No doubt in his State of the State address tonight, Gov. Scott Walker will claim credit for expanding enrollment in the state's Badgercare low-income health insurance program while also claiming moral high ground for fighting entreaties from the federal government to pay for even more enrollees -- because, you see, federal spending is "uncertain," thanks mostly, of course, to Walker and his own Republican Party.
And it's true that his budget did add 83,000 childless adults to Badgercare eligibility, a good thing if that's all you look at.
But the truth is that Walker, with help from the US Supreme Court's conservative majority, has created a brand new donut hole preventing many more low-income people from seeking affordable health insurance in Wisconsin. And it appears to affect a greater number of citizens than anyone heretofore has spent much time talking about.
Nearly canceling out the 83,000 citizens he added to the eligiblity list, Walker also dumped 77,000 working-poor adults from Badgercare Plus, the state's version of Medicaid. He said those 77,000 could instead apply for subsidized coverage from private insurers functioning under the federal health insurance marketplace.
However, as always planned, the federal health insurance marketplace has been forwarding applicants from among those 181,000 citizens -- and eventually applicants among the 77,000 dumped from Badgercare -- right back to state government, where, thanks to Walker's action, none of those people will be eligible for Badgercare Plus. Ping-pong! A very much larger group of Wisconsin's uninsured are now stuck between a rock and a hard place.
According to the Urban Institute (see URL below), 181,000 is the total number of uninsured, low-income people in Wisconsin who would have qualified for Badgercare Plus but who will now get neither that nor federally subsidized private health coverage. It's all thanks to inter-related actions by Walker and the conservative majority on the US Supreme Court. Assuming no overlap between that larger group and with those affected by Walker's Badgercare cut-off, roughly a quarter million of Wisconsin's working poor may be left uninsured, even though the new health reform law was structured and funded to insure them.
In short, hundreds of thousands of residents of Wisconsin and millions more in a couple of dozen other states where lawmakers similarly refused to expand coverage are wandering in a figurative health-care desert, in a politically engineered no-coverage zone between Medicaid and the Affordable Care Act ("Obamacare"). If you were a politician trying to interfere with Obamacare's goal of reducing America's huge uninsured population, this was a big win. Cynical and harmful, but big.
Walker's prescription to the contrary, many if not all low-income adults who could have been on Badgercare would not have enough income to qualify for the Care Act's federal insurance subsidy, which is why the law was designed to steer them to Badgercare. When you're working full time but making, say, three or four hundred bucks a week before deductions, laying out hundreds every month for a subsidized health insurance premium just isn't in the cards. The federal law recognized that. Walker didn't, or did but didn't care.
Conservative critiques aside, none of this is Obamacare's fault. The reform measure as enacted was structured to get many more uninsured, low-income citizens into Medicaid programs. But that was before the US Supreme Court's conservative majority got involved and a bevy of Scott Walker-type governors leaped at the court's decision, Walker himself included.
Under the Affordable Care Act as enacted and signed into law by the president, all adults nationwide with incomes below 138% of the official poverty line ($15,850 for an individual and $32,500 for a family of four) were to be covered by Medicaid. Citizens with incomes above that level up to 400% of the poverty line would qualify to receive federal subsidies to defray the cost of buying insurance on the new, state by state, marketplace exchanges. For those added to Medicaid, states would get subsidies to defray the full extra cost at first, and 90 percent of the cost beginning in several years.
But a Supreme Court ruling last year left it up to each state to decide whether to expand Medicaid. Only 25 states and the District of Columbia so far have chosen to proceed. In those places, Obamacare will work as originally envisioned. In Wisconsin, it isn't working as planned, because Walker in effect sabotaged the process.
Using the Supreme Court ruling, Walker refused $119 million in additional federal aid in the next two years, with more millions to follow later. The money was to cover state costs for expanding the Badgercare rolls. Walker made that happen by declining to follow the law's plan to cover everyone below 138 percent of the federal poverty line. Instead he chose to only cover Wisconsin residents at or below the actual poverty line, event though many people well above that line remain impoverished in the modern economy, so much so that they're eligible for food stamps and unable to afford health coverage even when they work full time -- like, for instance, many Wal-Mart employees.
Nevertheless, you can bet Walker and some other GOP politicians will continue to blame the huge uninsured gap on -- who else? -- Barack Obama.
Walker's maneuvering on this entire matter has not only been cold-hearted, but also contradictory.
When he dumped those 77,000 residents from Badgercare (which dumping he has since delayed by three months because the federally run insurance marketplace had startup troubles), Walker said the state simply couldn't trust that the extra federal support for prospective Badgercare enrollees would continue beyond a few years. However, Walker registered no such uncertainty when, in 2012, he accepted $23.3 million in additional federal funding to cover more children of poor families under Badgercare.
Logic suggests that Walker's real purpose in leaving these 77,000 out in the cold wasn't the "uncertainty" of long-term federal funding, the very kind of federal funding he clearly has had no trouble accepting in the past. Rather, he chose to risk the health and finances of many tens of thousands of Wisconsin residents by refusing to embrace the Affordable Care Act, which Walker and his political ilk have continually demonized. They hate the law, and even fear it. More than one Republican has openly said that successful health care reform could doom the GOP in coming elections. Thus, Walker is practicing highly situational ethics, at best.
In 21 states including Wisconsin, some 4.9 million people will not have health coverage in 2016 if those states don't eventually expand Medicaid, according to the Urban Institute. CNN Money reported that another 1.5 million uninsured are in six states still considering expansion -- Wisconsin not among them.
In states like California that are accepting federal subsidies to expand Medicaid rolls, millions more citizens will newly have affordable health insurance. Indeed, some states have gone above and beyond the law, actively seeking out Medicaid-eligible citizens, knowing full well that a healthier population overall reduces health care costs for everyone.
But in Wisconsin, it is quite possible that hundreds of thousands of currently uninsured and -- thanks directly to Walker's actions -- soon to be uninsured individuals will be unable to get health coverage. And any number of those individuals can be expected to show up at hospital emergency rooms (who, also thanks to Walker, are expecting to take a bigger financial hit) when they have health problems. Some of those uninsured, as has happened in the past, might die from festering illnesses that could have been prevented at less cost with earlier, regular care. It's not exactly a Walker-mandated death panel, but it does represent a higher than necesssary death risk, an expensive risk generated by cruel, laissez-faire Republican politics.
[UPDATE: Walker’s decision to deny federal health care funds for more than 150,000 low-income Wisconsinites will result in up to 671 deaths that could otherwise be prevented, one of 25 states where deaths will happen, according to researchers at Harvard University and the City University of New York (CUNY). The study ]
Nationwide, few able-bodied, working-age, low-income adults have ever until now qualified for Medicaid. Wisconsin prior to Walker was a progressive exception, with Badgercare reaching out to cover more and more poor children and working-poor adults. We were ahead of the curve then and falling behind it now. But sensible health care policies will be a reality again some day, when less cynical, more thoughtful and compassionate lawmakers return to power in Madison.
