Chris Schaefer, M.A.
During his campaign, Governor Tony Evers vowed to “fight like hell” to expand Medicaid and increase the number of individuals dependent upon government for their healthcare needs. Despite his promise, Medicaid expansion was removed from the 2019-21 biennial budget.. With Republicans in control of both legislative houses and the state’s budget writing Joint Finance Committee, Medicaid expansion is unlikely to become a reality. Governor Evers has vowed to “fight like hell” to expand Medicaid; however, it cannot occur without support from the Republican-controlled legislature.
Presumably, Governor Tony Evers supported Medicaid expansion because he believed that growing the state’s welfare rolls would increase his vote totals in future elections, and that government was better suited than the private sector to provide Wisconsin’s poorest residents with health insurance. But his proposal grows government, creates a budgetary shortfall, makes individuals more dependent upon the state for their healthcare needs, and eschews free-market principles.
The reality is that BadgerCare, health insurance for the state’s uninsured, current covers more than 776,000 low-income Wisconsinites and is fiscally unsustainable due to former governor Jim Doyle’s robust expansion of the program. In fact, under Doyle’s auspices, such a significant number of citizens enrolled in the program, Medicaid vastly exceeded its budget. As a result, more than 21,000 Wisconsinites were devoid of health insurance (McIver Institute, 2019). According to the Wisconsin Legislative Fiscal Bureau (2019), the state spends nearly $3 billion annually on BadgerCare. Currently, the program provides coverage to individuals earning up to 100 percent of the federal poverty line ($12,500) annually. Governor Evers has claimed that expanding this program to include individuals earning up to 138 percent of the poverty line ($17,200) would make an additional $320 million in state funding available over the biennium. Acceptance of federal Medicaid dollars, Governor Evers argued, would help offset the cost of increasing the number of recipients on BadgerCare. His administration has consistently argued that expansion of the program would be fiscally prudent, as federal funds would be used to increase the number of BadgerCare recipients (Beck, 2019).
Expansion of this program would result in health insurance for those with privately-funded or employer-sponsored plans increasing by $600 million (Williams & Flanders, 2019). Individuals at or above 138 percent of the federal poverty line are eligible for subsidies under the federal marketplace. These subsidies are designed to offset the cost of their health insurance premiums.
The Kaiser Family Foundation found that Wisconsin is one of just 14 states that has not accepted Medicaid expansion. If expanding health insurance coverage is one of Governor Evers’ foremost priority, why is Medicaid expansion unlikely to become a reality? The simple answer: Wisconsin Republicans control both houses of the legislature and hold a 12-4 majority on the budget-writing Joint Finance Committee. In late May, JFC voted along party lines, to remove Medicaid expansion from the biennial budget. Thus, there is no procedural option available to Governor Evers, to reinstate funding—passage of legislation by the Republican-controlled legislature, would be the only way to reinstate Medicaid expansion.
Individuals currently earning up to 138 percent of the poverty line are eligible for generous subsidies, often as high as 90 percent, under the Affordable Care Act’s health insurance marketplace. The claim that those making up to 138 percent of the federal poverty level lack access to health insurance or care, is patently false. Healthcare is available to every Wisconsinite, regardless of income level, in the way of free or reduced cost clinics and emergency rooms. The intricacies of subsidy levels and Affordable Care Act will be analyzed in part two of this series on healthcare in Wisconsin.
Rather than expand welfare, the legislature should identify ways to connect Wisconsin’s uninsured with the highly-subsidized plans in the federal marketplace or privately-funded policies. Medicaid expansion would increase premiums for privately-funded or employer-sponsored policies, and result in more Wisconsinites becoming uninsured. Wisconsin’s nonpartisan Legislative Fiscal Bureau found that the Badger State does as well or better than most of the 36 states that expanded Medicaid. In June 2019, for example, Wisconsin’s uninsured rate of 5 percent is one of the nation’s lowest. Additionally, Wisconsin’s 3 percent unemployment rate mean that the Badger State is in a better economic situation than many states that accepted federal Medicaid expansion dollars. Expanding access to privately-funded policies or federal market place subsidies is a much more viable option to expanding Medicaid.
On July 3, 2019, Governor Evers signed the $82 billion budget into law, issuing 78 partial vetoes, despites its lack of funding for Medicaid expansion. Recognizing that the 2019-21 biennial budget contained funding for many of the issues he championed during his campaign, particularly record investment in public education—Evers used his partial veto authority to increase public education by $65 million more than approved by the Republican-controlled Joint Finance Committee. The Medicaid expansion debate is far from over and will likely dominate the 2020 midterm elections. Governor Evers has indicated that his administration will continue to advocate for Medicaid expansion and will use the issue to frame his political opponents of healthcare for Wisconsin’s uninsured. Stay tuned to part two of this series, which explains the history of government-run health insurance in Wisconsin and Medicaid’s innumerable shortcomings.
The views and opinions in the article are the writer’s and they may differ from that of the Pax Americana Institute
Sources and Additional References:
Beck, M. (2019, June 3). Tony Evers continues to push Medicaid expansion despite Republican opposition. The Milwaukee Journal Sentinel. Retrieved from https://www.jsonline.com/story/news/politics/2019/06/03/tony-evers-continues-push- medicaid-expansion-despite-republican-opposition/1330044001/
Flanders, W., & Williams, N. (2019). The impact of Medicaid expansion: Examining costs to consumers and the net impact on Wisconsin. Milwaukee, WI: Wisconsin Institute for Law and Liberty Press. Retrieved from
McIver Institute (2019, May 1). An unwise expansion. Retrieved from http://www.maciverinstitute.com/2019/05/an-unwise-expansion/
Wisconsin Legislative Fiscal Bureau. (2019). Medicaid assistance and other related programs: BadgerCare Plus, EBD Medicaid, Family Care and SeniorCare. Madison, WI: Wisconsin Legislative Fiscal Bureau Press. Retrieved from http://docs.legis.wisconsin.gov/misc/lfb/informational_papers/january_2019/0041_medic al_assistance_and_related_programs_informational_paper_41.pdf