Rejecting Medicaid expansion leads to other problems. But maybe that's why WisGOP wants to do it

If Medicaid expansion is going to go down tomorrow (as the GOP-controlled Joint Finance Committee plans to do tomorrow), at least Governor Evers and the Dems aren’t going down without a fight for once. There has been plenty of talk and articles flying in state media in the last few days, and it’s time to look at a couple of the consequences of NOT expanding.

As I and many others have mentioned over the last few years, taking Medicaid expansion would save state taxpayers dollars by making the feds (WHO GET SOME OF THEIR TAX MONEY FROM WISCONSINITES) cover the costs of Medicaid and related health services. In addition, Guy Boulton’s rundown in today’s Journal-Sentinel notes that failing to take Medicaid expansion also puts at risk many dollars that would be sent to state hospitals.

The increased funding includes $200 million in so-called hospital access payments — with the federal government paying 90% of the cost.

Hospitals get an additional $4,027 for inpatient services and $318 for outpatient services this year from those payments. This is in addition to the basic rates paid by Medicaid programs.

The size of the payments would go down but the number of patients eligible for the payments would increase under Evers’ proposed budget.

That’s part of a group of provisions in the Health Services budget which uses the 90% share that expanded Medicaid brings in as a way to free up state dollars to help add money to hospitals that serve low-income recipients.

Theoretically these provisions could be kept in the budget without Medicaid expansion, but it would mean state taxpayers would pick up 41% of the costs for all of those initiatives. That adds $90 million to the $1.4 billion that already has to be cut under the GOP’s plans to keep tax cuts for the rich and corporate while tanking tax reforms that help lower-income Wisconsinites.

In addition to the fiscal side of what getting rid of Medicaid expansion would do to hospitals, not expanding Medicaid also likely would reduce access for many individuals that are just over the poverty line and have to buy a policy on the insurance exchanges that likely aren’t going to be great about paying for hospital expenses.

But because Republicans are more concerned with the well-being of insurance companies and oligarch donors, they’d rather leave those low-income individuals and hospitals at risk. This is also from today's J-S article -

Republican opponents also contend that expanding Medicaid programs will result in costs being shifted to private health plans because hospitals and other health care providers typically lose money on patients covered by Medicaid programs.

“We do not want to hurt the private-sector health insurance market," Assembly Speaker Robin Vos, R-Rochester, said at a news conference at Milwaukee Mitchell International Airport May 2.

Private health plans typically pay much higher rates than BadgerCare Plus and other Medicaid programs.

Naturally, the GOPs ignore the fact that Evers' budget raises those reimbursement rates to providers and caregivers to deal with this issue. But that becomes a lot harder to do if you don't have the state tax dollars available from expanding Medicaid. Which means their "Medicaid doesn't pay enough" argument is another installment of your favorite GOP game show "LYING OR STUPID??"

Also amazingly, the GOPs are still hanging their heads on a study from a Bradley Foundation front group and UW professor/GOP hack Noah Williams (that professional BSer Will Flanders was still hawking to right-wing clickbait sites last week) which claims Medicaid expansion will cause insurance companies to raise costs for everyone else. As mentioned last month, that study was quickly debunked by actual academics, who showed the absurd, cherry-picked assumptions that were made.

Interestingly, the Evers Administration responded with a study by Wakely Consulting that shows Medicaid expansion actually cuts premiums for other people that buy policies on the Obamacare exchanges.

Since the CMS data is 2019 Open Enrollment data, Wakely used this information, along with market information, to estimate the average enrollees between 100% and 138% FPL in 2020. Wakely estimated that, on average, approximately 25,000 to 30,000 on-Exchange enrollees would be newly Medicaid eligible if Wisconsin expanded its Medicaid program to 138% FPL. In other words, an average of 25,000 to 30,000 enrollees would likely shift out of the individual market, should the state expand Medicaid to 138% FPL, over the long term. It is important to note that the 25,000 to 30,000 is an average number of enrollees over the course of the year.

The large shift of enrollees out of the individual market into Medicaid is likely to produce direct effects on individual ACA market premiums. Previous research has shown that Medicaid Expansion reduces individual market premiums. For example, HHS conducted in-depth analysis on the impact of Medicaid Expansion on premiums. Controlling for numerous factors, HHS1 estimated that, on average, premiums were 7% lower in states that expanded Medicaid. Sen and Deliere estimated that Marketplace premiums were on average 11% lower in states that expanded Medicaid compared to states that did not, controlling for demographic and health characteristics of the state. These reports are not in conflict and just demonstrate the potential range in relative premium changes due to improvements in morbidity Wisconsin’s ACA individual market. The effects (e.g., premium reduction due to improved morbidity) may not be completely realized in the first year of Medicaid Expansion. Nonetheless, Medicaid Expansion in Wisconsin could change both the size of the individual market and the morbidity of Wisconsin’s ACA individual.

Now take that with a grain of salt, because it’s not exactly what the Bradleys and their GOP puppets are claiming (that Medicaid expansion raises premiums for all those with insurance), and the Evers Admin probably wouldn’t have released the study if it didn’t help their side. But I’ll trust the guys who use comparisons of what has actually happened vs the guys paid by the Kochs and Bradleys who do sloppy, hole-filled work to reach a certain conclusion.

So let’s see if the GOPs actually try to sabotage Governor Evers’ budget and large numbers of Wisconsinites by tanking Medicaid expansion tomorrow. Or do they realize the Black Man in the White House isn’t there anymore, and it’s OK to use the ACA to its full extent now? Especially when it saves state tax dollars and will help many of our hospitals stay afloat for the coming years.

Ah, who am I kidding? I have no illusions that the GOPs will do the right thing (because they’re paid not to), but now the situation is primed to let the GOPs take the blame for the budget cuts and the mess that follows. That is, if Evers and Dems choose to keep it in the front of people’s minds (HINT- they should).