Despite unrelenting pressure by congressional Republicans to repeal President Barack Obama’s health care overhaul, some GOP governors in swing states acknowledge that the Affordable Care Act is the law of the land.
Some Republican governors’ reluctant acceptance of Obamacare is based on financial prudence and political necessity – the law provides new policies that could prove popular, while efforts to ruin them ultimately could upset consumers.
“We’re going to do our level best to make it work as best we can,” Iowa Gov. Terry Branstad said. “My approach is to not spend a lot of time complaining.”
That same view has been embraced by Republicans John Kasich of Ohio, Susana Martinez of New Mexico, Brian Sandoval of Nevada, Rick Snyder of Michigan and even Rick Scott of Florida.
But not Scott Walker of Wisconsin, who has joined congressional Republicans who are trying to derail, defund or demolish the ACA. Walker and his allies already have begun rear-guard action against reform, causing tens of thousands to lose coverage or expanded benefits and tens of thousands more to be denied the coverage intended for them next year.
Why? “To sabotage the Affordable Care Act and get political credit for that from the far right and parlay that into his run for president,” said Robert Kraig, executive director of Citizen Action of Wisconsin.
Kraig said Walker doesn’t want Democrats getting credit for something that represents “a huge step forward in the history of economic security in the United States, because there’s going to be – for the first time – a backup system where everyone can buy health care.”
So to build up his far-right cred and national profile as he prepares to run for his party’s 2016 presidential nomination, Walker has broken with other governors in his party and will turn his back on some $12 billion in funding through the ACA that would have all but eliminated the waiting list for insurance for the poor and working families who have their Medicaid payments delivered through the BadgerCare program.
To ensure that the poor people of Wisconsin will suffer when the ACA begins enrollment, Walker’s biennial budget made major changes to BadgerCare. Counting on public ignorance, he’ll attempt to position the problem as a consequence of the ACA.
Estimates are that 96,000 childless adults, children and parents who earn more than 100 percent of the federal poverty level – about $12,000 for a single person – will be kicked off coverage as a result of Walker’s budget.
“He is literally going to cost the state $148 million in this biennial budget to cover fewer people with health care,” Kraig said.
Kraig also claims that Walker’s rejection of federal funding could cost the state up to 10,000 new jobs in health care, one of Wisconsin’s largest employers.
In addition to turning away the money for Medicare expansion and throwing poor people off health care, Walker refused to set up a state insurance marketplace, raising an outcry from consumer advocates, doctors, nurses, health insurers, business groups and other stakeholders. Instead, he’s forcing Wisconsinites to go through a federally-created marketplace.
The state’s medical groups had backed the creation of a statewide exchange but Walker ignored them, returning a $38 million check that the federal government had given ex-Gov. Jim Doyle to fund it.
“Under Doyle, we had a whole plan for the exchange and a website set up allowing people to go through the whole process of signing up online,” Kraig said. “Our online exchange was to be used as a prototype for the nation. We were one of only five states given this opportunity.”
Insurance marketplaces – or exchanges – under the ACA will be open for enrollment starting on Oct. 1, with coverage beginning Jan. 1. The marketplaces will offer a choice of health plans with some tax breaks for low- and middle-income consumers.
Despite Walker’s efforts, insurers have established marketplaces in the state’s three regions, said John Tomlinson, who specializes in designing employee benefit and health insurance plans for businesses at Mid-State Insurance in Mequon. Three exchanges have been established in the Milwaukee area and five in Madison, he said.
One of the Milwaukee exchanges – Wisconsin Physicians Service – will cover only health care provided by Aurora. A fourth exchange for the Milwaukee area is currently in the planning stages, he added.
Nonprofits step in
Walker has left Wisconsinites on their own to navigate the complexities of acquiring coverage under the new system, but progressive nonprofit groups have stepped in to try steering people through the process.
“There could be issues around literacy. They may not be English-speaking, they may be homeless. They could get the notice in late September, and they may not understand it,” said Molly Bandt, director of Covering Kids and Families in Madison. “There are still things to work out – although on the positive end, there’s a lot of energy in trying to get the word out.”
Covering Kids and Families, which works to get children and families enrolled in Medicaid programs, is among the groups planning seminars at job centers, schools and libraries across the state. Trainers will discuss the ACA, explain what is and isn’t changing and help people figure out which plans work best for them.
The Milwaukee Health Care Partnership has been asking churches, community leaders and advocacy organizations to help reach out to low-income people losing their coverage. The idea is that it’d be most effective to reach people through those they already know and trust, executive director Joy Tapper said. Pastors and neighbors can contact Medicaid recipients, let them know about the coming change and direct them to the partnership for more information, she said.
That strategy worked well in Massachusetts, where organizers identified word-of-mouth as one of the most critical factors in successful outreach, Tapper said.
Besides making it difficult for people to acquire coverage under the ACA, Walker and other Republican leaders have been criticized for promoting false statistics to scare people into avoiding the ACA. The Cap Times reported last month that anonymous emails were being circulated claiming that if medical tests prove to be flawed, the ACA will not pay for retesting; that the only pain medication covered under Obamacare is aspirin and that people on Medicare will lose the right to choose their own doctors.
Republicans have focused a lot of their efforts to sabotage the ACA on young people, who are being hit with pleas not to sign up for health care coverage, as required under the “individual mandate” provision in the law. GOP leaders believe that by keeping young, healthy people from joining the system, they can make it fail by limiting the risk pool only to the sick and elderly.
At the beginning of September, Walker’s administration was condemned for releasing a phony analysis that tried to terrify consumers with the specter of dramatic premium rate increases under the ACA. But the analysis didn’t take into account federal tax subsidies, which are expected to lower premium costs as much as 77 percent. It also failed to show the comparativec costs related to the benefits or co-pays under different policies.
When asked by media to provide the premium costs on which the projected percentage increases were based, the administration refused to release the numbers and then later admitted that the increases were not based on actual numbers.
Even those who understand the political gamble Walker is making with Wisconsin’s health care have a hard time understanding how he can morally justify working to deny health care accessibility to the poor and middle class.
Some pundits say Walker doesn’t understand the risk he’s taking just a year after Democrats succeeded in casting Republicans as the party of the prosperous.
Other Republican governors understand, and that’s why they’re climbing on board with Obamacare.
Lori Lodes of the Center for American Progress, a liberal-leaning think tank that supports the law, put it this way: “They can’t risk pursuing a partisan agenda that would turn down taxpayer dollars and deny their constituents health care.”
In Michigan, where Snyder faces an uphill re-election fight and there is disagreement in his party about the law, the governor has argued that receiving an estimated additional $1.4 billion in federal money to bring roughly 500,000 residents under health coverage makes economic sense.
Ohio’s Kasich, also faced with a difficult re-election road, promotes expanding Medicaid as a moral issue.
Kasich advisers say agreeing to include more low- and moderate-income people in the program could soothe relations with female voters or independents angry about the budget he signed in July that included intrusive new restrictions on abortion.
“Among suburban women, it could soften his image,” said Bob Klaffky, a Kasich adviser.
Other Republican governors who have agreed to the Medicaid expansion include Jan Brewer of Arizona, Chris Christie of New Jersey and Jack Dalrymple of North Dakota. Arizona, where Brewer isn’t seeking re-election, and North Dakota are Republican-leaning states; New Jersey, where Christie is running this fall, is considered Democrat-leaning.
Martinez and Sandoval have gone the furthest toward implementing the law.
– Graeme Zielinski and The Associated Press contributed to this article.