Scott Walker’s Health Care Dilemma
His rejection of federal Medicaid dollars either costs Wisconsin lots of money or lots of lives.
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 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.
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.