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Postpartum Medicaid extension dodges foes, becomes law

Legislation to provide healthcare coverage to low-income mothers after giving birth met heavy opposition, but prevailed — frequently by a single vote.

Flanked by lawmakers and stakeholders, Gov. Mark Gordon holds up legislation to extend postpartum Medicaid coverage during a formal ceremony to sign the bill on March 3, 2023. (Maggie Mullen/WyoFile)

Maggie Mullen, WyoFile

When Gov. Mark Gordon signed a bill to extend postpartum Medicaid coverage Friday, Sen. Fred Baldwin (R-Kemmerer) shed a few tears — a moment of joy after months of uncertainty. 

Addressing the lawmakers and advocates assembled to celebrate House Bill 4 – Medicaid twelve month postpartum coverage becoming law, Baldwin said, “This is what I came to Cheyenne for. Everybody in this room is responsible for this.”

For low-income mothers who have just given birth, HB 4 extends Medicaid coverage from 60 days to a full year — a time when access to care can mean life or death for those experiencing conditions like postpartum depression and cardiovascular disease. 

Yet not all lawmakers agreed with the measure. House Bill 4 was on shaky ground for most of the 2023 general session, clearing several hurdles by a single vote and relying on a little-used legislative maneuver to remain alive in the Senate. 

“It was a long path. But nothing worth doing is easy. And this is certainly worth doing,” Gordon said during a bill-signing ceremony that was emotional for many of the lawmakers and stakeholders who packed the room. 

Gordon made the bill one of his top legislative priorities, highlighting it during his state of the state address as part of a push to improve mental health resources. That and the help of a coalition of advocates that kept busy behind the scenes, got HB 4 across the finish line. 

About one-third of Wyoming’s births are covered by Medicaid, according to a Legislative Service Office memo. It will cost the state an initial $1.9 million, which will be matched in federal dollars. 

A long path 

“It’s such a good feeling today,” Rebekah Smith Hazelton, director of the Wyoming Women’s Foundation, told WyoFile following the ceremony. “We’re just so grateful that the Legislature took up this issue and that they got the support for it.” 

Smith Hazelton and her colleague, Marissa Carpio, followed HB 4 from its drafting as a Labor, Health and Social Services Committee bill during the interim to its final passage, which meant long days in Cheyenne, meeting face to face with lawmakers and collaborating with other advocates. That also meant being along for the twists and turns the bill took through the Legislature. 

“There were some doubts at times,” Smith Hazelton said. 

The bill, for example, spent weeks at the bottom of the general file in the House and nearly died by deadline. It was finally heard on the floor after Rep. Steve Harshman (R-Casper) struck a deal with Majority Floor Leader Chip Neiman (R-Hulett). Harshman withdrew an amendment to run the program through the supplemental budget bill after Neiman agreed to bring the bill to the floor. Both lawmakers kept their respective promises and ultimately the House voted 34-28 to send the legislation to the second chamber. 

Once in the Senate, the bill received almost unanimous support during its hearing in the Labor, Health and Social Services Committee. Sen. Lynn Hutchings (R-Cheyenne) was the sole committee member to vote against the bill — and apparently the only person in the meeting room who opposed the bill. No one responded when Baldwin, the committee’s chairman, asked if anyone was there to speak against it. 

“People should learn to be responsible for their own health care needs,” Hutchings said during the meeting, while also criticizing the program for “entangling” the state with the federal government

Those who spoke in favor of the bill included representatives from the Wyoming Psychological Association, the Wyoming Hospital Association, the Wyoming Nurses Association, as well as several medical professionals. Lily Leman and Gwen Hargett, two students from Cheyenne Central High School, also braved the meeting, testifying for their first time at the Legislature.  

“I think most people and most women … aren’t on Medicaid because they choose to be on Medicaid,” Hargett said. “They’re on Medicaid because of their circumstances that have put them in that position.”

Erin McKinney, the clinical director for women and children’s services at Cheyenne Regional Medical Center, provided expertise from her 22 years in the medical field. 

“Consequences of untreated postpartum depression impacts two generations, not just the mother,” McKinney said, adding that untreated postpartum depression increased negative outcomes for children, including delayed cognitive and language development. She then spoke from personal experience, noting that her own postpartum depression impacted three generations, including her father who was seated not far behind her. It was the kind of testimony that moved Sen. Dan Dockstader (R-Afton) to support the bill. 

“I would say there’s a time to be fiscally cold and conservative,” Dockstader said. “And there’s a time to look after the well-being of a mother and newborn child.” 

Final hurdle

Then the bill hit a familiar snag on the Senate floor. It was early evening on the last day for legislation to receive an initial floor vote in the second chamber. Sitting near the bottom of the list once more, HB 4 had not yet been debated. Lawmakers were expected to adjourn at any moment. Leaving the bill untouched would have spelled its demise. 

Carpio, with the Wyoming Women’s Foundation, said there was little she and other advocates could do at that point, besides sit in the Senate lobby and hope for the best. 

Shortly before the deadline, however, Baldwin brought a motion to move HB 4 up the list. His little-used procedural maneuver earned the requisite simple majority by one vote. Sen. Larry Hicks (R-Baggs), who as the Senate majority floor leader, determines the order in which bills will be heard, countered by moving to adjourn. Hicks’ adjournment motion failed and lawmakers launched into debate. 

Baldwin, who works as a physician assistant, gave an example of a patient who died six months after giving birth due to a related complication. 

“That happened mostly because she couldn’t afford to come in and keep regular doctor’s appointments,” Baldwin said. 

Soon after, Hicks tried once more to kill the bill by bringing a motion to refer to the Senate Appropriations Committee. He used its fiscal cost as his argument for the motion, but as Sen. Eric Barlow (R-Gillette) pointed out, that particular committee had already approved the bill. 

Hicks never explained his opposition to the bill on the floor, but withdrew his amendment before debate resumed. The senator could not be reached for comment by press time. 

The bill had a smooth journey from there, though again, it was a single vote that decided to send it to the governor for his signature. 

“I can’t think of a better way to end the session, really, than the signing of a bill that’s going to help children and going to help others,” Speaker of the House Rep. Albert Sommers (R-Pinedale) said at the ceremony. “It’s so incredibly important that we help those that really can’t help themselves.”

The bill goes into effect in July.

This article was originally published by WyoFile and is republished here with permission. WyoFile is an independent nonprofit news organization focused on Wyoming people, places and policy.