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Wisconsin Counties Ask to Implement Health Care Reform Directly

Milwaukee is among the 20 counties seeking federal Medicaid funds

Aug. 7, 2013
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Unwilling to accept Gov. Scott Walker’s refusal to fully expand Medicaid programs at the state level with federal dollars, representatives of 20 Wisconsin counties—including Milwaukee County—say they are willing to take on that responsibility themselves.

Last week, a coalition of counties organized by Citizen Action of Wisconsin asked the state Department of Health Services (DHS) to help them receive Obamacare funds for Medicaid expansion so that they can enroll residents in BadgerCare.

But the counties cannot do it alone. The federal government would need to grant the state a waiver to do so, and the state would have to designate a state agency that would receive the money and pass it through to the counties.

DHS doesn’t seem interested in considering the counties’ request, although it will pass it along to the feds.

“The department’s focus is on reducing the number of uninsured in Wisconsin by nearly 50%, not on debating the policy decisions that are now law,” read a statement from DHS Secretary Kitty Rhoades provided to the Shepherd. “We have an aggressive timeline in place to implement the governor’s plan.”

The state DHS is currently working on Walker’s proposal to dismantle the state’s primary Medicaid program, BadgerCare, which was included in the biennial budget passed by the Republican-dominated Legislature earlier this summer.

Walker is turning down $12 billion in federal funds over 10 years to expand Medicaid under the Affordable Care Act. To gut BadgerCare, Walker is seeking a waiver from the federal government to remove everyone earning more than the federal poverty level from the program so that they can enroll in the planned health insurance exchange marketplace, a more costly solution for state taxpayers and those affected by the change. DHS will submit its request for a waiver on Aug. 9.

The cost of Walker’s plan to state taxpayers is an additional $119 million over the next two years to insure far fewer low-income Wisconsinites than what the Obamacare plan would pay for.

Citizen Action estimates that 98,122 people currently enrolled in BadgerCare would be kicked off of the program if Walker’s plan is approved, 17,083 of them in Milwaukee County. An additional 173,842 low-income Wisconsinites without health insurance would not be eligible for BadgerCare under Walker’s plan, 46,031 of them in Milwaukee County.

Citizen Action Executive Director Robert Kraig called the county-centered plan a compromise that wouldn’t upend Walker’s plan to turn down the federal Medicaid funds but would still provide access to affordable health care to Wisconsinites earning poverty-level wages.

“We’re saying that since you’re leaving money on the table there are a lot of counties that are interested in doing this since it’s better than not having this coverage at all for people,” Kraig said. That extra money coming into the state through Obamacare would also create more jobs in the health care field.


Conservative Ohio Accepts Obamacare Funds

The county representatives say that they are merely urging Walker to follow in the footsteps of the conservative Republican governor of Ohio, John Kasich. In February, the federal government signed off on Ohio’s plan to send Medicaid expansion dollars to Cuyahoga County, where Cleveland is located, through the state. The move would help to insure an estimated 30,000 uninsured Cuyahoga County residents who make up to 133% of the federal poverty level, or $14,856 for a single person.

But there’s one big difference between Ohio and Wisconsin. Although both
governors are very conservative, Ohio’s Kasich has embraced Obamacare’s full
Medicaid expansion over the objections of that state’s Republican-dominated legislature. To work around the ultraconservative Ohio legislature and to get the Medicaid funds for Cuyahoga County, Governor Kasich embraced this county-initiated avenue to Obamacare. Walker, on the other hand, has totally refused the Obamacare funds for Wisconsin.

Kasich’s decision angered his tea party constituents, but it was applauded by Ohio’s business community, Politico reported. Kasich explained that Obama’s federal health care reform would help prevent rural hospitals’ “financial chaos.”

Walker’s Wisconsin isn’t taking that route, however, but the Citizen Action coalition says that his decision isn’t necessarily a final one.

“Because there is no deadline for taking the money, this issue is not going to go away,” Kraig said. “Walker can change his mind at any time.”

He added that Wisconsin has often applied for and received federal waivers to create innovative Medicaid programs, including BadgerCare in 1997, FamilyCare, SeniorCare, BadgerCare’s family-planning services, and BadgerCare Core, which covers childless low-income adults. Milwaukee County’s General Assistance-Medical Program (GAMP), a precursor to BadgerCare, was created via a federal waiver as well.

Kraig said that Wisconsin’s county governments are well equipped to receive federal Medicaid funding to provide BadgerCare to those adversely affected by Walker’s proposal.

“Our county governments already receive a lot of federal Medicaid funding, especially for mental health services and FamilyCare,” Kraig said.

Kraig blasted Walker’s fiscally irresponsible decision to refuse the Medicaid expansion funds and Republican legislators’ willingness to rubber-stamp his plan.

“This may very well be the worst budget decision in decades,” Kraig said.


A National Movement of Local Governments

Milwaukee County Board Chair Marina Dimitrijevic supports the counties’ proposal, saying that Milwaukee County has the most to lose if Walker’s BadgerCare plan is implemented without enhanced Medicaid funding for low-income Wisconsinites. The Milwaukee County board was among the 12 counties that passed resolutions asking Walker to accept the expanded Medicaid funding.

Dimitrijevic said that local leaders around the country are looking for ways to bypass Obamacare-rejecting tea party governors so that their vulnerable constituents can still find affordable health care.

“This is the national local topic,” Dimitrijevic said. “There are so many local governments that are in a similar situation as us and they are grasping at what they can do. We are the ones who are going to be face to face with people who don’t have health care.”

Although Milwaukee has the most to lose by Walker’s rejection of the federal funds, other counties, including many in rural areas, support the alternative plan as well. Supervisors from Brown, Columbia, Dane, Dunn, Eau Claire, Iowa, Jefferson, Kenosha, La Crosse, Lincoln, Manitowoc, Marathon, Milwaukee, Oneida, Outagamie, Racine, Richland, Sauk, Winnebago and Sheboygan counties signed on to the letter to Secretary Rhoades.

“I feel like we’re being left out of a national movement to provide access to affordable health care,” Dimitrijevic said. “Milwaukee County deserves to be part of that.”


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