A growing group of leaders at the state, county and citizen group levels will not take "no" for an answer.
The group is pursuing its agenda with the doggedness of those who have tried 40 times, and failed 40 times, to repeal the Patient Protection and Affordable Care Act.
One key difference is this group supports parts, if not the entire, act. More specifically, they support the expansion of Medicaid in Wisconsin and the $12 billion in federal aid over 10 years that could go along with it.
In the state's 2013-15 budget, Gov. Scott Walker and the Legislature rejected the federal expansion and the funds. Instead, they approved changes to the Medicaid program, known as BadgerCare in Wisconsin, that would cover adults up to 100 percent of the federal poverty level, instead of 138 percent under the federal plan.
Citizen Action of Wisconsin and county leaders from throughout Wisconsin are working on an alternative.
They're calling on the state government to submit a demonstration waiver to the federal government that would allow county governments to "access enhanced Medicaid funds rejected by the state."
The counties, unable to apply directly to the federal government for the funds, are asking the state Department of Health Services to do so and then distribute the money to the counties.
Supervisors from 20 counties sent a letter to DHS secretary Kitty Rhoades asking the state to set up a pilot program. Among those signing the letter was Marathon County Supervisor John Robinson.
Marathon and 12 other counties approved resolutions calling on the state to accept the funding.
Given the state has 72 counties, you might not think 13 county resolutions and 20 county supervisors amount to much support.
However, those 13 counties account for 40 percent of the state's population, which was 5.7 million people, according to the U.S. Census 2012 estimate. The 20 supervisors have constituents in 20 counties that account for 58 percent of the state's population.
Those aren't numbers that are easily ignored. Plus, those voicing support for the waiver shouldn't be ignored, either. They are the local officials who are on the ground and know the needs of the people they represent.
Many of our state legislators, as well as our governor, started out in elected offices at the town, village, city and county levels. They should know the challenges county human services departments face in dealing with the uninsured and the underinsured, the number of which will increase as they are moved from BadgerCare to health care exchanges that we're not even sure they'll be able to afford.
This type of waiver is not without precedent. It's being done in Cuyahoga County in Ohio, which includes Cleveland, where the governor supported taking the federal dollars for Medicaid expansion, but the legislature there rebuffed him.
The state response here to this alternative has been rather muted - Walker told the Milwaukee Journal Sentinel he didn't think the counties could do it.
He's right. They need help from the state, which has been unwilling to change course despite public pressure from groups like Citizen Action Wisconsin and county leaders.
If Gov. Walker is hesitant to accept the money because he doesn't believe the government will be able to pay out down the road, why not take the money now? If the feds default, we would have to craft an alternative anyway, perhaps something along the lines of Walker's plan.
Walker has said that in 1994, 10 percent of the state population was on Medicaid and that has increased to 25 percent today.
However, the economy today is worse than it was in 1994. Medicaid enrollment has increased because of the recession, and more people are out of work. In 1994, the state jobless rate dropped from 4.6 percent in January to 3.7 percent in December. Either of those rates is significantly better than the 7 percent unemployment rate in June 2013.
Plus, while what we pay for health insurance has skyrocketed, what that insurance covers has plummeted.
We're not advocating the state spend money it doesn't have for a luxury. We're advocating for health care coverage for low-income people that would be largely paid for by the federal government.
We'd prefer the whole state take part. But in the meantime, this alternative is worth exploring.
- Green Bay Press-Gazette