AP Interview: Gov. Mead undecided on health care

CHEYENNE, Wyo. — Gov. Matt Mead said Thursday he's not inclined to expand the Medicaid program in Wyoming as much as the federal health care law calls for but still needs answers from the federal government before making a decision.

Mead, a Republican, wrote U.S. Health and Human Services Secretary Kathleen Sebelius on Thursday asking for details about pending deadlines and regulations the state faces under the federal Affordable Care Act.

"My gut reaction to Medicaid expansion is 'no way,'" Mead said Thursday in an interview with The Associated Press.

One of Mead's first acts as governor when he took office in early 2011 was to get Wyoming involved in the multi-state legal challenge that led to last month's decision by the U.S. Supreme Court upholding most provisions of the Affordable Care Act. In his letter to Sebelius, Mead said he would have preferred a different outcome in court, but respects the process.

"I have a responsibility to make what I believe are the best possible decisions in regards to health care for our citizens," Mead wrote to Sebelius. "I have grave concerns about the financial impact of expanding Medicaid."

Wyoming budgeted more than $500 million to cover its share of the Medicaid program in the two-year budget cycle that started this month. The federal government roughly matches that amount in the state to fund the program that provides health care for the poor.

There are now roughly 67,000 Wyoming residents on Medicaid and Mead said the proposed federal expansion could add as many as 30,000 more over the next few years. Wyoming is still studying how much expanding the program would cost.

While the health care law calls for the federal government to foot nearly all of cost of Medicaid expansion, Mead said he doubts it really would.

"There's a big question in my mind where that money is going to come from," Mead said. "In Wyoming, we could put anywhere from 18,000 to 30,000 people during that expansion. If we jump on that because of the promise of the share paid by the federal government, and then they don't have the money, you can't put 30,000 people on Medicaid year one and then Dec. 31st, say, 'oh, by the way, you're no longer insured.' That's just not the right thing to do."

While the Supreme Court upheld most of the federal law, it ruled that the federal government couldn't cut states from the Medicaid program entirely if they declined to expand their Medicaid programs. That's prompted many states to consider their options and some governors have said they won't expand programs in their states.

Wyoming faces a deadline in mid-November for specifying how it intends to create an insurance exchange: either by itself, with another state or by allowing the federal government to do it.

In his letter to Sebelius, Mead said Wyoming still needs to learn details of how a federally operated exchange would work.

"That deadline is looming," Mead said. He noted that the presidential election will be held before the deadline. Presumptive Republican nominee Mitt Romney has pledged to work to repeal the health care law if he's elected.

"For those states, like Wyoming, that want to wait some period of time, that election could have a big bearing on what if anything we do," Mead said.

Mead said he sees a philosophical difference between how he and officials in Wyoming approach the health care issue compared to officials in Washington. Unlike the federal government, Wyoming has essentially no debt and the state constitution requires the state to run a balanced budget.

"What we need to know as a state, particularly in Wyoming, is what is the cost, how are we going to pay for it," Mead said. "And what does happen if we sign off on Medicaid expansion, we add 30,000 people, and the federal government tells us, 'yeah, that was the deal, but we're out of money.' That's not going to be a shocker to me because they're out of money now."