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Analysis: Wisconsin GOP leaders will continue to refuse Medicaid expansion at their own peril

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Medicaid expansion would make health care affordable to the poor

 Scott Walker’s administration has been one of the nation’s most vocal opponents of the Affordable Care Act. Wisconsin was one of more than a dozen Republican-led states that did not fully expand Medicaid using federal money provided by the ACA, and his administration is currently embroiled in a costly lawsuit to have it declared unconstitutional. If the suit is successful, as appears likely with Trump’s Supreme Court, then the ACA’s mandate for insurance companies to cover pre-existing coverage would end.

Gov.-elect Tony Evers vowed during his campaign to drop the suit, to expand Medicaid in Wisconsin and to require insurance coverage for pre-existing conditions. First, however, he’ll have to overcome opposition from Republican leaders, who’ve rejected such positions in the past and have indicated their intention to treat Evers with hostility rather than cooperation.

In fact, they’ve all but promised gridlock for the next two years, as national Republican leaders did after the election of Barack Obama.

Enacted in 2010, the ACA required all states to extend Medicaid, a federal program that provides health care to adults earning up to 38 percent above the federal poverty line, which translates into an annual income of $16,753 or less. The ACA required states that didn’t already do so to extend Medicaid beneficiaries to low-income, childless and non-disabled adults.

In states that adopted Medicaid expansion, it reduced the uninsured rate and increased the economic security of low-income Americans. It also has produced jobs, particularly in the health care sector.

The U.S. Supreme Court in 2012 upheld the ACA, but allowed states to opt out of Medicaid expansion.

Changing attitudes

Wisconsin Republican leaders will continue to resist Medicaid expansion at its members’ peril, says Citizen Action of Wisconsin.

The group cites exit polling from Nov. 6 showing that a super majority of Wisconsin voters ranked health care as their top issue, and 67 percent of voters said they want “major changes” in the health care system. Those attitudes factored prominently into the victories of Tony Evers, Lt. Governor-elect Mandela Barnes, Sen. Tammy Baldwin, Attorney General-elect Josh Kaul and State Treasurer-elect Sarah Godlewski, according to Citizen Action.

Citizen Action organizer Jeff Smith also rode to victory in the state’s Senate District 31 (western Wisconsin) on health care reform, according to the group.

“One of the keys to the election was Scott Walker’s fundamental misreading of the public’s profound unhappiness with the health care system,” said Robert Kraig, executive director of Citizen Action of Wisconsin, in a statement to the press. “Pre-existing condition discrimination is not a small technical issue, it strikes to the heart of the problem with health care. It can only be meaningfully addressed by using our democracy to fundamentally reform the entire system to guarantee everyone access to high quality coverage, no matter what. This starts with a more robust public role in the system through Medicaid expansion to the full extent allowed by federal law … and taking on price gouging by prescription drug corporations.”

In the midterm election cycle, Democratic candidates in the state supported a BadgerCare Public Option, which Citizen Action members played a major part in developing. That plan would allow individuals and small businesses to buy into Wisconsin’s popular BadgerCare program at much lower cost than corporate health insurance. For example, Citizen Action's BadgerCare Public Option would cost up to $24,000 less for a family of four, according to Citizen Action research.

Directly to the voters

In 2014, health care advocates tried to persuade Wisconsin Republican leaders to expand Medicaid by taking the issue directly to the voters through non-binding ballot initiatives.

That effort failed, but more recently the strategy has begun working in other states.

Last year, Maine became the first state where voters, as opposed to governors or legislatures, decided to expand Medicaid under the ACA.

This year, voters in three red states — Idaho, Nebraska and Utah — backed binding referendums approving expansion of Medicaid, despite the opposition of their Republican leaders.

Passage of the referendums shows that the ACA has gained popularity over the years. It also shows that “Nebraskans wanted action,” said Nebraska Sen. Adam Morfeld of Lincoln, a Democrat who helped organize the Insure the Good Life drive and served as a consultant to it, told the Omaha World-Herald. “They provided action.”

The measure will extend benefits to nearly 90,000 people in Nebraska.

In Idaho, where 91,000 would gain coverage, the initiative passed with over 60 percent of the vote. It had the support of the Republican governor, Bruce Otter.

That was not the case in either Nebraska or Utah, where Republican governors opposed expansion. In Utah, 150,000 would gain access.

Thirty-five states plus Washington, D.C., have all approved Medicaid expansion. Montana is poised to join that group in the next few days after all the votes in that state have been tabulated. The momentum toward Medicaid expansion will likely add pressure on the remaining states, including Wisconsin, to do so.

The resistance of Wisconsin Republicans could come back to haunt them in 2020, just as Walker’s resistance did in 2018.

This analysis uses information from Stateline, a news service of The Pew Charitable Trusts. Read Stateline's story about Nov. 6 Medicaid expansions here.

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