Bruce Murphy
Murphy’s Law

Scott Walker’s Health Care Dilemma

His rejection of federal Medicaid dollars either costs Wisconsin lots of money or lots of lives.

By - Apr 29th, 2014 12:15 pm
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Scott Walker

Gov. Scott Walker

Scott Walker is playing a remarkable game with the Affordable Care Act. On the one hand, he has made a big deal of opposing “Obamacare” and rejecting federal money to expand Medicaid in the states, a key building block of the federal insurance plan.

This is great for Walker when he is campaigning outside Wisconsin. As Brian Sikma of RedState.com explained, “It is quite likely that conservatives reviewing a field of Republican governors in the 2016 campaign will measure each governor’s commitment to repealing ObamaCare against how they acted on the voluntary expansion of Medicaid… Walker’s handling of Medicaid puts him squarely in the lead among his peer governors” like New Jersey’s Chris Christie or Ohio’s John Kasich, who “opted to call for an expansion of Medicaid. Walker has possibly secured for himself a unique front-runner spot among his fellow Republican governors and rumored 2016 presidential contenders on the issue of healthcare.” (I did an earlier column explaining how Walker has positioned himself nationally on this issue.)

But Walker’s rock-ribbed, right-wing stand on this issue doesn’t look so good in his home state. The Legislative Fiscal Bureau concluded that the federal funding he rejected would have allowed the state to cover 84,700 more people while saving the state some $450 million through 2021. A poll by the Marquette University Law School found that 56 percent opposed this Walker policy and just 36 percent supported it.

Odds are the percentage opposing it would be even higher if more people truly understood what Walker was doing. To his constituents, who are far more concerned with getting health insurance coverage than helping Walker’s presidential bid, the governor has explained that the money had to be turned down because the federal government might some day change its policy and take away the funding. As countless stories have noted, the federal law guarantees 100 percent funding of the Medicaid expansion for three years. And even if the Affordable Care Act didn’t include this provision, why not accept the funding while you can get it, if only for one or two years? It still comes at no cost to Wisconsin taxpayers and with an obvious benefit for them.

That question has become more pointed as new studies have looked at the impact of turning down the federal dollars for Medicaid expansion. A study by the Commonwealth Fund projects the data to 2022, taking into account a gradual expansion of the numbers covered by Medicaid, and also considering that states like Wisconsin will be paying more in federal taxes to help support the growing Medicaid coverage in all the states that accepted the money. Wisconsin, the study concluded, will be losing $1.85 billion annually by 2022, the study concluded.

That estimate, by the way, does not take into account any additional cost from rising emergence room costs as those lacking insurance delay getting care until they have to go to the hospital.

Then there is the impact on people’s health because they lack insurance. A study by the Rand Corporation found that those eligible for Medicaid expansion “are disproportionately uninsured and therefore have limited access to care, so Medicaid expansion could lead to improvements in health outcomes for those newly eligible. Evidence also suggests that past expansions have yielded a significant decrease in mortality.”

Following up on that idea, researchers at Harvard Medical School and the City University of New York did devastating study estimating that “the decision by 25 states to reject the expansion of Medicaid coverage under the Affordable Care Act will result in between 7,115 and 17,104 more deaths than had all states opted in.”

The researchers found that because of the states’ opting out of the Medicaid expansion, 7.78 million people will be denied this coverage. Besides the estimated deaths this could cause, the lack of insurance would also result in 712,037 more persons diagnosed with depression; 240,700 more persons suffering catastrophic medical expenses; 422,533 fewer diabetics receiving medication; 195,492 fewer women receiving mammograms; and 443,677 fewer women receiving pap smears, the study projected.

The study’s projections were “based on previous studies that used state-level data on Medicaid expansions and death rates, the National Health and Nutrition Examination Survey Mortality Follow-up, and the Oregon Health Insurance Experiment,” the researchers noted.

The study also did a state-by-state estimate of projected deaths and health consequences for those states, like Wisconsin, that rejected the Medicaid expansion. I am hesitant to run those numbers because the study estimated that 107,000 people would lose coverage in Wisconsin, whereas the Fiscal Bureau’s estimate in 2013 was 84,700 and more recent estimates have put the figure at 77,000.

In short, the projected deaths and health problems for Wisconsin residents would have to be lowered. But given past studies showing the negative health consequences of losing Medicaid coverage, the only question is how bad the impact would be on Wisconsin.

