How Should Wisconsin Respond To The New Opportunities To Expand Medicaid With Federal Funding?

Recently, I sent a letter to State Representative Amanda Stuck, a supporter of “BadgerCare for All”, indicating some ideas about how the state of Wisconsin, given its current political alignment, might reform its Medicaid program.  “Badger Care for All” proposes that any individual (independent of his or her income) could purchase a BadgerCare insurance option (Wisconsin’s Medicaid program) , and that this would not come at taxpayer expense. Below are the salient parts of the letter.

I’m not a backer of “BadgerCare for All,” but I am a believer in universal coverage. Recently on this blog, I posted arguments as to why universal coverage does not require a single payer system. On the same blog, but in a different posting,  I’ve also argued that our current medical care system is unsustainable. I support the Affordable Care Act as a base from which to work, but there is a lot of work to be done.
At the state level, there are limited policy options, especially given the current political alignment in both the administration and the legislature. Governor Walker did one thing better than the governors of Florida, Georgia, and Texas; he provided a subsidized option for health insurance coverage for everyone below the federal poverty line. Of course, he did not go far enough since he refused to accept federal money for the expansion of Medicaid. Governor Hutchinson (a Republican) and the Arkansas state legislature accepted the expansion and used some of the funds to help Medicaid recipients purchase on the federal exchange . Hutchinson is now proposing a work requirement, a debatable option. Presently, Secretary Price (and probably VP Pence) has some interest in expanding Medicaid through providing more waivers to states that wish to try demonstration projects.

With all this in mind, I suggest the following:
1. Encourage your legislative colleagues and the Governor to seek a Medicaid waiver that parallels what Arkansas did.
2. Agree to the partial expansion that some states would like in which the federal government Medicaid program supports just those at or below the poverty line but not above it (that is, not between 100% and 138% since those people have subsidized options on the exchange.)
3. Some states (e.g., New York) are requiring insurers who participate in Medicaid to offer plans on the exchange. Ideally, I support one non-group market under the rules set out for the exchange. There would not be separate non-group and non-exchange (and more expensive) policies or Medicaid; non-group policies (serving individuals and families) would only be available  through the exchange with subsidies based on income and family size.

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