If Tony Evers becomes governor next year and takes federal Medicaid expansion money refused by Gov. Scott Walker, the Legislature might have a hard time turning it down even if both chambers remain in Republican hands, a health-care official said Tuesday.
“That’s a lot of money that would have to be unwound from the budget,” said Eric Borgerding, CEO of the Wisconsin Hospital Association, referring to some $190 million a year in federal funds. “That will make it very, very difficult to do.”
Borgerding and other top health-care lobbyists discussed Medicaid expansion, Walker’s plan to make Medicaid recipients work and undergo drug screening, and alternative insurance options promoted by President Donald Trump’s administration — key health-care issues this election season — at a panel organized by Wisconsin Health News.
Evers, the Democratic gubernatorial candidate, has vowed to pursue the Medicaid expansion allowed under the Affordable Care Act, which Walker, a Republican, and the Legislature opposed. The move, which would extend Medicaid to people who make up to 133 percent of the federal poverty level, instead of just those at or below the poverty line, could have brought $1.1 billion to the state from 2014 to 2019, according to the Legislature Fiscal Bureau.
If Evers wins the election and includes the money in his proposed budget, the Legislature would face obstacles to pulling it out, Borgerding said. Any extra federal Medicaid money should be used for health care and not other budget priorities, he said.
John Sauer, CEO of Leading-Age Wisconsin, which represents nursing homes and assisted-living facilities, said such additional Medicaid money should be used to increase the state’s payments to nursing homes, which he said are among the lowest in the country. “That coupled with the workforce crisis is landing us in a bad spot,” Sauer said.
The money could also “start impacting health more upstream,” such as by investing it in things like housing, early childhood education, an expanded earned-income tax credit and other programs that improve families’ well-being, said Stephanie Harrison, CEO of the Wisconsin Primary Health Care Association, which represents community health centers.
Walker’s plan to require childless adults on Medicaid to be screened for drugs and work if they are able, submitted to the federal government in June 2017, could be approved soon. In Arkansas, where a similar work requirement started in June, more than 4,500 people have lost Medicaid coverage.
Harrison said the Wisconsin plan could present challenges for “people who are falling off of the program just when they need that health support in order to get back into the workforce.”
Borgerding said new co-payments also included in the Wisconsin plan, such as $8 per emergency room visit and $8 monthly premiums for some people, wouldn’t prevent patients from seeking care at hospitals even if they couldn’t pay. Therefore, hospitals would be “left to bare the brunt of the incentives that don’t work,” he said.
Nancy Wenzel, CEO of the Wisconsin Association of Health Plans, said association health plans, bolstered in June by Trump administration rules to expand them, could shake up the insurance market. Association health plans, which let small employers and sole proprietors buy insurance together as a large group, don’t have to cover benefits such as maternity care and prescription drugs, so they are often cheaper and attractive to people with few medical problems.
The plans could “siphon off the healthy population” from the Affordable Care Act marketplace, making it “even more fragmented” and in need of “even more support from government,” Wenzel said.
Dr. Bud Chumbley, CEO of the Wisconsin Medical Society, which has an association health plan for its doctor members, said the plans can be a good way of insuring more people.
“If constructed right, with a comprehensive set of benefits, they can fill a need,” Chumbley said. “If they’re short in the benefits, then I think they can do a disservice.”