Healthcare Is Huge in Presidential Race

There’s so much to be scared about in the high-stakes November presidential election that it’s easy to overlook the issue of health care. But it is a hugely important concern for the nation and arguably even more consequential for Wisconsin.

Some may think the issue was largely settled by the passage of the Affordable Care Act or Obamacare in 2010. But Republicans and President Donald Trump did their best to overturn the ACA and failed, while finding ways to slightly reduce its coverage and enrollment. By contrast, President Joe Biden has greatly expanded the reach of the ACA, to its highest level ever. Meanwhile, Trump is again promising to overturn the ACA if he serves a second term.

How big was the ACA revolution started by President Barack Obama? The plan provided coverage in two main ways, through the ACA marketplaces providing lower-cost care and through expansion of Medicaid, and today that provides 40 million people in the U.S. with coverage.

By 2016, six years after it was passed, the percent of Americans without insurance had dropped from 16% to 9%, with nearly 13 million people signing up for coverage in the ACA marketplace. That number dropped to less than 12 million people under Trump, but has since risen to 21 million people under Biden, leaving just 7.2% of the country without health insurance.

Biden made this happen through two pieces of omnibus legislation, his American Rescue Plan and the Inflation Reduction Act, which expanded the tax credits that help Americans purchase marketplace insurance and extended eligibility to households above 400 percent of the Federal Poverty Line.

Meanwhile Medicaid expanded to add an additional 17.5 million people under Biden. Some of this was due to more states voting to accept expanded Medicaid; that number is now up to 41 states (including DC).

All told, the impact of the ACA, including both the marketplace coverage and Medicaid expansion, may have doubled under Biden. The program is now as much Bidencare as Obamacare.

That’s true in Wisconsin as well, where the percent of people who are uninsured dropped from 9% to 5.2% by 2022. That year just over 212,000 Wisconsinites had signed up for coverage through the ACA marketplace. But by 2024, the number enrolled rose to 266,000 people, a new record for Wisconsin and a 25% increase in just two years.

Much of that increase was tied to the subsidies of Biden’s American Rescue Plan Act and Inflation Reduction Act, one analysis noted: “Last year, 89 percent of Wisconsinites who enrolled on HealthCare.gov qualified for these cost savings.”

The percent who were uninsured would have dropped even lower if Wisconsin wasn’t among the 10 states that have refused the federal expansion of Medicaid. This would expand coverage to 89,700 additional people in Wisconsin, the state Department of Health Services has estimated, giving them improved access to preventive health services, medications, care for chronic diseases, and behavioral health services that would improve their health. That, in turn, would help them address health issues more promptly, decreasing absenteeism at work and increasing productivity, boosting the Wisconsin economy.

But those numbers barely begin to show the impact on Wisconsin of refusing to expand Medicaid. Wisconsin is unique among the 50 states in that it shouldered much of the cost of covering health care for lower income people through its Badger Care program. That was former Republican governor Scott Walker’s way to oppose Obamacare while avoiding criticism for leaving hundreds of thousands of Wisconsinites without coverage. He left state taxpayers to pay the bill for his opposition to the ACA and since 2014 that has cost them an estimated $2.1 billion.

But with the added incentives under the Biden administration the annual loss to taxpayers has grown. DHS has estimated that Medicaid expansion would save taxpayers an additional $1.6 billion in just the two years of the 2023-2025 biennial budget “due to enhanced federal funds” that would be received.

For years, this was a moot issue as the gerrymandered Republican Legislature continued to support Walker’s costly plan. But the advent of fair maps is likely to markedly change the Legislature: Assembly Speaker Robin Vos has suggested the new maps will give Democrats 10 additional seats. And given polls showing strong support, by 62% of voters, for accepting federal dollars to expand Medicaid, the GOP may have to support this — or lose more seats.

Which would be a massive gain for state taxpayers. Unless Donald Trump returns to the White House and kills the entire program.

“Obamacare sucks!!!” Trump has declared, promising as president he will replace it. And many Republican leaders also made clear they seek the same goal. Since the ACA became law in March 2010, Republicans in Congress have voted more than 50 times to repeal or roll it back. Republican Wisconsin Reps. Glenn Grothman and Mike Gallagher (who has since retired), along with GOP Sen. Ron Johnson, all voted for the 2017 repeal that nearly passed. Eric Hovde, the Republican challenger to Democratic Sen. Tammy Baldwin, ran for Senate in 2012 on a promise to “replace Obamacare in its entirety” and “move to a free-market approach.”

Should Trump and Republicans succeed this time in overthrowing the ACA, it would devastate the nation’s health care system. Which makes this a major issue in the fall election.