Fight Over Medicaid Expansion Brewing in Wisconsin

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Medicaid expansion is one of 70 non-fiscal items Republican lawmakers in Wisconsin have vowed to remove from Democratic Gov. Tony Evers' budget when the Joint Finance Committee begins voting next week.

In response, Evers said he would "fight like hell" to expand Medicaid.

"We're not ceding anything, we're not negotiating against ourselves," he said. "We have to have this."

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Republican Assembly Speaker Robin Vos said Evers was using "heated rhetoric" to push "massive welfare expansion."

Shortly after the Republicans announced their plan, the state's Office of the Commissioner of Insurance released a report assessing the impact of Medicaid expansion. The report was produced by Wakely Consulting Group, LLC.

The Wakely report states that about 25,000 to 30,000 non-Exchange enrollees would be newly Medicaid eligible if Wisconsin expanded its Medicaid program, and that Affordable Care Act premiums would go down.

"The large shift of enrollees out of the individual market into Medicaid is likely to produce direct effects on individual ACA market premiums," it states.

The number of new enrollees represents an average number of enrollees over the course of the year, the report says. It only evaluated ACA enrollees and excluded the majority of Wisconsinites who have health insurance through their employer.

The problem with the Wakely study is that it "looks at a very narrow slice of the pie," the Wisconsin Institute for Law and Liberty (WILL) argues. "It examines the effect of Medicaid expansion on just 6 percent of the population, but has nothing to say about the impact on the 57 percent of Wisconsinites who have insurance through their employer. Providing Medicaid to individuals who already have access to heavily subsidized insurance through the exchanges will hurt more Wisconsinites than it helps."

According to an analysis by the Henry J. Kaiser Family Foundation, Wisconsin has no health insurance coverage gap. In 2016, only 7 percent of Wisconsin residents reported having no health insurance.

About 16 percent of Wisconsin's population is covered by Medicaid according to data from the same timeframe. Among them, 72 percent are adults. Of the adults, 62 percent are working, the Kaiser Foundation notes.

There is no reason to expand Medicaid, WILL argues, because those who would move to Medicaid already have access to subsidized health insurance. And doing so would increase health insurance costs to a family of four with private insurance by as much as $700 per year, resulting in a net cost of more than $400 million to the state, according to an analysis produced by WILL.

The Kaiser Family Foundation description of per capita cost of private health insurance mislabeled data, according to the Centers for Medicaid Services (CMS), which oversees Medicaid. The term should be "per enrollee," CMS notes. The estimated statewide net effect, based on roughly two-thirds of Wisconsin residents having private insurance, WILL estimates, would be an additional cost of $400 million.

"It remains unclear if cost-shifting happens to those with other public insurance, such as Medicare, which could serve to further increase that figure," WILL added.

If Medicaid were to expand in Wisconsin, an estimated 176,000 additional people would be enrolled, according to an analysis by the Urban Institute. Based on this projection, WILL states taxpayers would pay approximately $6,250 per Medicaid enrollee.

This dollar amount multiplied by 176,000 is far greater than the projected number estimated by Wakely, WILL notes. Medicaid expansion is both unnecessary and financially unsustainable, WILL argues, especially in light of the fact that Wisconsin has no health insurance coverage gap.