Bill Kaplan: Ending Medicaid expansion gridlock

Photo by Michelle Stocker, The Capital Times

The column below reflects the views of the author, and these opinions are neither endorsed nor supported by WisOpinion.com.

Sixteen GOP-led states, including three in process, have Medicaid expansion. Moreover, 55 percent of Republicans, nationwide, support expanding Medicaid (Kaiser Family Foundation). And, in Wisconsin, 43 percent of Republicans and 70 percent of all Wisconsinites support Medicaid expansion (Marquette Poll). Wisconsin Democratic Governor Tony Evers tried mightily to convince the GOP-led legislature to expand Medicaid: fought for its inclusion in the state budget; withdrew Wisconsin from the Scott Walker–Trump lawsuit seeking to have the Affordable Care Act (ACA), which includes Medicaid expansion, declared unconstitutional, and allocated $500,000 for outreach workers to help enroll eligible Wisconsinites in BadgerCare (Medicaid) or to be covered by ACA private insurance.

However, the GOP-led legislature has opposed Medicaid expansion, which substitutes federal for state expenditures (saving $324 million in state tax dollars, while expanding health coverage for over 80,000 Wisconsinites). The savings could be used for education, mass transit and roads. And, state taxpayers would no longer pay federal taxes to expand Medicaid only in other states – but not Wisconsin. Nonetheless, GOP legislative leaders continue the legislative gridlock. Out of step with GOP Governor Warren Knowles, who established the state Medicaid program, and GOP Governor Tommy Thompson, who enlarged it.

Let’s reframe and reset the debate and move Wisconsin Medicaid expansion forward. First, the recent nonpartisan study ranking “healthiest and least healthy counties in Wisconsin” (Robert Wood Johnson Foundation and UW-Madison Population Health Institute) is invaluable. The Evers administration should distribute it to all legislators, the media and business, community, health, labor and religious leaders. The least healthy counties are all over Wisconsin, including rural areas and Milwaukee, Northern rural Wisconsin is especially saturated with counties having terrible health outcome measures. And, it ranks poorly in health factors (socioeconomic). No wonder the 7th congressional district (CD) has so many covered by ACA private insurance. Medicaid expansion would be a blessing. Almost every state congressional district has counties scoring poorly. Only the wealthy Milwaukee suburbs of the 5th CD show few problems. (State) “health officials estimate that more than 400,000 people in Wisconsin had no medical insurance at some point last year” (Wisconsin Public Radio).

Second, Wisconsin should follow Kansas Democratic Governor Laura Kelly and establish a “Governor’s Council on Medicaid Expansion”. The Kansas Council was tasked to focus on: “What do we need Medicaid expansion to achieve for Kansas? (and) What can we learn from other expansion states that will help – or hinder – those goals?” It includes Democratic and Republican legislators, heads of the Kansas Hospital Association and Kansas Medical Society and other health care and insurance representatives. The group has already heard from Democratic and Republican health experts on the many benefits of Medicaid expansion: reduction in the uninsured rate, improved health outcomes, fewer disparities, lower uncompensated care, state budget savings and economic growth.

I would suggest two cochairs for a Wisconsin Council – former Republican state Senate leader Dale Schultz and Doctor Susan Turney, CEO of the Marshfield Clinic Health System. These distinguished leaders, with other participants, could help end Medicaid expansion gridlock in Wisconsin.

–Kaplan wrote a guest column from Washington, D.C. for the Wisconsin State Journal from 1995 – 2009.

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