In case you haven’t heard, voters in Rock County in an advisory referendum on the April 6 ballot favored Wisconsin accepting additional Medicaid funding to provide health care coverage to more low-income residents.
The margin in the vote was overwhelming with 77% in favor of expanding Medicaid. That huge percentage indicates there was bipartisan agreement on the matter.
If you follow Wisconsin elections, you know that anything above 55% is a comfortable margin, so 77% certainly qualifies as a landslide.
Most Rock County media attention was focused on the five town referendums approving the use of ATVs on public roads. But the countywide referendum on Medicaid funding could affect many more Rock County residents than those who wish to ride ATVs on public roads.
Under the traditional Medicaid program, the federal government provides matching funding on a 60-40 basis. In Wisconsin, certain waivers and other features of the program result in the feds funding about 65% of the program.
Some administrative functions are matched at higher rates. Those functions include modernizing the enrollment process.
Under the Affordable Care Act, additional federal Medicaid funding was made available to states. Initially, this additional funding was 100% federally funded. It has now changed to a 90-10 federal-state ration, where it will remain.
When the ACA federal enhancement was offered, then-Gov. Scott Walker decided not to participate. His main objection was that the federal government could not be trusted not to let federal funding drop below 90% and that eventually, states would be on the hook for the entire amount.
Another criticism of the program was that it included childless adults and children not in the home.
Walker also changed the eligibility requirements for Medicaid from 138% of the poverty level (roughly $12,000 annually) to 100%, making fewer people eligible.
Wisconsin is one of just 12 states to turn down the additional federal funding. The others are Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas and Wyoming
In the 38 states that have opted to take the Medicaid expansion over the years, many have had Republican governors who made the decision. That’s another indication that the additional funding for Medicaid is not simply a partisan issue.
Why did Rock County voters vote for expanding Medicaid with 90% federal funding?
Since the enhanced federal funding under the Affordable Care Act was adopted Jan. 1, 2014, through June 21 of this year, Wisconsin will have turned down $300 million a year for a total $1.6 billion. Those figures are from the highly respected Legislative Fiscal Bureau.
Some could argue that by turning down the additional federal funding, Wisconsin helped reduce the federal deficit and/or debt. That’s not the case. The additional federal funding was already appropriated; what Wisconsin turned down was passed along to other states participating in the program.
States accepting the additional Medicaid funding cannot use it to replace those served by the traditional funding. The intent was to provide coverage to new recipients.
Looking at the list of states not accepting the additional federal Medicaid funding, it shows Wisconsin as the only Midwest state turning it down and joining mostly Deep South states as leaving billions of dollars on the table.
Rock County voters on April 6 sent a message to Madison that Wisconsin should participate in the 90-10 Medicaid split with the federal government. The $1.6 billion Wisconsin turned down was sent to participating states, including our Midwestern neighbors.
Receiving the 90-10 federal funding would allow Wisconsin to provide more low-income residents with health care, something providers, especially hospitals, would welcome.
Those not now insured often wait until a medical issue becomes severe and then go to emergency rooms, where hospitals are required to care for them. That uncompensated care, called charity care, drives up the overall cost of health care to those with private insurance, including coverage through an employer or if individuals purchase coverage directly from the insurer.
If Medicaid was expanded, more patients would be covered and that could bring about stabilized, if not lower, health care costs.
Like partisan gerrymandering, Wisconsin voters ask for relief, but nothing happens. Perhaps the realization that $1.6 billion was left on the table that could have been used to provide health care to low-income residents will lead the state to revisit the issue.