The column below reflects the views of the author, and these opinions are neither endorsed nor supported by WisOpinion.com.
Forty states, 19 currently GOP-led, have expanded Medicaid under the Affordable Care Act, with 90 percent federal funding. Four states (Missouri, North Carolina, Oklahoma and South Dakota) that recently expanded Medicaid get the 90 percent federal funding plus an extra federal bonus for 2 years. Wisconsin is eligible for all this funding, including the bonus, when it expands Medicaid.
The nonpartisan Wisconsin Policy Forum said Wisconsin would get an “estimated $1.7 billion savings from state expansion over the next two years” (substituting federal funding for state spending for currently covered childless adults). The Forum went on to say that the “savings … could be spent to improve the state’s healthcare system, address other spending priorities, reduce taxes, or some combination.” Moreover, expansion would cover over 90,000 Wisconsinites, many in rural areas, working low-income jobs, mostly without health insurance.
The above savings could help financially struggling hospitals. Ascension Wisconsin just announced it was closing a Waukesha hospital and labor-delivery units elsewhere. Earlier, 2 hospitals in western Wisconsin closed. Meanwhile the Wisconsin Hospital Association reported that uncompensated care (“charity care” and “bad debt”) cost $1.4 billion. And, the Center for Healthcare Quality and Payment Reform continues to warn of “rural hospitals at risk of closing”, including those in Wisconsin. The Center said: “What is causing the loss of rural healthcare services? In most cases, the biggest reason is that (private) health insurance plans pay rural hospitals less than what it costs to deliver essential services such as emergency room visits, labor and delivery, and primary care.”
Again, the savings from Medicaid expansion could be used in part to support rural hospitals. When the above mentioned 2 hospitals closed in western Wisconsin Democratic Governor Tony Evers pointed out that Medicaid expansion would have helped. Reinforcing Evers, the Kaiser Family Foundation (KFF) has reported: “A KFF synthesis of recent studies finds that Medicaid expansion has been beneficial to the finances of hospitals and providers, driving decreases in the share of uninsured patients, increases in Medicaid-covered patients and declines in uncompensated care.”
Nationally, Medicaid expansion has covered 23 million Americans, including millions in rural areas. Notably, the Wisconsin Policy Forum said: “residents of (Wisconsin) rural counties are most likely to benefit by Medicaid expansion.” The need is great. Mary Wakefield, former chief of staff for 2 North Dakota Democratic U.S. senators and a rural health care policy expert, told me: “Rural communities often face significant health care challenges, including higher rates of uninsured, less access to health care services and shortage of health care providers. … Additionally, more than their urban counterparts, rural residents tend to have disturbingly higher rates of serious illness like heart disease, cancer and some respiratory diseases, making access to health care critically important.”
Medicaid expansion is common sense, adds up financially and is good politics. In November, Wisconsin Democrats gained 4 state Senate seats and 10 state Assembly seats, running on expanding Medicaid. It’s inevitable. Do Wisconsin GOP legislators want to keep their seats? It’s past time for a change.
–Kaplan wrote a guest column from Washington, D.C., for the Wisconsin State Journal from 1995 – 2009.
