Friday, February 15, 2013

Walker's Medicaid plan- even worse than you thought

Something wasn't adding up to me when I looked at Governor Walker's plans for Medicaid over the next 2 years. It wasn't just the stupidity in turning down the Obamacare-related Medicaid expansion (though as I said yesterday, that decision was stupid enough on its face). But what was bothering me was because the "increases in state spending" weren't ringing true, as Medicaid costs would go up on their own over the next 2 years without much expansion of services, simply because costs go up year-over-year.

Then I took a look at Page 3 from the "Work Makes you Free!" slideshow that Walker gave to WMC oligarchs yesterday, and it started to fit together. The slide makes a big show about mentioning that Walker's plan will increase General Fund revenue for Medicaid by $221.4 million next year, and another $200.9 million on top of that in fiscal year 2015, meaning a net increase of $643.6 million from what is projected for 2013 (+$221.4 million year 1, +$422.3 million year 2). Sounds like a lot, but it's really about 15% over 2 years.

After seeing that, I then looked at the Department of Health Services' budget request for the next 2 years, and my suspicions were confirmed. WALKER IS BARELY ADDING MORE THAN WHAT DHS SAID THEY NEEDED! Here's the comparison:

DHS budget request for Medicaid- $635.9 million increase
Walker Medicaid plan- $643.7 million increase
Difference- $7.7 million.

That's right, instead of increasing the Medicaid budget by 15.8%, which is what DHS said it needed just to keep up, Walker's taking all the credit for asking for an increase of 16.0%, and added increase of...0.2%. Basically nothing at all.

The DHS request also increased coverage in a much more responsible way than Walker's plan would, just assuming current law would continue as it were.
The funding requested in this item is based on MA caseload and intensity projections developed by DHS for the 2013-15 biennium. Those projections assume that current law pertaining to the MA program will remain in effect throughout the 2013-15 biennium. For these purposes, "current law" includes changes to the BadgerCare Plus program that were approved by the Legislature's Joint Committee on Finance and the federal Centers for Medicare and Medicaid Services (CMS) that went into effect July 1, 2012. Those changes relate primarily to the premiums and "other insurance" rules for non pregnant, non-disabled adults in the program with incomes greater than 133% of the federal poverty level. The Department's projections assume that any approvals needed to keep those changes in effect throughout the 2013-15 biennium will be obtained. Current law also includes continued enrollment in the Family Care, Family Care Partnership, PACE, and IRIS programs since the enrollment cap for those programs was lifted on April 3, 2012. The Department's request does not include an expansion of Family Care and related programs into additional counties during the 2013 15 biennium.
So they basically assumed a status quo budget, on Medicaid, which already pushed more than 11,000 off the Badgercare rolls due to higher premiums demanded by the state. But at least it covered people making up to 133% of poverty.

Walker's plan doesn't even do that. I'll start with this passage from the Governor's press release on the Medicaid plan.
Governor Walker’s proposal will cover people living in poverty through Medicaid and allow individuals above that level to access affordable health insurance coverage through the federal health insurance exchange. This proposal affects non-elderly, non-disabled adults. Under this plan, Wisconsinites in poverty will be covered by Medicaid and those above poverty up to four times the poverty level would receive federal health insurance premium subsidies to purchase health insurance offered in the exchange. By doing so, Wisconsin is projected to reduce the number of uninsured adults, ages 19-64, by 47 percent with 224,580 fewer people uninsured.
So the plan is to expand state Medicaid eligibility for some groups (particularly childless adults), and shove low-income recipients with children out into the Obamacare exchanges starting in 2014...and into the hands of Walker's buddies in the insurance industry.

Let's go back to page 5 of the "Work Makes you Free" plan. and note the graphic.

Amount of uninsured, Walker plan vs. taking Medicaid funds
Through Wisconsin Medicaid-
Taking ACA Medicaid funds- 90,691 LESS
Walker plan- 5,417 MORE

Through private insurance and Obamacare exchange-
Taking Medicaid- 161,987 more
Taking ACA Medicaid funds- 229,997 more (68,010 more than taking Medicaid)

The goal with this is two-fold.

