Editorial: Walker should accept federal Medicaid expansion

9:27 PM, Feb. 22, 2013  |  Comments
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Gov. Scott Walker's distrust of the federal government's promises has led him to make a decision that will negatively affect taxpayers, health care providers and the uninsured.

In turning down federal money for Medicaid expansion, the governor is predicting the government won't make good on its promise of funding it. The governor basically believes the federal government will default on its pledge given the financial outlay required under the Patient Protection and Affordable Care Act coupled with a $16 trillion debt.

In his budget address on Wednesday, Walker said his plan "prevents putting the state at risk of the federal government not being able to fulfill the enormous new financial obligation under the Affordable Care Act."

Walker's surely not alone in his skepticism, but it's a risky proposition to base a decision on health care coverage for low-income residents on a belief that the federal government will buckle.

Medicaid provides health care coverage for low-income families and individuals. (It's known as BadgerCare in Wisconsin.) An estimated 50 million people nationwide are on Medicaid. The federal government covers 60 percent of the costs; the state pays for 40 percent.

The federal government's obligation increases under the Affordable Care Act if states accept full expansion. Medicaid would be fully funded in the first three years of the program (2014-2016). The percentage would gradually be reduced to 90 percent by 2020 and beyond.

That's about $12 billion in Medicaid funds over 10 years, according to some estimates. The state would save $66 million in the first three years. An additional 175,000 childless adults would be covered, according to the Legislative Fiscal Bureau, and health care advocates estimate the federal expansion would create 10,000 health care jobs.

However, federal funding would remain at 60 percent for states that opt out, which is what Walker is proposing. His plan calls for reducing the Medicaid eligibility rate from 200 to 100 percent of the federal poverty level, removing an enrollment cap for adults without dependent children and moving others into the federal health care exchanges.

Walker says his plan will reduce the number of uninsured by 224,580. By moving more people to the insurance exchange, the number covered under Medicaid would drop by 5,417. The ACA would decrease the number of uninsured by 252,678 and cover 90,691 more on Medicaid, while shifting fewer to the exchange.

Walker has expressed his dislike for the Affordable Care Act, delaying decisions last year on the health exchanges until after his recall election and then waiting until after the presidential election. Ultimately he decided not to set up a health insurance exchange and to go with a federal government option.

Now he's unwilling to sign on to a federal expansion of Medicaid even though his plan would cost the state $250 million more than full expansion through 2020, according to a Milwaukee Journal Sentinel report.

That doesn't make sense. Why would the official who said no to eliminating same-day voter registration because it would cost the state $5 million offer a proposal that would cost the state $250 million?

The only answer must be that he doesn't believe the federal government will make good on its funding promises and will leave states holding the bag. That's a huge gamble, and it's not one we're willing to take when you're talking about people's health care.

We call on the Legislature to amend Walker's proposal. Adjusting the income threshold for Medicaid from 100 percent of the federal poverty level to 133 percent would bring Wisconsin within federal guidelines and allow for 100 percent funding, according to an October report in the Journal of Health Politics, Policy and Law. It's a move that also has the backing of the Wisconsin Hospital Association.

"Aside from the politics, the Medicaid expansion is good policy," according to the authors of the report, "Sound Policy Trumps Politics, States Should Expand Medicaid," by providing care for patients, reducing uncompensated care, helping states pay for that care and offering "a relatively inexpensive way to expand coverage."

People's health and their ability to pay for it without going into financial ruin are at stake . The federal government can help with Medicaid funding. Those financial considerations should outweigh any skepticism or politics in play here.

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