Guest column: When rich dictate to poor

Medicaid expansion in Wyoming makes sense for all

Chris Peck
Chris Peck

Well-to-do people imagining the lives of the poor can devolve into an embarrassing, sometimes shameful exercise.

 That’s what worries me about the back-and-forth going on in Wyoming now related to the question of whether the state should expand Medicaid.

At the moment, state legislators and Gov. Matt Mead are shaping up dueling plans to dictate to poor folks what they should do about health care.

This fashioning by moneyed people of a health plan for poor people comes through as part of the debate over whether Wyoming might expand Medicaid.

Medicaid, as you probably know, is a government insurance program for people who have little or no money.

Medicaid covers kids who live in poor households.

Medicaid covers low-income senior citizens.

In theory, Medicaid covers anybody in Wyoming living on $16,104 a year or less.

That works out to living on $309 a week — for food, shelter, clothes, transportation, and health care.

In Wyoming, about 83,000 men, women and children don’t have any health insurance.

At least 20,000 of these residents would qualify for Medicaid under the new rules outlined in Obamacare, also known as the Affordable Care Act.

 For those 20,000 people to get health insurance the state legislature and the governor have to agree on a plan.

With reluctance, the legislature and governor are now exploring options.

That’s good.

But the work so far is shining a light on the way richer people often think about poorer people.

 Wyoming politicians seem particularly worried that people making $309 a week are likely to rip off the system.

 They seem to imagine that the poor have a stash of cash under the mattress that they should use to pay for some portion of that medical care.

Maybe pitch in $25 a month to make sure they can get heath care  – as is outlined in the plan approved by the Joint Labor, Health and Social Services Interim Committee.

To me, this approach seems small-minded.

Exactly where is a kid, or a fixed-income grandma, or a young father or mother working a low-wage job going to dig up that dough?

What’s the message, honestly, that is being sent? You’re poor, so we’ll make it harder on you?

And here is the real kicker on all of this.

The federal government is offering to pay 100 percent of the costs of Medicaid expansion in Wyoming for the next four years. There is no requirement that Wyoming tack on a charge for this.

 Of course there are reasons for that. Sen. Charles Scott of Casper says that charging the poor for what in other states is free medical insurance is a way to make residents more responsible for their health care.

OK. A life lesson is being wrapped into health insurance.

I get the sentiment, but I go back to the question: if you’re living on $309 a week, or are a kid, or are old and feeble, what’s the point of that life lesson other than to rub it in about being poor?

And even if the more wealthy don’t agree with that, it’s puzzling that the rich don’t see the benefit to themselves of having the state sign up for Medicaid expansion. Here are some obvious examples:

•Hospitals and doctors will begin getting paid for care they now provide for free. Today, Wyoming docs and hospitals can’t really turn away poor sick people or kids. They treat them, and take about $200 million a year in uncompensated losses.

If Medicaid expansion goes through, these docs and hospitals will be paid.

•Earlier treatment of expensive health problems. If you have health insurance, you are more likely to go to the doctor or take your baby to see a doctor. This lowers the cost of health care for everybody who has insurance, including the wealthy. No longer are the poor as likely to simply use the emergency room when things get really bad and really expensive. Examples: Oregon has seen a 35 percent reduction in emergency room visits after expanding Medicaid.

•Less costly to Wyoming state government. Yes, if the state simply signs on for the Medicaid expansion and doesn’t require poor people to pay a portion, the state will still enjoy a net savings to the state budget of $47 million between 2015 and 2020, according to the Wyoming Department of Health.

The benefits outlined here all fall to people and institutions of means: doctors, hospitals, insurance companies, state government.

 One way to look at the current debate would be to make this point: expansion of Medicaid in the state helps the well-to-do.

There is, of course, another group of people who will benefit: the poor among us.

If rich and not-so-rich can be in this together, there is not much argument against the expansion of Medicaid in Wyoming.

Chris Peck is the former editor of the Spokane Spokesman-Review and the Memphis Commercial Appeal. He is co-owner of the Riverton Ranger in Riverton, Wyo., and resides in Memphis.