Robin Vos unmoved by poll showing support for Medicaid expansion: 'Sometimes you have to lead by what you believe in'

In a Wednesday interview, Vos, R-Rochester, likened the situation to the 2011 debate over the Act 10 legislation curtailing public sector collective bargaining, during which polls showed public opposition to the measure.

“Sometimes you have to lead by what you believe in and not just follow public polling,” Vos said.

Results released last week from the most recent Marquette Law School Poll found 70 percent favor expanding Medicaid, as Evers proposed in the next state budget. A previous Marquette poll in January also found public support for the move.

Meanwhile, the study released Wednesday by two UW-Madison economists looked at extending Medicaid coverage to about 80,000 people whose pay is up to 138 percent of the federal poverty level, as Evers proposed.

It found the move could save $19 million to $103 million — the mid-range savings estimate is $65 million — by reducing uncompensated care. The study was released by Gwyn Pauley and Matt Wiswall of the UW-Madison Department of Economics.

Those findings contradict a February study by the conservative Wisconsin Institute for Law and Liberty and UW-Madison professor Noah Williams. It found Medicaid expansion would cost Wisconsin $600 million, largely by shifting the cost to providers of absorbing low Medicaid reimbursement rates to care given through private insurance.

Republicans in the GOP-controlled Legislature have cited the February study as a reason to oppose Medicaid expansion.

Vos said Wednesday he hadn’t read the new study. He said the focus should be on helping the uninsured sign up for private insurance on the Affordable Care Act exchange, which is subsidized solely by the federal government.

For Medicaid expansion, the federal government pays at least 90 percent of the cost, with the state picking up 10 percent, instead of the regular Medicaid arrangement of 60 percent federal and 40 percent state.

“You do not need to have them on Medicaid, which is partially state-funded,” Vos said. “I do not want to create any increased liability for state taxpayers when we have the option to have the burden entirely fall on the federal government.”

‘Absurd’ stance

Will Flanders, research director at the Wisconsin Institute for Law and Liberty, said Wednesday he stands behind the research and methodology in the February report.

“The reality is, Medicaid expansion in Wisconsin would move a bunch of people off of private health care into government-run health care. Economics 101 would indicate that this will have some negative impact on the private sector and our study estimated a net cost of $600 million,” Flanders said.

The new study makes an “absurd assumption” that only new Medicaid enrollees who previously had private insurance will generate costs, he said.

According to Andrea Palm, secretary-designee of the state Department of Health Services, additional federal money obtained through Medicaid expansion would save the state $324 million over two years. That money could be invested in other programs to draw down more federal dollars, for a total $1.6 billion in new investment in hospitals, nursing homes, dental care, maternal care and other health services, Palm said.

Taking Medicaid expansion in 2014 would have saved the state $1.1 billion through 2019, according to the Legislative Fiscal Bureau.

In a minority

Wisconsin is among 14 states that did not take the federal funding available for the full Medicaid expansion allowed under the Affordable Care Act.

It is the only one of those states that has no gap in coverage for people with low incomes. Wisconsin’s Medicaid program covers people up to the poverty level, unlike those in the other states, and the subsidized private insurance on the Obamacare exchange is available for people who make more.

About half of the 80,000 adults who would gain Medicaid coverage through expansion are currently uninsured, Palm said.

The new study, unlike the February report, considers the current cost of providing free or discounted care to uninsured people, and of their unpaid bills — what is known as uncompensated care. The savings gained by covering those people through Medicaid would exceed the cost to private insurers, which was the key factor in the February report’s estimated $600 million cost, according to the new study.

The new study also says the February report failed to control for long-term trends in health care costs and to adjust expenditure data for inflation.

In addition, the February report overestimated the cost of increased emergency room visits, Pauley and Wiswall said.