More children lack health insurance in most states that have refused to expand Medicaid under the Affordable Care Act (ACA) than in the states that accepted Medicaid expansion, according to a new study released Friday.
Wisconsin has not accepted federal money to expand Medicaid — also known in this state as BadgerCare — which has become one of the most heated partisan battles with Republicans staunchly opposed and Democrats pushing the expansion frequently in bills and amendments.
Overall, in the 12 states that haven’t taken the ACA Medicaid expansion funds, 8.1% of children lack health insurance coverage, according to the study, produced by the Center for Children and Families at Georgetown University’s Health Policy Institute. In states that have accepted the additional funds, 4.1% of children are uninsured.
Wisconsin is an outlier in the study, with 3.8% of children uninsured although it is not a Medicaid-expansion state. But that reflects the state’s long-standing work in covering children, according to William Parke-Sutherland, health policy analyst at Kids Forward, a Wisconsin advocacy group for children and families.
Medicaid expansion would allow the state to push the percentage of children without coverage down further, he says.
“The story this tells is that we could be doing better if we expanded, because we’ve started out from a fairly strong position,” Parke-Sutherland says, “and other states that have expanded are doing better than us or catching up to us.”
In West Virginia, for example, 3.5% of children lack health insurance, according to the study. The state accepted the ACA Medicaid expansion dollars starting in 2014, when they first became available.
The federal health coverage law offers states additional Medicaid funds if they agree to make the health insurance program for the poor available to families with incomes of up to 138% of the federal poverty level.
The findings come as Gov. Tony Evers renews his call for Wisconsin to join the majority of states and accept the expansion funds in the state’s 2021-23 budget. By accepting the federal expansion for BadgerCare, Wisconsin could cover 91,000 more residents and save $634 million over two years, according to the governor’s budget documents.
Republicans in the Legislature, who have consistently opposed expansion, have said they plan to reject that item.
Meanwhile, Democrats in Congress working on the $1.9 trillion federal COVID-19 legislation have included a sweetener to persuade holdout states to accept the expansion funds. Wisconsin alone could receive $1.3 billion, according to the Center on Budget and Policy Priorities.
Former Gov. Scott Walker’s administration, instead of accepting the ACA expansion funds, obtained a federal Medicaid waiver that allowed Wisconsin to move parents with incomes from 100% to 200% of the federal poverty level off of BadgerCare. The state expanded coverage to all adults up to 100% of the poverty level.
That change cost about 60,000 parents coverage, Parke-Sutherland says. Walker’s plan was for the displaced parents to obtain coverage, subsidized by the federal government to make it more affordable, on the ACA’s private insurance marketplace, but only a little more than half of them found other coverage.
While the plan maintained coverage for children, Parke-Sutherland says that by not covering more parents as ACA expansion would allow, some children also have gone without health insurance.
Studies have shown that if parents have coverage, “children are more likely to have coverage and they’re more likely to get care,” he adds. “There’s fewer barriers to access when kids and parents have the same coverage.”