Gov.-elect Walker supports Medicaid expansion

By Bill Kaplan

Headline: Gov.-elect Walker to take office as "pro-expansion". No, we are not in the "Twilight Zone". However, breaking with his Wisconsin namesake, Alaska Independent Gov.-elect Bill Walker campaigned on expanding Medicaid. The former Republican formed a "unity ticket" (supported by Sarah Palin) with a Democrat running for Lt. Gov., replacing a GOP incumbent opposed to Medicaid expansion. Over 40,000 Alaskans would get health care coverage under Medicaid expansion. Moreover, Modern Healthcare said Alaska would gain "additional federal Medicaid funding of from $2.1 billion to $3.7 billion by 2020" (Lewin Group). The noise you hear is federal money from Wisconsin taxpayers "flying" north. 

Wisconsin GOP Gov. Scott Walker should use common sense over ideological stubbornness and GOP presidential primary aspirations. Wisconsin Medicaid enrollment has remained flat given Walker's machinations of enrolling thousands while throwing (other) thousands off, letting many fall between the cracks with no health care coverage. Moreover, as Wisconsin's budget deficit explodes, the nonpartisan Wisconsin Legislative Fiscal Bureau makes clear the advantages of Medicaid expansion. 

* Wisconsin would save $206 million 2013-2015 and another $261 million to $315 million 2015-2017; 

* Wisconsin would be able to cover another 120,000 people by 2016 with fewer out-of-pocket costs. 

It gets worse. The Urban Institute (D.C.) spelled out the consequences of Walker's rejecting federal Medicaid expansion money for Wisconsin 2013-2022: 

* Wisconsin will lose $12.3 billion in federal Medicaid spending; 

* Wisconsin hospitals will lose $3.7 billion in reimbursement. 

While Wisconsin hospitals prepare for more uncompensated care costs from Wisconsinites with no health care coverage, the story is brighter in Iowa. Medicaid expansion, implemented by Iowa GOP Gov. Terry Branstad, has reduced by almost half the number of hospitalized Iowans without health care coverage. Iowa hospitals also saw their uncompensated costs drop by 18.5 percent with less cost-shifting to privately insured Iowans. In contrast Wisconsin hospitals had to beg Walker to add inadequate funds to the state budget to pay for uncompensated care. 

So far 27 states, including 9 that are GOP-led, have embraced Medicaid expansion. And, GOP-led Indiana, Tennessee, Utah and Wyoming are negotiating or signaling support for Medicaid expansion. Democratic-led Montana is also moving ahead to expand Medicaid. Moreover, a commission of health care experts appointed by GOP Gov. Rick Perry came out for Medicaid expansion. They said the high number of Texans without health care coverage was "unacceptable" and that Texas "should be maximizing available federal funds through the Medicaid program to improve health care for all Texans." 

One last point. Medicaid is not just for poor people. Historically care for the disabled and elderly (e.g., many middle class people unable to afford nursing home care) has accounted for most Medicaid spending. Gov. Scott Walker: take the federal Medicaid money! 

-- Kaplan wrote a guest column from Washington, D.C. for the Wisconsin State Journal from 1995 - 2009

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