Medicaid expansion study divides Democrats, Republicans

Feb. 20, 2019

MADISON Republicans opposed to Democratic Gov. Tony Evers' plan to expand Medicaid coverage in Wisconsin got some ammunition Tuesday, while Democrats and health care advocates dismissed as unreliable the new report saying expansion would shift $600 million a year to the private insurance market.

Democrats including Evers want Wisconsin to join 36 other states in accepting federal money to expand Medicaid as allowed under former President Barack Obama's health care law. Evers plans to include expansion in his state budget to be released next week and promised to make a push across the state to increase pressure on Republicans to approve it.

"We will take this directly to the people of Wisconsin," Evers said Tuesday during an interview with journalist Mike Gousha at the Marquette University Law School. "The people who are part of the system support it, the people who are shut out of the system are supportive."

Evers and backers of expansion argue that such a move would save the state hundreds of millions of dollars, while also making Medicaid available to about 75,000 more low-income people.

Exit polls after the 2018 election showed health care was the top issue for voters who elected Evers over Republican Gov. Scott Walker, who long opposed taking the federal money to expand Medicaid. Evers made health care accessibility and expanded Medicaid a central part of his winning campaign.

Republican opponents have long argued that putting more people on Medicaid will shift costs to the private sector. The new report from the conservative Wisconsin Institute for Law and Liberty and the Center for Research on the Wisconsin Economy, housed at the University of Wisconsin-Madison, attempts to quantify those costs.

The report compared private sector health insurance costs and emergency room visits in states that expanded Medicaid eligibility and those that did not. It determined that even after calculating savings to the state that come from accepting the federal Medicaid money, costs to people on private insurance would go up $600 million a year.

The report said because Wisconsin has a low reimbursement rate for Medicaid providers, they will lose money as more of their patients are on Medicaid instead of private insurance. Providers will then pass along those increased costs to consumers, the report said.

That has long been the argument of Republicans who have blocked Medicaid expansion.

The study provides "hard numbers" opponents can use to make their argument against Medicaid expansion, said Sen. Chris Kapenga, of Delafield. He was joined by fellow Republican Sens. David Craig, of Big Bend, and Duey Stroebel, of Cedarburg, and Rep. Joe Sanfelippo, of New Berlin.

Other Republican leaders, including Assembly Speaker Robin Vos and budget committee co-chair Rep. John Nygren, cited the report while arguing anew Tuesday against expansion.

But Bobby Peterson, an attorney at ABC for Health, a group that advocates for poor people, said the research was "half-baked and half a loaf" that "pushes a political agenda and not serious debate." He said it failed to take into account numerous factors, including a reduction in uncompensated care at hospitals if Medicaid coverage expands.

Robert Kraig, executive director of Citizen Action of Wisconsin, which supports Medicaid expansion, also faulted the study for failing to take into account the cost of untreated illnesses and injuries.

"Contrary to the claims in this biased report, there is a well-established consensus of national research showing that Medicaid expansion increases access to health care for working people struggling to get ahead while also reducing the cost of private health insurance," Kraig said.

Evers said he had not read the report but that the election results showed voters were in favor of Medicaid expansion.

Democratic leaders in the Senate and Assembly Sen. Jennifer Shilling and Rep. Gordon Hintz both blasted the report as a desperate attempt by Republicans to justify limiting health care access.

Wisconsin has missed out on $1.1 billion in federal money since 2014, according to the nonpartisan Legislative Fiscal Bureau. The state would save about $513 million over the course of the next two-year budget, which runs from July through June 2021, if it accepted federal money for full Medicaid expansion, the Fiscal Bureau said.

Wisconsin's BadgerCare Plus Medicaid program covers about 773,000 people, about 300,000 of whom are non-disabled, non-elderly adults. Expanding eligibility to those earning up to 138 percent of the federal poverty level would increase enrollment by about 76,000 parents and childless adults.

Evers won't propose new prison as part of overhaul

MADISON, Wis. Gov. Tony Evers said Wednesday that he won't call for building a new adult prison in the Green Bay area, while his pick to lead the state Corrections Department assured lawmakers that the Democrat's administration was moving as quickly as possible to shut down the state's troubled juvenile prison.

Evers is promising to enact changes to the criminal justice system to reduce the prison population as much as half, while also following through with closing the Lincoln Hills juvenile prison as required under a law approved unanimously by the Legislature last session.

But Evers has angered some lawmakers by saying the schedule to close Lincoln Hills by 2021 is too aggressive and may have to be delayed up to two years. Department of Corrections Secretary-designee Kevin Carr tried to soothe lawmakers' concerns Wednesday, telling the Senate judiciary committee that Evers wants inmates out of the facility as soon as possible.

The facility north of Wausau in Irma has been under investigation for four years amid allegations of prisoner abuse.

Carr said told the committee that Evers is committed to closing the prison as soon as possible. But he called for patience, asking lawmakers to be realistic about how long it will take to build new county facilities to replace Lincoln Hills. He stressed that as soon as those facilities are ready the prison will close.

"The governor and I are in total agreement. Whenever there is an acceptable location where we could move the youth from (the prison), existing or new, that provides the programming, we would do it if we could," Carr said.

Republican Sen. Van Wanggaard, chairman of the committee, said lawmakers would not support pushing closure back to 2023.

"I hope you will support us on that in your conversations with the governor," Wanggaard said.

Evers is under pressure to come up with a solution for Wisconsin's overcrowded adult prisons. As of last week, 23,636 inmates were in a system that was designed to hold 17,867. That is 32 percent over capacity.

Lawmakers, economic development officials and other leaders in the Green Bay area have been pushing for closing the century-old Green Bay Correctional Institution in Allouez and replacing it with a new prison as part of a larger redevelopment project.

But Evers told reporters that his budget to be released next week will not have money for a new prison in Green Bay.

"It's something we have to weigh but it will not be part of the budget," he said.

His budget will include funding to hire additional guards and pay them more.

Carr told the committee that Wisconsin prisons face a 16 percent vacancy rate among guards and correctional sergeants. Starting guards make $16 an hour but they should earn $22, Carr said.

Carr was one of two key Evers cabinet appointees facing legislators on Wednesday.

Transportation Secretary-designee Craig Thompson was up for a hearing before the Senate's transportation committee. Republicans have been leery of Thompson's background as a lobbyist for the Transportation Development Association of Wisconsin, which has advocated for raising taxes and fees to rebuild Wisconsin roads. Senate Republicans have resisted the idea of raising taxes or fees for road work.

Evers, when asked Wednesday about Thompson's chances of confirmation, said he expected him to win approval.

"I know he's had good conversations with individuals and I assume that will translate into a good result for him," Evers told reporters.


Associated Press