MJS Our View: We urge the governor to expand Medicaid program

We urge the governor to expand Medicaid program

A key provision of Obamacare is an expansion of this program for the poor. Wisconsin should not be left behind.

Feb. 11, 2013 6:05 p.m.

Wisconsin should expand its Medicaid program through the Affordable Care Act.

If Gov. Scott Walker decides to do that, more than 100,000 people would be affected, nearly all of them either unemployed or only working part time. That single act could save lives - and may save money in the long run if it leads to better health care.

While advocates for the poor argue passionately for the governor to take this step - and we agree it's the right one - the decision is not as clear-cut as those advocates would have you believe. There are risks in expanding the program, a decision that was left to the states by last summer's U.S. Supreme Court ruling that upheld Obamacare. Walker is expected to announce his decision in a matter of days.

For one, while federal money covers the full cost of Medicaid expansion from 2014 to 2016, the federal share will gradually decline to 90% in 2020. There are concerns that even that 90% share might be in danger in an era of austerity, and even with a 90% match, the additional burden on the state purse would be substantial.

Critics are correct in arguing that expanding Medicaid does nothing to attack the very real problem of controlling out-of-control costs in the American health care system. They are also correct that shifting the burden from Wisconsin to the federal government doesn't relieve the state's taxpayers, who also pay federal taxes (although the state may be able to shift significant costs to the feds in future years).

And there surely are problems with access to health care for the poor - simply having insurance, whatever the form, does not ensure good care if there aren't enough physicians or clinics seeing the poor.

Nevertheless, Walker should expand the program.

Expansion of Medicaid is one of the key provisions of the Affordable Care Act. The program would expand to include people with household incomes below 138% of the federal poverty line ($15,414 for an individual this year) who are not now eligible for coverage. BadgerCare - Wisconsin's Medicaid program - already is more generous than that, but many low-income people without children or whose kids are grown still fall between the cracks. Recently, the waiting list to get on BadgerCare ballooned to 140,000. Low-income folks don't have good options for affordable health insurance any other way - a lot of low-wage jobs simply don't provide it.

And while there surely will be an additional cost to the state's taxpayers after the initial period of federal support, those costs will be moderated if more of the poor are seen earlier and get better preventative health care. Left untreated, chronic illnesses such as diabetes only worsen - and get much more expensive to treat. Health insurance, in that sense, saves money. Yes, access is a problem in urban areas such as Milwaukee, but that's a separate challenge and is no argument for failing to cover people who need it. Expanding Medicaid also could reduce the cost of bad debt and charity care, although the extent of those savings isn't known.

In addition, the state would leverage billions of dollars more in federal assistance. The state would save $66 million in the first three years of the program but pay back those savings and pay up to $67 million more over the next four years, a nonpartisan Legislative Fiscal Bureau study shows. But an estimated $4.38 billion in federal money would become available to provide health care through 2020, the bureau reports.

Opponents of Medicaid expansion argue that a so-called "woodwork" effect will lead many people to sign up who currently are eligible but not receiving Medicaid. But as the Fiscal Bureau recently noted in its report, that is likely to happen anyway, whether Medicaid expands or not. And if they are eligible, they should be covered.

This can't be an easy call for a governor so opposed to Obamacare, but we think it's the right one and hope he sees it that way, too. Both sides agree that expanding Medicare will save lives. It will bring billions of dollars of federal money to a state that historically has lagged in that key category. The added expense, which will be moderated by better care and federal money, is worth it.