How purple Pennsylvania did what Wisconsin has not — expand Medicaid

Pennsylvania Gov. Tom Wolf told Gov. Tony Evers that he is shocked by the extremes Wisconsin Republicans are going to in their efforts to stop Medicaid expansion, which his state passed and implemented under divided party control.

In many states, including Pennsylvania, it has not been a red versus blue partisan battle to the extent that it has been in Wisconsin. 

“This is just going to make lives better and it’s actually going to produce revenue for the state of Wisconsin,” asserted Wolf. “What’s not to like about that? I am at a loss to understand why anybody looking at this could say anything other than, ‘Yes, please.’”

Wolf is a Democratic governor of a state with divided branches of government, like Wisconsin. One of his first actions upon becoming governor in 2015 was to expand Medicaid while both legislative houses were under GOP control.

He has a message for Wisconsin Republicans who may be business owners, or care about their constituents who run companies. Wolf, who owned a lumber and building product company, the Wolf Organization, for much of his career before he was elected in 2014 — says expansion is a boon for business.

“So here’s the business case, there are a number of reasons why I think we need to make sure that Medicaid expansion happens in [Wisconsin], as it did in Pennsylvania — why Wisconsin has to do it too,” said Wolf. “First, the system we have in place is expensive.”

People without insurance end up using emergency rooms as primary health care, he said. At his company, he tried to figure out each year how much of the insurance premiums his business was paying were actually “subsidizing many of our competitors who were not giving good health care to their folks,” — driving up insurance premiums as emergency room use increased.

Health care is something the Pennsylvanian governor believes is a public good. But having employers pay for it suggests it is actually a private benefit. That creates a system that doesn’t work well.

“The United States is the only developed country in the world where we put the burden of health insurance, health care, paying for health care, on the backs of employers,” Wolf added. “What sense does that make?”

Encouraging Wisconsin Republicans to pay close attention to Wolf’s pro-business argument that expansion makes for a better state economy, Evers vowed that “as long as I have breath in my body,” he would continue to push Medicaid expansion, which he says surveys show is supported by 70% of Wisconsinites.

Evers is not deterred by legislative rejection of a special session he called to take place last week and that GOP leaders gaveled out within a matter of seconds in both the Senate and Assembly.

Democrats have tried the carrot approach with Wisconsin Republicans. The American Rescue Plan Act included a $1 billion incentive for each of the dozen remaining states that have not expanded Medicaid if they changed course. In May, Evers laid out more than 50 economic development projects that an $850 million chunk of that $1 billion could fund, while saving the rest for a rainy day.

“We have to have better health care. We have to have affordable health care. We have to have a quality health care system,” Evers said. “But at the end of the day, those things make for a better economy.” 

“And it does impact businesses in a positive way,” he continued. “This is not creating a welfare state, as Republicans would like to put it. It is creating better health care for Wisconsinites.”

Purple states with divided government

Wolf spoke with Evers, as well as with U.S. Sens. Tammy Badwin (D-Wis.) and Bob Casey (D-Pa.) during a virtual discussion hosted by Protect Our Care’s Joe Zepecki.

Casey focused on two points he credited with fostering bipartisan support in his state. First was the importance of Medicaid expansion in rural areas. “This is a really good deal for rural areas, Medicaid expansion and Medicaid itself,” Casey said. Pennsylvania has 48 counties that are predominantly rural, he stated, and in 25 of them the number one employer is a rural hospital. 

“And if we don’t use the opportunity we have with Medicaid, more rural hospitals will close and jobs will go with them.”

Second, both Casey and Wolf said the expansion has played a significant role in addressing the opioid crisis.  

“It just so happened in our state, and this is true of many states, that just as Medicaid expansion was going into effect, what was exploding in our communities? The substance use disorder problem, the big category of which was the opioid crisis,” said Casey. “There are tens of thousands of people in our state who would have no treatment, no coverage for an opioid problem if they did not have Medicaid expansion. So I can give you lots of reasons, based upon our experience in Pennsylvania, why I hope more states will join the list of states that have expanded Medicaid.”

Other statistics he cited included Medicaid expansion driving down maternal deaths and infant mortality.

Baldwin took a shot at the blink-and-you-missed-it special session last week, saying that expanding BadgerCare would “extend quality health care coverage to over 90,000 working Wisconsinites and save taxpayers money. It should take them just one minute to say yes, instead of spending one minute this week to say no.”

In answering a question from the Examiner on what more Democrats and Wisconsinites who want Medicaid expansion can do, Baldwin asserted there “is more we can do.” 

She asked people to remember the battles the public waged when they thought the Affordable Care Act, which included the Medicaid expansion, was going to be killed in Washington under full Republican control. There were extensive phone and postcard campaigns waged by the public reaching out to all the federal representatives. “We need to activate … from the grassroots,” Baldwin said.

Then, noting that some people might think it’s a tangent, but she does not, she said there must be fair district maps. 

“What we have in Wisconsin is a very gerrymandered state,” said Baldwin. “We have a fairly strong Republican majority in both houses of the state Legislature. Yet, in numerous legislative elections over the past decade since the gerrymandered map came out, a majority of Wisconsinites have voted for Democrats.

“I think the high point was when 54% of Wisconsinites in aggregate had cast their ballot for a Democratic representative or state senator and yet, the state house remained nearly two thirds under Republican control,” said Baldwin. “That is not a one-person, one-vote system — that is exquisitely, surgically precise gerrymandering. Fair maps will help us get fair representation, which will help us expand Medicaid.”

“And that is your mic drop moment from Sen. Baldwin, folks,” said Zepecki, wrapping up the conversation.