Anne Ladd belongs to the Rotary Club, and she sees there a prime example why Wyoming needs to expand Medicaid.

"There are always these people running around and filling water glasses and clearing tables," Ladd said during a forum Tuesday about a proposal to expand Medicaid coverage in Wyoming.

"That's exactly the population we're talking about," Ladd said.

This population amounts to about 20,000 residents and they need help, she and other panelists said at a forum sponsored by the Equality State Policy Center, which is working as group called Healthy Wyoming.

Ladd added that Wyoming is the only state that has seen a rise in the uninsured, and blames that partly on the lack of Medicaid expansion and higher health care costs compared to other states.

Besides Ladd, the other panelists were attorney Neil Short, John Corra representing the Wyoming Business Alliance, and retired orthopedic surgeon Dr. John Bailey.

The Legislature's Joint Labor, Health and Social Services Committee has dealt with Medicaid expansion proposals in recent sessions, and the full Legislature has rejected them.

But the session beginning Feb. 8 could be different because Gov. Matt Mead has included it in his proposed budget, said Bri Jones, executive director of the Equality State Policy Center and moderator of the forum.

"Joint Appropriations (Committee) will consider it in the coming weeks, and I think it's the best opportunity expansion has had," Jones said.

Besides Mead's support, the looming budget shortfall because of the energy industry's decline makes the offer of $268 million of federal money -- some of which comes from Wyoming taxpayers -- during the next biennium that much more attractive, Jones said.

"It would benefit every sector of our economy, and that's why we're asking the Legislature to pass it this year through the budget," she said.

Bailey said 30 other states have expanded Medicaid, which is part of the Affordable Care Act. Those states have seen job growth and a reduction in health care costs, he said.

The lack of expanded health care insurance is costly in economic and personal terms, Bailey said.

He's answered calls to the emergency room -- the most expensive way to get treatment -- for a diabetic patient whose circulation has dropped to nothing and has an infected foot, he said. The only treatment is to amputate the leg and spend weeks receiving care. Other patients at the hospital will pay his bill through higher costs. The patient probably will lose his job and then need public assistance, Bailey said.

Short added greater access and ability to pay for health care will result in healthier communities.

Jones and Ladd hammered on the moral imperative for Medicaid expansion.

"Those are people that we know all across our communities -- ranch and farmhands, waiters and waitresses," Jones said. "(These are) people who are working and trying hard to make a living and just are low income and just deserve to have health care and contribute to our communities."

Ladd, who has worked with several health-care policy organizations, has heard objections about expanding social service organizations to the effect that people will abuse the system.

Creating an abuse-free system is impossible, but that's not a reason to deny assistance, she said. "For the most part, most people try to play by the rules."

Despite the support of the governor, business groups and health care associations, coupled with the budget problems, Ladd said the toughest hurdle for Medicaid expansion still may come from the contempt of some lawmakers for their own constituents.

"Some of the way the legislators talk about the low-income (workers) is kind of appalling to me," she said. "It's like if you're low-income you're not worthy."