Paying patients at hospitals will continue to cover the costs of those without health insurance because the Legislature refused to expand Medicaid, the chairwoman of the board of the Memorial Hospital of Natrona County said Tuesday.

"It was very disappointing that the Senators rejected the expansion," Serena Cobb said.

Besides upwards of 20,000 Wyoming residents not having health insurance, their eventual need for care will further burden hospitals as they socialize their losses by either cutting services or shifting costs to patients with insurance, said Cobb and Wyoming Hospital Association president Eric Boley.

"The senators' misconceptions about expansion is going to hinder those 20,000 folks in our Wyoming population as far as their ability to get routine care," Cobb said. "So when their health reaches a critical or emergent point in their life, they're going to visit the emergency room, and it's going to put undue burden (and) create more uncompensated care to our bottom line."

Boley concurred. "Health care in the state as we know it is at risk right now."

Friday, the Senate voted 20-10 against a bill to expand the program. According to its sponsor Sen. Bernardine Craft, (D-Rock Springs), said the expansion would bring $268 million to the state and offer health insurance coverage to roughly 20,000  residents who don't currently have it.

Sen. Charles Scott, (R-Casper), argued against the bill, saying it would be hard for Wyoming to back out of the program once the state accepted expansion. Scott also disputed claims that covering the cost of treating uninsured patients across the state is proving to be a hardship for many hospitals.

The Memorial Hospital of Natrona County, the Wyoming Medical Center and the Wyoming Hospital Association sharply disagree with the latter assertion.

The county commission-appointed Memorial Hospital trustees oversee the nonprofit Wyoming Medical Center Inc.'s lease of the county's hospital assets. The WMC's "rent," in effect, is to maintain the value of the property and to provide charity care to the indigent.

The trustees held their monthly meeting Tuesday, and heard the monthly report about the cost of uncompensated care, which is the combination of charity care and bad debt.

The WMC's Chief Financial Officer Yvonne Wigington said the hospital wrote off $28.7 million in uncompensated care charges -- $12.9 million in charity care and $15.8 million in bad debt from July through December. The total is $2.2 million more than the hospital had anticipated, and all of that $2.2 million is bad debt, some of which is related to the economic downturn.

If this trend continues, the hospital will write off $57.4 million in charges for the 2015-2016 fiscal year.

Boley of the Wyoming Hospital Association said that figure represents the WMC's charges to the patients. It's actual uncompensated costs of delivering care are about $30 million.

That's a significant hit to the bottom line, and the national experience of expanding Medicaid would very likely reduce that amount, Boley said.

"States that have adopted expansion are seeing a 63 percent decrease in their uncompensated care at their hospitals," he said. "As a nonexpansion state like ours, we're seeing a 3 percent annually."

"We watched (uncompensated care costs) grow from about $90 million in 2013; 2015 it's up to about $116 million," Boley said. "That's just our costs, that has nothing to do with charges, that's just the cost of delivering that care."

The Wyoming Hospital Association is among a coalition called Healthy Wyoming composed of health care organizations, community leaders, and business, education, religious and labor groups.

"We're bound and determined to fight for the uninsured, and those that need this care and coverage," Boley said.

"From a hospital perspective we've got to find something to stem the bleeding," he said. "If we see 3 percent increases on an annual basis with no help, we are going to see some more hospitals that are going to fold."