For advocates who say Wisconsin should accept $1.6 billion in federal funds to expand Medicaid, or BadgerCare as the state’s program is called, the reasons include protecting the working poor, promoting preventive health care, easing the financial strain on small business — and the big bonus that the American Rescue Plan Act (ARPA) is making available to states that sign on now.
“BadgerCare expansion would save our state nearly $300 million per year,” said Brian Ewert, a Marshfield physician and kidney specialist, in an online news conference Monday morning sponsored by the Committee to Protect Health Care, an advocacy group. “Thanks to the American Rescue Plan, we could save an additional $1 billion during the first two years of expansion.”
Federally subsidized Medicaid expansion was included in the Affordable Care Act (ACA) to cover people who weren’t previously eligible for the federal/state health insurance program for the poor.
States that agreed to expand their Medicaid programs to cover non-elderly, non-disabled adults with incomes up to 138% of the federal poverty guidelines — currently $17,130 for a single person and $29,207 for a family of three — could get the entire expansion covered with federal funds in the first when it began in 2014, phasing down to 90% of the cost by 2020.
The expansion was made voluntary by a 2012 U.S. Supreme Court ruling that first upheld the ACA.
Wisconsin under former Gov. Scott Walker turned down the expansion funds and the GOP-controlled state Legislature has blocked Evers from acting on his own to accept the money. Wisconsin is just one of 12 holdouts, according to the Kaiser Family Foundation, down from 20 states that refused initially.
As a result, Wisconsin has already passed up as much as $2.8 billion, according to a 2018 Legislative Fiscal Bureau report. “Expanding BadgerCare will bring our federal tax dollars back home, helping support hospitals, nursing homes and creating jobs here in Wisconsin,” said Ewart.
The Marshfield physician was one of three Wisconsin doctors who took part in the Committee to Protect Health Care news conference to make the case for accepting the expansion when the Legislature meets Tuesday in a special session called by Gov. Tony Evers.
While Republican lawmakers opposing expansion have called it “welfare,” Ann Helms, a Milwaukee neurologist, pointed out that many of the 91,000 state residents who could gain coverage are already in the workforce.
“Many of these families have jobs that don’t provide health insurance,” Helms said. “For these Wisconsinites, BadgerCare covers health care essentials like doctor visits, prescriptions, mental health care, screening, hospital services and more.”
Comprehensive health coverage when symptoms of illness are mild and can potentially be treated more easily and at lower cost save both health and money, Ewert and Helm observed.
“I have seen in my own practice how increasing access to care can help patients with early kidney disease stop it from getting worse, and therefore helps prevent the need for dialysis,” Ewert said.
Helms said in her practice she sees what happens when even simple treatments get overlooked.
“I treat stroke,” she said. “So I see patients when they have no choice but to go to the hospital.” And some of them who lack coverage “end up with catastrophic medical bills and never able to work again — so they end up on permanent disability.”
All of that, she said, might have been avoided by an early diagnosis and treatment for high blood pressure or clogged arteries or other chronic medical conditions at far less expense.
“They’d be able to still be working, and their life wouldn’t be destroyed,” Helms said. “From a just-being-good-to-other-humans perspective, but also from an economic perspective, it’s a bad choice no matter how you look at it not to cover people who are in need of health care — which is everyone.”
When Walker rejected the federal Medicaid expansion, his administration proposed, and the Legislature approved, an alternative that lifted an enrollment cap on BadgerCare but also lowered the program’s income ceiling to the federal poverty guideline.
The change enabled about 83,000 poor, childless adults to join the program, but it also kicked off about 90,000 people with incomes between 100% and 200% of the poverty guideline.
Walker reasoned that those people could buy heavily subsidized health insurance through the private market provided by the ACA’s health care marketplace, and defenders of the state’s current system have claimed that because of that, there is no “coverage gap” in Wisconsin.
But that’s not accurate, said Madelaine Tully, a family practitioner in a Milwaukee community health clinic.
“Even with increased financial support, many Wisconsin residents right now cannot afford private insurance,” Tully said. “Deductibles, co-pays and other out-of-pocket costs burden low wage workers who are balancing housing, transportation, utilities, food and other essential needs on a very limited budget.”
Tully also said that the current BadgerCare income ceiling discourages some people who currently qualify for the plan from taking a higher paying job — and with it the greater expense of additional costs that come with private insurance that they would then have to purchase.
The push for expansion isn’t limited to the health care profession. Some small business owners see in BadgerCare an opportunity to provide health care coverage for employees in businesses where margins make purchasing a health plan too costly.
That has been a message that Main Street Alliance, a small business advocacy organization, has been sounding for several weeks. At a news conference the group organized Monday with Lt. Gov. Mandela Barnes, Chef Dave Heide, of Liliana’s in Fitchburg, said that being able to offer health care would help small employers who have struggled to find workers.
“Our whole industry has been crippled by a lack of staffing,” Heide said, with access to health care and access to child care among the top reasons. BadgerCare expansion offers a path to solving some of that problem.
Barnes said he has heard from farmers for whom health care is the key to being able to hold onto their land and pass it on to the next generation. “If they’re not able to get access to health care, then they have to make the decision of whether they’re going to stay there or they’re going to go somewhere else.”