When I asked for comment from the Walker administration, I was referred to Claire Smith, communications specialist for the state Department of Health Services, who initially told me that “Wisconsin is the only state out of the 24 states not expanding their Medicaid programs as part of the Affordable Care Act that does not have a gap in health care coverage.”

Of course, if that were true, that would only increase the extra cost for Wisconsin taxpayers of rejecting federal coverage. But when I then asked Smith about the 77,000 people who are projected to lose Badger Care, as Wisconsin has dubbed its Medicaid program, Smith replied that “those who transitioned from BadgerCare Plus to the Marketplace have access to affordable health insurance through the federal Health Insurance Marketplace.” She also referred me to a state report making this same argument.

Leaving aside the irony of the Walker administration citing Obamacare as the protector of these folks losing Medicaid, the reality is the Affordable Care Act recognized that people eligible for expanded Medicaid would never be able to afford decent private health insurance through the marketplace and will likely go without it. That’s why the plan included the Medicaid expansion to cover them — which Walker rejected.

And so the governor has to dance around the issue. If he says everyone is really covered, the only way that could happen is by state taxpayers making up the difference. If he admits not everyone is covered, then it’s likely, based on past studies, that there will be dreadful health consequences for those who lose the coverage. It’s a high price to pay to elevate Walker’s presidential prospects.

Short Take

An Atlantic Cities writer notes that the impact of rejecting Medicaid expansion will fall hardest on urban areas. “Because big cities are also magnets for the uninsured, with their more extensive health infrastructure, the burden of caring for a state’s uninsured disproportionately rests on its urban hospitals and taxpayers.” As the former Milwaukee County Executive, Scott Walker should be quite aware of this.

Categories: Murphy's Law, Politics

14 thoughts on “Murphy’s Law: Scott Walker’s Health Care Dilemma”

  1. J. Kennedy says:

    Walker is as phony and corrupt as a $3.00 Bill. Wisconsinites need to wake up and can this corrupt politician ASAP. He works full time for the 1% and AGAINST the 99%. Again, I am a republican leaning voter but these Tea Party phonies are against workers, worker rights and all things union.

  2. Dave K. says:

    “Odds are the percentage opposing it would be even higher if more people truly understood what Walker was doing. ”

    With the kind of money we expect to see coming in from outside groups, and the amount of campaign lies and half-truths that will be floated via all of that money, I don’t expect people will really understand what’s going on. Clever packaging and relentless marketing will make poor people believe they have a shot at the American dream, which will get Mr. Walker not only re-elected in Wisconsin, but probably make him a finalist in the race for President.

  3. Andrey says:

    “It still comes at no cost to Wisconsin taxpayers and with an obvious benefit for them.”

    Medicaid expansion does not pay for the administrative costs required to expand the program, so there would be a cost to the taxpayers, of which some 90% are already insured, so they would have no benefit in seeing Medicaid expanded anyway.

  4. Chris Kuhl says:

    Boy, when you “slant the deck” to try and land some ideological blows, you omit two key things that totally prove how on the mark Gov Walker is:

    – Since our President and his Democrats in Senate haven’t balanced the budget (or even produced a budget!) since they took office, so ALL OF THESE Federally promised monies are BORROWED.

    – Your justification somehow rationalizes this insanity by stating “why not accept the funding while you can get it”?!?!? It’s thinking like this that has left $17TRILLION in debt to this point!

    – Lastly as far as that RAND report, the “shining start” of how expanding Medicaid to the uninsured actually improves their health outcomes has fallen flat on its face in Oregon:

    – Conclusions

    This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services.
    (http://www.nejm.org/doi/full/10.1056/NEJMsa1212321)

    To you EVERYTHING that Gov walker does is nail you are the (ONLY) hammer around.

  5. wisconsin Conservative Digest says:

    Wis. has the best combination of plans in the country courtesy of tommy, Scott and others in the form of Badger care. add to that Obamacare and Medicaid and we have almost complete coverage. by Walker not getting involved in the exchanges, he saved us several hundred million. Oregon after spending 300 million has tossed theirs. By not buying into the increased Medicaid he has saved us hundreds maybe billions of dollars. Studies have shown that under the new medicaid, when the Feds drop it in several years ,the Medicaid dollars will squeeze out education dollars. Next under Act 10, letting public employees pay into their pensions and health like the rest of us, they have best deal in world, we save billions and Finally by ditching the halfast train we will save billions. Thank God for Scott Walker or we would be Ill. or Detroit. If we only would have elected him in 2006 just think how much better we would have been instead of having the worst governor in out history, Doyle.

