It's over: Expand Medicaid

By Bill Kaplan

Medicaid, a federal-state health coverage program for the disabled, elderly and poor (many working), was implemented in 1966 by Wisconsin GOP Gov. Warren Knowles. Much of the nation followed Wisconsin's lead. No longer. Thirty-one states to date have expanded Medicaid under the Affordable Care Act, including 10 states that were GOP-led and all of Wisconsin's neighboring states. But not Wisconsin -- an outlier.

Except for state GOP Sen. Luther Olsen, Republican legislators and GOP Gov. Scott Walker don't want to discuss, let alone expand, Medicaid. Most Wisconsin Republicans have displayed a suspension of common sense, ignorance of math (Medicaid expansion receives 100 percent federal funding through 2016, declining to 90 percent in 2020 and thereafter) and a contempt for majoritarian public opinion (polling and advisory referendums). It's reminiscent of Japanese soldiers fighting on after WWII ended.

Japan formally surrendered to the U.S. on September 2, 1945. However, some Japanese troops refused to accept or believe that Japan had lost. They fought on, "loyalty was not only blind but deaf" (Washington Post). Finally, in 1974 the last Japanese soldier surrendered in the Philippines. Fanaticism trumped common sense and logic. Just like Wisconsin Republicans fighting on against expanding Medicaid.

But Medicaid expansion has been a big success everywhere: 14.5 million additional individuals have enrolled in Medicaid, and expansion has generated economic and job growth, freeing state savings to fund education, roads and mass transit. Moreover, expanding Medicaid has reduced uncompensated hospital care and cost shifting to private insurers. Finally, struggling rural hospitals have received a financial lifeline.

Progress continues. GOP-led Arkansas has just reauthorized Medicaid expansion with substantial Republican support. Democratic-led Louisiana is implementing Medicaid expansion. The state estimates it will save more than $1 billion over 10 years. And, state hospitals have agreed to pay Louisiana's small share of expansion after 2016. Finally, a GOP-led Senate and Democratic-led House in Maine voted to expand Medicaid. Maine GOP Sen. Tom Saviello spoke to those opposed: "You will say no to our dollars coming back to our state to help the less fortunate and working poor. You will be saying no to the millions of dollars to help the drug addicted get treatment. You will be saying no to mental health care. You will be saying no to preventative medicine." Ditto for Wisconsin.

Medicaid expansion in Wisconsin would provide coverage for over 80,000 and save Wisconsin $1 billion through 2020-21 (Legislative Fiscal Bureau). The small state share after 2016 could be paid by Wisconsin hospitals or closure of the manufacturing-agricultural tax credit loophole, as suggested by Wisconsin Democratic Rep. Dianne Hesselbein. Moreover, Wisconsin Democratic Sen. Tammy Baldwin introduced a bill to fully fund (100 percent for 3 years) states like Wisconsin that miss the 2014-16 deadline.

Enough! High time to expand Medicaid in Wisconsin. As former Arizona GOP Gov. Jan Brewer said: " have to look at the reality. You have to do the math ... It's not only a mathematical issue, but it's a moral issue."

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


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