Could Medicaid expansion get a second life?

It was a key plank in candidate Tony Evers’ campaign health-care platform during last year’s governor’s race: Reverse former Gov. Scott Walker’s rejection of federal funds to expand Wisconsin’s Medicaid coverage.

But with his Medicaid expansion plan stripped out of the budget by the Republican-dominated legislature, the governor and health care advocacy groups are looking at what can be done to achieve at least some of the benefits they had been counting on.

“We anticipate stand-alone legislation will be introduced for many of the priorities that weren’t funded in the budget, including expanding Medicaid or BadgerCare,” said William Parke-Sutherland, health policy engagement coordinator at Kids Forward, a children’s advocacy group.

“There’s a broad range of advocates and others working on this — women’s health care advocates, disability rights advocates, kids’ advocates, aging and long-term care advocates who are talking about the importance of Medicaid expansion,” he added. “I think we definitely moved the needle, and I think there are definitely Republicans who know this is an important issue and this isn’t going away.”

‘Spending a lot more to accomplish a lot less’

Federally funded Medicaid expansion was part of the Affordable Care Act’s mix of provisions to expand health coverage to the uninsured. But the decision whether to accept federal funds was left up to individual states, which set their own budgets and administer the Medicaid program.

States that accepted Medicaid expansion were required to expand coverage to people with incomes up to 138 percent of the poverty level. In return, the federal government would cover at least 90 percent of the cost of Medicaid in the state. States that did not  accept the expansion remained at the standard match rate — 58.5 percent from the federal government.

To date, 37 states have accepted the Medicaid expansion funds, along with the federal requirements that accompany them, while 14 have not, including Wisconsin. Instead, Walker restructured BadgerCare and BadgerCare Plus — the state’s version of Medicaid.

Walker removed people with incomes over the federal poverty line from eligibility, while expanding coverage for childless adults up to the poverty level. The people removed from BadgerCare were directed to sign up for coverage through the Affordable Care Act for private insurance coverage, which included federal subsidies for people with lower incomes.

By rejecting the federally funded Medicaid expansion, “We are spending a lot more to accomplish a lot less,” said William Parke-Sutherland, health policy engagement coordinator for Kids Forward Wisconsin. An estimated 82,000 people who would have gotten health coverage under Evers’ budget provision now won’t, he said. And a Legislative Fiscal Bureau estimate earlier this year pegged the cumulative cost to the state of not taking the Medicaid Expansion at $1.1 billion.

Looking to others for inspiration

Eric Borgdering, president of the Wisconsin Hospital Association, is skeptical of the prospects for salvaging the Medicaid expansion this year.

“I think the chances of expansion happening as a stand-alone legislation are probably pretty slim,” Borgerding told the Wisconsin Examiner. For that reason, he said, his organization is looking at how other states may be finding compromise approaches to achieving at least some of the same ends. In Arkansas, for example, he said, lawmakers “took expansion but it delivers the coverage largely through the ACA marketplace. … The commercial private sector helped deliver that coverage, but it’s Medicaid.”

Bobby Peterson, executive director of ABC for Health, which seeks to help consumers navigate the healthcare system, said his organization is looking to what he called “Medicaid In-spansion” as a smaller — “but important” — and partial alternative that could promote “the room to grow and expand the current program features.” Some of those eligibility features have largely gone dormant or underused during the Walker years, Peterson contends.

The programs his group is calling to beef up include:

• HealthCheck, aimed at ensuring widespread, Medicaid-covered, comprehensive and preventive health checkups and services for children under the age of 21;
• Medical Assistance Purchase Plan, allowing people with disabilities to work and still have access to Medicaid with higher income and asset limits to qualify;
• Identifying people with fluctuating income levels who would qualify for “Gap Filler” coverage under BadgerCare Plus.

Peterson is still open to a stand-alone bill to revive the full Medicaid expansion proposal. That would offer an opportunity “to provide voters a clear idea of the supporters and opponents of such action,” he said.

“A stand-alone bill must be a clean bill that permits expansion of Medicaid for BadgerCare Plus in Wisconsin,” he added. “This is not a bill larded up with ‘poison pill’ provisions’ ” — such as drug-testing requirements for Medicaid recipients that have been pushed in the past under Walker — “that creates punitive sanctions for people seeking healthcare coverage and services and pretends to be an expansion.”

A bill that doesn’t meet that standard, he said, should be vetoed.