WASHINGTON - Wyoming, the second to last state to construct a plan to provide health insurance to kids of the working poor, has finally adopted the necessary legislation, but it took two years and a contentious battle among lawmakers. On March 1, Republican Gov. Jim Geringer signed into law a bill that launches KidCare, Wyoming's version of the Children's Health Insurance Program (CHIP). Congress established the program in 1997 as part of the Balanced Budget Act, but Geringer and conservative legislators had long opposed the structure of CHIP, labeling it an "entitlement" program rather than a block grant, and a threat to "personal responsibility."
"We are increasing access to healthcare for our children while keeping the responsibility for healthcare within the family and the community," said Geringer as he signed the bill, flanked by 100 Wyoming pre-schoolers.
Agreeing on the legislation ignited much discussion in the state's legislature over the past two sessions. Debate focused on whether it was the responsibility of Wyoming taxpayers to pick up the tab for the program.
Washington is the only other state that has not submitted a CHIP plan to the Health Care Financing Administration, the agency that administers the program along with Medicaid and Medicare. But Washington's Medicaid program already covers children up to 18 whose families are at or below $33,400, which is 200 percent of the federal poverty level.
Congress made available $48 billion over 10 years to fund state CHIP programs at a three-to-one federal/state matching rate. In the first fiscal year of Wyoming's program state funds will provide $485,000 of the program costs. Unlike Medicaid, the program cannot exceed the funds appropriated by the legislature each year.
What passed in Wyoming was a compromise program that includes a Medicaid look-alike component (covering kids up to 133 percent of the federal poverty level) and a privately administered voucher component (covering those from 133-150 percent). The 1999 federal poverty level is $16,700 for a family of four.
The bill passed the House 39-19, and the Senate 17-13.
"The compromise kept everyone at the table," said Rep. Fred Parady, (R-Rock Springs), freshman chair of the Joint Labor, Health and Social Services Committee.
"The committee was very split philosophically. Some wanted a publicly- administered program that looked like Medicaid, others wanted a private program using vouchers," said the Wyoming Health Department's Tom Pringle
Pringle said because 95 percent of the healthcare providers in Wyoming accept Medicaid, the same doctors would see children in both components. He said that many of the legislators pushed for the voucher option so that parents who make more money will be involved in choosing a health plan for their kids.
"As you are working yourself up in income levels, the idea was that parents make more choices. You are acquainting the family with private health insurance, and it is more likely that they will keep the insurance as they make more money," Pringle said.
Even with the voucher option included, Parady said a strong element of the conservative wing of the legislature said "this is up to parents to control these things."
"While KidCare insurance is a fine idea, where is parental responsibility?" said Rep. Marlene Simons, who serves on the Wyoming House Appropriations Committee. "The federal money is not free money, it is our tax dollars and most of the people in Wyoming are responsible for their own and don't agree with new programs taking their tax dollars."
Because Wyoming was nearly the last state to create a CHIP program, Tom Pringle said the Wyoming Health Department felt pressure to participate, although many state legislators did not.
"Wyoming is fairly resistant to that pressure," said Parady, who is a manager of a soda ash mine in Southwestern Wyoming. "This is a citizen legislature, we come from all walks of life."
Nationwide, the Census Bureau estimates there are an estimated 10.7 million children without health insurance. Five million of the kids come from families whose annual income is less than 200 percent of the federal poverty level and would be eligible for most CHIP programs.