A bill that would expand Medicaid coverage for some 19,000 Wyoming workers who earn too much to qualify for standard Medicaid, but can't afford private insurance, is making its way through the state Legislature.

Ana Marchese - director for the group Healthy Wyoming - said expansion would bring millions of federal tax dollars back to the state, and would largely help women working at jobs that pay low wages and offer no health benefits, including restaurant, construction, agriculture and retail.

"In Wyoming, more than half of those covered by Medicaid expansion would be low-income women," said Marchese. "Wyoming has one of the highest uninsured rates for women of childbearing age. This has big consequences for the health of mothers and infants."

Wyoming is one of just 11 states that have not expanded Medicaid coverage. The most recent American Cancer Society poll found that nearly two-thirds of Wyoming voters across the political spectrum support expansion, including 66% of Republicans.

Critics have long warned about the potential costs, and some lawmakers are leery of entering into a deal with the federal government.

House Bill 80 cleared the Joint Revenue Interim committee, but has not yet been scheduled for a hearing.

Expansion has been a lifeline for rural hospitals, according to a Families USA report, lowering the likelihood of closure by 62% - largely by reducing losses when people without insurance can't pay.

Wyoming hospitals spend $120 million a year in uncompensated care.

Marchese pointed to hospitals in Kemmerer and Rawlins that recently closed labor and delivery services due to financial struggles.

"After Montana expanded Medicaid, uncompensated care went from $143 million to $89 million in 2019," said Marchese. "And that's a big deal, that keeps hospitals open."

Marchese said expanding coverage will also boost Wyoming's economy.

People with insurance tend to be healthier, more productive workers with fewer sick days. Insurance also gives workers access to less costly preventive care.

"When people lack coverage they often seek treatment at the emergency room, which comes with a hefty price tag," said Marchese. "Having health insurance, and being able to take care of your own physical and mental health, has a positive impact on your ability to work."

It's been 13 years since more than 156,000 West Virginians gained health insurance coverage through the Affordable Care Act.

As sweeping and sometimes controversial as the ACA has been, its longer-term effects are still being felt today at the state level.

Gary Zuckett, executive director of the West Virginia Citizen Action Group, pointed to a new West Virginia law capping insulin copays at $35 per month. The law goes into effect January 1.

"I think we now have the best insulin copay cap legislation in the country that we just helped get passed in a very 'red' legislature," Zuckett noted. "Which does show you that health care is not partisan."

Federal data shows since the launch of the federal health insurance exchange, enrollment in health insurance plans has doubled from 8 million to more than 16 million nationwide.

According to the West Virginia Center on Budget and Policy, the Medicaid expansion included in the ACA allowed more than 200,000 West Virginians to gain access to health coverage.

Zuckett cautioned when the "continuous coverage" rules enacted during the pandemic expire April 1, the state will begin re-evaluating people's eligibility, which could signal a setback in progress.

"A lot of people won't qualify or won't fill out the paperwork, and they'll lose their health insurance in West Virginia," Zuckett explained. "That could be as many as 50 or 100,000 people. So, that's going to be a step backwards."

According to America's Health Rankings, around 6% of West Virginians were uninsured in 2021, far fewer than the nearly 16% of the state's population who lacked coverage prior to the Affordable Care Act.

Beginning next year, more Kentuckians will have expanded access to biomarker testing - which helps doctors customize cancer treatment. Advocates of the new law say it will save lives and improve patients' quality of life.

Signed into law by Gov. Andy Beshear, House Bill 180 requires both private insurers and Medicaid to cover biomarker testing after a cancer diagnosis.

Doug Hogan - director of government relations for the American Cancer Society Cancer Action Network (ACS CAN) - explained that without biomarker testing, doctors typically try several rounds of chemotherapy or other treatments, without knowing which will work best for the patient.

He said biomarkers increase the odds of matching the right treatment to a specific cancer.

"We will be the fifth state in the country to adopt an enhanced access to biomarker testing law," said Hogan. "And so, we're on the cutting edge. This is the way that we can utilize technology to improve health outcomes."

The bill passed unanimously in both the House and Senate. According to the American Cancer Society, more than 30,000 Kentuckians will be diagnosed with cancer this year.

Hogan added that the new law will allow care teams to use the latest technology to make the best decisions for their patients.

"It is so important for these patients to get that right treatment at the right time," said Hogan. "It really will improve their health outcomes. It will save lives in many instances, and certainly will improve the quality of life."

Research shows biomarkers can in many cases reduce the cost of therapy, especially for lung cancer and colorectal cancer patients.

Cancer-care costs are expected to top more than $245 billion by 2030, according to the American Association for Cancer Research.





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Oregon's nonprofit hospitals are not doing enough to provide assistance on medical bills for low-income patients, but a bill in Salem aims to change it.

Nonprofit hospitals are required by federal law to alleviate medical costs for patients who cannot afford them.

Matt Swanson, political strategist for the Service Employees International Union Oregon State Council, said investigations have found the institutions are not going far enough to help.

"People really aren't getting the assistance they need," Swanson explained. "Instead, they're getting every last dollar really wrung out of them in order to satisfy a bill that they really can't pay, and it's risking other things in their life, like housing and food and the ability to get over their health issue."

House Bill 3320 is designed to ensure people get the financial assistance they need and hospitals are transparent about their assistance practices. In written testimony on the bill, the Oregon Association of Hospitals and Health Systems said it agrees with parts of the legislation but wants lawmakers to keep in mind insurers are part of the cost picture as well.

Swanson added it is important for people who cannot afford medical bills to know they have assistance available.

"The purpose of this bill is to really tighten up what compliance looks like," Swanson emphasized. "And ensure that everyone gets screened before they are sent a bill, so that the hospital is giving a hand to folks who need the help, instead of letting them get lost in systems that are often confusing and overwhelming at a time when they're really struggling."

The bill received a public hearing last week and is scheduled for a work session Wednesday.


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