The evidence is clear. Medicaid expansion will not improve the health of Wyomans. Nor will Medicaid expansion deliver on the promise of cost savings. For those simple reasons alone, Wyoming should "just say no" to Medicaid expansion.
Governor Mead is right to be skeptical of expansion. A study published in May in the New England Journal of Medicine concludes there is scant evidence that expanding Medicaid improves the health of state residents. In 2008, Oregon expanded Medicaid coverage to some eligible residents but not all, due to budget limitations. Instead, state officials used a lottery system, which in turn allowed researchers to conduct a randomized, controlled test, known as the gold standard. The results were surprising and sobering. Critical health indicators, including blood pressure, cholesterol, and glycated hemoglobin, showed no significant difference between those who "won" the Medicaid lottery and enrolled, and those who did not receive government health insurance. There was also no significant increase in diagnosis for these issues. The only significant measurable health improvement for the new enrollees was that they suffered lower rates of depression than the control group.
Proponents of Medicaid expansion point out that new recipients used more health care services and felt more financially secure. There is a significant difference between "feeling" healthy and actually being healthier. Wyoming residents deserves better than substandard insurance.
Medicaid expansion will not make citizens healthier nor will it make the state fiscally healthier. Wyoming, like most states, is already too dependent on federal funds. State Budget Solutions found that in 2011, over 39 percent of all funds in Wyoming's general fund budget came directly from Washington, D.C.
President Obama and Congressional Republicans discussed lowering the Medicaid reimbursement rate. That might be the only thing that sparring politicians in the nation's capital agreed upon in years. Wyoming cannot accept Medicaid expansion and hope for the best--knowing very well the state is not prepared to handle any slowing of federal funds.
Now is the time for state leaders to consider creative alternatives that actually meet the top challenges of the health care system--reducing costs and improving health outcomes for Wyoming residents who need help.
There are better options that generated successful outcomes in other states. Medicaid Cure is a unique program that succeeds wherever it tried--first in Florida, and now expanding to other states. The program lets patients choose their insurance coverage from several private plans, recognizing "one size fits all" Medicaid does not work. Results in Florida show that low-income residents on the program enjoy improved health outcomes when compared to standard Medicaid recipients. Medicaid Cure is also good for the state's bottom line: Medicaid Cure could save the state nearly $1 billion annually when implemented statewide.
The allure of funding from the federal government is certainly tough to ignore. Currently, Wyoming is among half of the states choosing not expanded Medicaid, and for good reason. The program is a budgetary disaster, and more importantly, it fails low-income residents who need better health care, not just a sheet of paper from the federal government that tells them they are insured.
Bob Williams is the President of State Budget Solutions (www.statebudgetsolutions.org), a national organization dedicated to fiscal responsibility and pension reform. Williams is also a former state legislator and gubernatorial candidate.