally held accountable. Costs flatten and patient health and satisfaction improves.” 

Why States Are Rejecting Obama’s Medicaid Expansion
Benjamin Domenech, a senior fellow at The Heartland Institute, reports on several reasons why states are refusing to expand their Medicaid programs under Obamacare. 

The Oregon Experiment—Effects of Medicaid on Clinical Outcomes
This article from the New England Journal of Medicine examines Medicaid outcomes in Oregon. Oregon offered researchers the opportunity to study the effects of being enrolled in Medicaid (compared to being uninsured) based on data from a randomized, controlled trial, the “gold standard” of scientific research. The results showed no improvement in health for enrollees, but improved financial protections and increased medical spending. 

Research & Commentary: States Should Avoid Medicaid Expansion
Kendall Antekeier of The Heartland Institute explains the Supreme Court ruling on Medicaid expansion and urges states to avoid expansion. “States should think twice about giving up more control of their Medicaid programs only to further expand a system that is already fiscally unsustainable,” she writes. 

Medicaid: To Expand or Not To Expand
Nicole Kaeding of Americans for Prosperity argues states should avoid expanding their Medicaid programs because doing so would support the flawed and expensive federal health care law, place heavy financial burdens on the state, and expand an already-broken system. 

The End of Federalism: How Obamacare Will Impact States
This brief fact sheet from The Heritage Foundation identifies the consequences of expanding Medicaid programs to meet federal requirements. 

Medicaid Expansion: We Already Know How the Story Ends
Jonathan Ingram of the Foundation for Government Accountability examines the Medicaid expansions in Arizona, Maine, and other states. He found expansion supporters have a poor track record of keeping promises.

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Health Care News at, The Heartland Institute’s website at, and PolicyBot, Heartland’s free online research database at 

If you have any questions about this issue or the Heartland Institute Web site, contact Heartland Institute Government Relations Director John Nothdurft at [email protected] or 312/377-4000.