1. Much like how they did in raising premiums to get people off of Badgercare, this puts more low-income individuals into the hands of the private insurance industry. (you wonder why the corporate greedheads at WMC love this plan?)

2. Overload the Obamacare exchanges that start next year, and then take advantage of the complaints of individuals that can't afford the premiums, or complain that "Obamacare is costing more than it should." Which is then an excuse to dismantle it and leave even more people at the mercy of the insurance companies. This is what makes the whole "I'm encouraging independence" line Walker's giving such bullshit, because it's actually discouraging people from having options and more disposable income in their pockets (which is true freedom), and instead leaving them to have to beg insurance companies and corporations for help. Which is just the way Republicans want the world to run.

And remember, Walker had the chance to formulate a state-run insurance exchange that would complement Wisconsin's Medicaid plans, but he and DHS delayed doing any work on it, gambling that the Republicans would win the White House in 2012 and end Obamacare, and when that failed spectacularly this November, Walker turned down creating a state exchange, and will let the feds set it up instead. But that's all part of the design, because in right-wing bubble world, they can't have people be helped through Obamacare, because then it becomes a lot harder to privatize health care once people see how it works and gives them economic security. Always remember, social outcomes don't matter when it comes to TeaBags like Walker- only political outcomes do.

Lastly, you know what's missing from the "Work Makes you Free" Powerpoint? A request of the WMC oligarchs to hire and insure low-income individuals, so they don't have to take up space on the Medicaid rolls and reduce the burdens of health insurance on the state budget. No, having the WMC types do their share to help solve this problem is never asked. You know, for a bunch of guys who claim to idolize Reagan, they sure seem to forget this statement.

"The best social program is a productive job for anyone who's willing to work"

In fact, the WMC crowd doesn't want to create jobs, but instead hoard profits and funnel the money upwards into their pockets. Walker and the WMC crowd want the working poor to stay destitute so they are stuck into low wages, and a low number of options for coverage. And God Forbid that low-income people actually do one of the best acts of independence- unionizing to demand higher wages and benefits. That is absolutely not part of the Walker plan, and will be actively discouraged, even though unionizing and getting higher wages would go a long way toward solving the uninsurance problem that exists in this country (failing the best solution, which of course is Medicare for all).

These people are the sick ones, not the Medicaid recipients. This Walker plan will not work, it'll throw even more people into desperation than even keeping the status quo Wisconsin Medicaid program would, and turning down the Medicaid expansion will cost taxpayers more in the short and long runs. The Walker Medicaid plan is a total lose-lose scenario, and much like with the turning down of high-speed rail, it'll cost Wisconsin taxpayers more money in exchange for less services. It is the work of someone who wishes to destroy the state, with Walker and his contributors grabbing the leavings and skipping town, which is the real Walker plan. Unless we expose it and stop it.

  EDIT: The Journal-Sentinel continues to imitate an actual news organization, as they grabbed a Fiscal Bureau estimate, and it shows Walker's plan would cost Wisconsin taxpayers an extra $250 million over the next 7 years,   and that 9,000, not 5,000, Wisconsinites would be kicked off of the state's Medicaid rolls. This really plan really is the worst of both worlds- higher cost and lower service.


  1. It's even worse that *you* thought, Jake.

    I know of a blogger who delved into the details and found that the agency requests were based on a nice, rosy scenario where Republicans in D.C. don't ensure that the sequester actually happens:

    As I understand it, Medicaid itself is exempted from the sequester but it'll sure impact the rest of the budget and I have little doubt where Walker would look to make up the difference.

  2. Geoff- Oh, I'm dead aware of the looming deficit in the 2013-2015 budget. This post was just running long, because Medicaid spending has to be laid out when you explain it.

    And by the way, in addition to Walker selling off the power plants to pay for roads, the Journal-Sentinel reported that transit will be moved to the general fund, which is another $212 million that has to be cut somewhere else. The math and the policy Walker's trying to pull over is an epic FAIL.