The Legislature's failures to expand Medicaid have left Wyoming Medical Center officials shaking their heads.

"Nobody knows what to do at this point," hospital CEO Vickie Diamond said during the monthly meeting of the Memorial Hospital of Natrona County board of trustees on Tuesday.

"It's not too hopeful," Diamond said, especially when chambers of commerce, county commissioners and health care organizations supported it.

The approximately 17,000 Wyoming residents who would be covered by the Medicaid expansion would mean hospitals would not need to write off so much uncompensated care -- charity care and bad debt -- for patients who now cannot afford to pay. The Wyoming Medical Center alone estimates it will write off about $56 million in uncompensated care this fiscal year. Those losses are socialized as other patients pay for that uncompensated care.

The Memorial Hospital board, appointed by the Natrona County Commission, oversees the lease of the county's hospital assets -- mostly in the 1200 block of Second and Third streets -- by the nonprofit Wyoming Medical Center Inc.

Two trustees said many legislators apparently have a poor understanding of the business of health care, or the business of running businesses.

"They really do believe what I call 'the propaganda,'" Carol Crump said.

Some legislators believe that if Medicaid is expanded, people will leave their private insurers and sign up for Medicaid, Crump said.

That simply is not true, because Medicaid is fraught with its own problems of bureaucracy for poor patients, she said. "It's not a fun alternative."

Trustees board Chairwoman Serena Cobb said another wrong-headed perception arises from people seeing construction, such as the building of the McMurry West Tower at the WMC. "'I see the cranes and expansion, so you must not be hurting,'" Cobb said, paraphrasing critics of Medicaid expansion.

This discussion about financial responsibility, Crump added, reminded her of her experience while serving on the Casper city council.

Legislators who opposed allocating more money to local governments told her they didn't need it because they had cash reserves, she said. But without those reserves, what does Casper do when the roof of the Events Center collapses, she asked rhetorically.

Diamond said hospitals like any other business need to invest in people and technology for the future. Most of those in the black run on operating margins of 1 percent to 3 percent, and they try to keep cash on hand for emergencies, she added. "You don't want to start dipping into reserves."

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