Wisconsin hospitals should help pay for Medicaid expansion

By Bill Kaplan
Groundhog Day came early again (62nd time) in Washington as the House on Wednesday voted to eviscerate the Affordable Care Act (ACA). All Wisconsin GOP reps., including Speaker Paul Ryan, voted for ending the ACA's health care coverage gains, while Democratic Reps. Gwen Moore and Mark Pocan were opposed (Democratic Rep. Ron Kind didn't vote). Earlier, Wisconsin sens. split, with Sen. Ron Johnson for repeal and Sen. Tammy Baldwin against. Press coverage and new ACA coverage data slammed the GOP playbook:

• The conservative Washington Times said: Speaker Ryan "formally" signed the ACA "repeal bill" on Thursday. "Yet the GOP's signing ceremony had a pep rally-like atmosphere, with some House Republicans arriving early enough to get a prime spot in front of the cameras";

• The Hill reported: GOP has "no clear-cut plan" for replacing the ACA;

• U.S. Department of Health and Human Services announced: "11.3 million individuals nationwide (includes nearly 220,000 Wisconsinites) are signed up through the health insurance marketplaces" (private health care insurance, with most to receive tax credits to help pay for it);

• U.S. Centers for Medicare and Medicaid Services released new data: Since the implementation of the ACA's Medicaid expansion "13.5 million" additional individuals have enrolled in Medicaid;

• The Congressional Budget Office estimated: Repealing the ACA would increase the number of uninsured Americans by at least "22 million".

So no surprise on Friday when President Obama vetoed this tawdry effort to deny millions affordable quality health care coverage. But more needs to be done regarding states implementing Medicaid expansion. To date 30 states have taken 100 percent federal funding to expand Medicaid. This includes 10 states initially led by GOP govs. In addition, newly-elected Louisiana Democratic Gov. John Bel Edwards pledged to expand Medicaid by July 1.

Wisconsin can learn from Louisiana. When federal funding of Medicaid expansion starts to decline from 100 percent in 2016 to 90 percent in 2020 and beyond, the Louisiana Hospital Association has agreed that the state's hospitals will pay Louisiana's 10 percent share of the expansion cost. Moreover Indiana hospitals agreed to the same funding approach when GOP Gov. Mike Pence expanded Medicaid. And, Virginia hospitals have signaled to state Republican legislative leaders that they are prepared to do the same. 

While the Wisconsin Hospital Association (and state medical leaders) have come out for Medicaid expansion, more needs to be done. The Wisconsin Hospital Association should deflate the specious reasoning against Medicaid expansion by offering to have Wisconsin hospitals pay the 10 percent share. Combined with a full-court press by the health care sector to engage GOP legislators, Medicaid expansion could become a reality in Wisconsin. It would reduce uncompensated hospital care, strengthen struggling rural hospitals, create more jobs for health care workers, provide coverage for over 80,000 and save Wisconsin $1 billion through 2020-21 (Legislative Fiscal Bureau). It is a win-win for Wisconsin with substantial savings for unmet state needs that vastly exceed estimated cost savings for Gov. Walker's plan to adopt self-insurance health coverage for state employees.

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

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