Two Natrona County legislators on Wednesday defended their decision to not expand Medicaid -- an action that could have covered about 20,000 low-income adults -- during the recent budget session.

"I just don't think we're there yet as a state," Rep. Steve Harshman said during a post-Legislature forum sponsored by the Casper Area Chamber of Commerce at the Ramkota Hotel.

Harshman and Rep. Tim Stubson responded to this question posed by chamber members: "Casper has become the center for medical care in our State and in this region, at the same time you have voted down Medicaid Expansion four times. When will you propose a viable solution to this problem and how do you plan to support Casper's medical community moving forward?"

Harshman said this isn't about whether or not he supports local health care.

"The Wyoming Medical Center is core institution in Casper," he said. "I don't think it's about that. I think it's trying to do what's right for Wyoming."

Gov. Matt Mead put it in his proposed budget in December. The proposal would have added about $268 million from the federal government to the 2016-2018 biennium.

A coalition of business and labor groups and health care providers, especially hospitals including the Wyoming Medical Center, supported the expansion. WMC officials have cited the experiences of other states where it has cut uncompensated care -- charity care and bad debt -- write-offs.

But the Joint Appropriations Committee rejected Mead's proposal before the session began, and subsequent attempts failed to bring it back before lawmakers.

Harshman said expansion is difficult, and the Legislature needs to resolve a number of issues including upwards of 6,000 of the potential 20,000 eligible recipients may leave private health for the state program.

The Legislature, he said, did support some health care measures, including appropriating money to help hospitals with uncompensated care, and establishing a statewide data base to determine the costs of health care.

But proposal still needs work, Harshman said. "We're still searching for that Wyoming solution."

Stubson said Medicaid expansion is possible, but it would require more than what Mead proposed.

"It has to be sustainable," he said. "It has to be something that Wyoming people can count on over time. It has to be affordable. We have to have something that controls costs in that expansion model. And it has to be something that allows Wyoming to keep its options open."

The proposal, tied to a certain percentage of the federal poverty level, would have meant a person earning $1 over that would not be eligible for Medicaid, Stubson said. "Do you not think that creates a huge disincentive for folks to improve their lives through education, better jobs, more work hours?"

After the forum, Stubson said uninsured people are in the community, but he acknowledged he had not spoken to people in that position about what they thought about the Legislature's actions.

Kimberly Holloway, who is a trustee on the board that oversees the Wyoming Medical Center's lease of Natrona County's hospital assets, said after the forum the Legislature is making Medicaid expansion unnecessarily difficult.

"Their hands are not tied," she said. "They have these choices to make and they just refuse to do so."

Expansion would benefit both patients and health care providers, but the problem is more deeply rooted than that, Holloway said.

"They have cold hearts and lack of empathy, and they really don't think about who is really the person that would qualify for this program," she said. "These are not parasites, these are not people who feed off everybody else and take advantage of or living high off the hog because they qualify for federal programs."