Scott Walker's Badgercare tinkering continues. And, arguably, it's further proof the problem is mostly one of his own doing.
Read the news story linked below for details. In short, because of inconsistencies between the state's Badgercare rules and federal Medicaid rules, the Walker administration says it needs the legislature to revisit Badgercare a second time and approve a "technical" fix. Walker called a special session earlier this year to make another fix related to Badgercare.
This second fix, according to Kitty Rhoades, secretary of the Wisconsin Department of Health Services, likewise results from the federal Affordable Care Act and its initial startup problems during the first round of enrollments. Wisconsin Republicans are once again blaming "Obamacare" for the state's problems, but reality is far more nuanced than that, and more than headlines proclaiming "healthcare.gov woes." From a news report in the Milwaukee Journal Sentinel:
Under the legislation already signed, those state residents who are just above the poverty limit of $11,490 per year for single adults will stay on BadgerCare until April 1 instead of being dropped on Jan. 1. Republicans paid for those extra three months of coverage for the one group by delaying for three months the addition to BadgerCare of the 83,000 people below the federal poverty limit.
Under the latest proposal that Rhoades is describing, any qualifying Wisconsin parents or caretakers above the poverty line would be able to receive BadgerCare through March 31 so long as they apply for the coverage before Feb. 1.
But most of the misery these changes represent is to be found between the lines. Here's a short history:
Taking advantage of a conservative-led Supreme Court decision that unraveled a key measure in the federal health care reform law, Walker decided last year at the last minute that Wisconsin would skip out of the Affordable Care Act's expansion of Medicaid, foregoing a hundred million dollars and more in additional federal aid. Instead, Walker significantly narrowed Badgercare eligibility for single adults, dumping 53,000 residents who are just above the official poverty line (a line which is set very low, meaning many people above the line are, in practical terms, likewise impoverished). Walker told the abandoned citizens they could instead enroll in private insurance marketplace plans under "Obamacare."
Of course, no one ever expected such individuals could afford those plans even with the federal subsidies. Also, of course, Walker doesn't regard the Care Act's health insurance marketplace is or will ever be workable. So, in effect, he chose to consign those single low-income adults to a place he considered hell, for the convenience of his own budget and belief system. You simply can't have it both ways, but there he was, trying to have it both ways.
The state has offered a low-cost, high-risk insurance pool that might serve as a better alternative, but that goes away in 2014 precisely because it's a high-risk plan, which was one of the reasons why the federal law mandated Medicaid expansion and offered greater financial support to the states to accomplish it. Until, that is, the Roberts wing of the US Supreme Court undid the states mandate, allowing Walker's opt-out recklessness.
Declining the federal dollars that would have followed expansion, Walker's overall Badgercare configuration as early as 2011 in turn helped push the program's budget forecasts into the red. And why were Badgercare costs going up? Because more people had lost work and become impoverished in this state, thus qualifying for the program. The Walker administration was philosophically opposed to expanding public health care, however, so it bent over backwards to avoid doing that, even though the feds were prepared to underwrite the effort as part of a wider plan to lower overall health care costs in this country by improving the nation's overall health and spreading out the financial risk pool.
Indeed, despite Walker's claim that he'd balanced the state budget, his administration simultaneously had to certify that Badgercare was facing a huge deficit in order to get federal permission to dump those 53,000 unfortunates. Meanwhile, despite that huge service cut, the Walker administration is reporting that Badgercare costs are going back into the red some more -- by a reported $93 million. That's in large part because the national economy is improving and broader federal aids are declining. But apparently that doesn't take into account the additional new Badgercare enrollees who still qualify to join up under the federal law.
Those deficits, in the form of unsubsidized higher costs, will be covered by state taxpayers and may never go away, at least as long as Walker is around and persists in his policy. Unless, of course, he figures out another way to throw other low-income people off public health coverage.
How's that "certainty" thing workin' out for ya, Governor? You have certainly created a mess and cost state residents in the process.
Never mind that none of this would have happened if Walker had done the fiscally prudent thing -- which even some other Republican governors did do, seeing it as a no-brainer. He was ideologically opposed to that, however, and, according to him, there was no certainty the federal funding would last more than two or three years.
Ironically, as a result of his viewpoint, Walker's own Badgercare budget projections didn't even remain intact for weeks. But, no matter. Also, no matter that the state under Walker continues to receive huge amounts of federal aid for other programs, which are no more assured in perpetuity than federal funding for Badgercare. But come election time we'll no doubt be asked to conveniently ignore that incongruity, like Walker himself continues to do. Instead, we'll be told once again to blame...Obamacare!
Look around, folks. In states across this country that accepted the additional Medicaid funding provided under "Obamacare," more working poor and just-plain poor people have health insurance, all the costs are covered, and the risk is spread widely, instead of narrowly. It's a win-win, and thanks to Wisconsin's recalcitrant governor, you and I and every other taxpayer in the state are paying more for care here while subsidizing lower-cost care in other states. And regarding those dumb outcomes, Walker points his finger of blame towards the White House, rather than towards a mirror.