  6. Donna Kiser says:

    Can’t get a budget or anything else passed inside that do nothing Congress. Take a look at the “proposed” 2015 budget here http://www.politico.com/story/2014/03/obama-budget-2015-104229.html that will go nowhere because it wants to make that ever growing 1% pay their fair share.

    Now, as far as WI having the best coverage in the country, and I rarely swear online, but BULLSHIT! I’m a 58 yr old woman who has worked and paid taxes all my life. Became disable in 2008, received Medicare in 2010, but according to Walker and his “plan” my little $1100 monthly is too much for any assistance with the portion Medicare doesn’t pay. Sooo, everything is good if you have lots of money and you never get sick. Otherwise, kiss off and die, right?

  7. Dave Reid says:

    @WCD “Finally by ditching the halfast train we will save billions.” Well not so much. The $800 million was still spent, just not in Wisconsin. Then there were the freight track repairs, track repairs between MKE and CHI, train shed update, and so on that we are now going to pay from the Wisconsin budget, instead of out of the $800 million. Nope. It actually cost us more, not less.

  8. tim haering says:

    Geesh! ObamaCare has death panels and WalkerCare is a death panel! How’s a person to survive modern health care?!

  9. Terry Radtke says:

    Sad as it might be, Walker’s political math is correct: his suburban white constituents have health insurance (for now) and never saw a tax they didn’t hate. Those who would benefit from Medicaid expansion wouldn’t vote for him anyway. His guarantee that “every one will be covered” is a promise that can be broken with no consequences to this year’s election or beyond.

  10. Andy says:

    The people “dropped from medicaid” by Walker will be covered by Obamacare (with government subsidies, Obamacare is affordable for all, remember?) and Walker has otherwise added more people for eligibility in Badgercare. Of course those people will have to wait for their eligibility because of all the issues with Obamacare… but it’ll come eventually…

    Really this is a win-win I thought?

  11. Bruce Thompson says:

    Andy,
    I think we really to await some actual counts of enrollment. However, I think it is reasonable that Wisconsin will come in somewhat better than those states that left large gaps in insurance and those that expanded Medicaid. As I understand it, as soon as someone qualifies for the exchange subsidy, Wisconsin forces them off Medicaid. Some people will decide to skip insurance, who would have liked to stay on Medicaid and could have in the states opting for Medicaid expansion. One issue I have not seen discussed is what happens to people whose income is just around the Medicaid/exchange dividing line. Will they have to change plans as their income fluctuates?

    Chris Kuhl: I am curious if you apply your philosophy to your private decisions. It would seem like you should avoid taking allowable deductions on your taxes so that you don’t make the federal deficit worse.

  12. Ttyler5 says:

    Mr. Thompson wrote, “Chris Kuhl: I am curious if you apply your philosophy to your private decisions. It would seem like you should avoid taking allowable deductions on your taxes so that you don’t make the federal deficit worse.”

    Oh yeah, right. It’s all the taxpayer’s fault. We just don’t pay enough. Why, if we would just pay more there would be no national debt.

  13. Andy says:

    BT,
    This goes back to our philosophical differences again, because while you say some people who qualify for subsidies on the exchange may wish to stay on medicaid, that doesn’t mean they should be able to. Medicaid is for those who can’t afford health insurance on their own and with the subsidies, supposedly it’s designed so they can indeed afford it on their own.

    This actually goes hand in hand with the Chris Kuhl question, because I know I for one will take advantage of any tax or monetary benefit the government makes available to me. The poor do it, the rich do it… nearly everyone does it. Very few in practice would actually pass on those just to reduce government spending. Tthat is exactly why all programs must be scrutinized as to whether they’re really necessary, and who they are necessary for… otherwise we create a lot of waste and the “handouts” that fiscal conservatives despise so much.

  14. Rain Techmeier says:

    Count my daughter as one of the death statistics. She worked, the company didn’t have insurance. Many don’t. There will be many more deaths.

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