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Wisconsin Republicans seek compromise on Medicaid expansion

April 28, 2019

MADISON, Wis. (AP) — Wisconsin Republicans open to a possible compromise with Democratic Gov. Tony Evers on Medicaid expansion are looking at ways to accept the federal funding while not appearing to cave in on the issue, even as GOP leaders remain steadfastly opposed.

Evers is also publicly refusing to bend from his full expansion proposal, despite its near-certain demise in the Republican-controlled Legislature. Chatter about finding a compromise is giving a thin thread of hope to those who have pushed for years to take the money and use it for a host of health care initiatives.

“I honestly think we have to take it,” said Republican Sen. Luther Olsen of the Evers Medicaid expansion proposal. “Whether we do or not, I don’t know. We need to look with an open mind what it does for the state of Wisconsin.”

Evers ran in support of taking the money that his predecessor Republican Gov. Scott Walker refused to accept. Evers made it a centerpiece of his budget, good for $324 million in federal funding that could be invested in other programs to tap even more federal dollars and result in a $1.6 billion investment in health care priorities.

That includes increasing reimbursement rates for doctors and other health care providers, raising county aid for crisis mental health services and spending more on women’s health care initiatives.

Those who would benefit from more health care spending are pushing to figure out a way to fund their priorities even if expansion is rejected.

“Health care is a priority for both parties and this budget certainly has enough in it to coalesce around,” said Wisconsin Hospitals Association president and CEO Eric Borgerding.

Evers, in an interview, said the issue is “pretty simple.”

“It brings in the revenue we need in the state of Wisconsin to a point where we can make a significant difference in people’s lives,” Evers said. “It’s something that 70 percent of Wisconsinites support, so that’s where I am at.”

Assembly Speaker Robin Vos has been the most outspoken against taking the Medicaid expansion, seemingly leaving little room for compromise. He acknowledged this week that there has been talk of looking at what other states have done, but he’s unmoved.

“I don’t know why people are talking about that because we’re not doing it,” Vos said.

Accepting the money would make 82,000 more low-income parents and childless adults in Wisconsin eligible for the coverage. About half of them are receiving insurance through private plans sold on the marketplace that are heavily subsidized, while the other half don’t have insurance.

Vos and other Republican opponents don’t want to move more people onto Medicaid, which they say will push more costs into the private sector for providers who receive low reimbursement rates for care. Republicans also say the federal government can’t be trusted to keep up funding levels, which will shift more expenses to the state.

Still, some Republicans like Olsen have been talking about alternative approaches that wouldn’t shift those currently on private insurance into the state-run BadgerCare program.

Arkansas and Utah are frequently mentioned as models. In Arkansas, the Medicaid expansion money had to be used to purchase private insurance through the marketplace, an approach that could win over some free market Republicans. In Utah, lawmakers are asking for increased federal funding to cover 90 percent of the cost even though they plan to cover fewer people than specified under former President Barack Obama’s signature health-care law.

Two Wisconsin Republican senators — budget committee co-chair Alberta Darling and health committee chair Patrick Testin — say both approaches are worth a look. Darling even quizzed the head of Evers’ health agency why they didn’t model their approach after what Arkansas did.

“I’m open to talk about it,” Darling said in an interview. “I’m not saying we’re going to go there because there’s been such a strong ‘No.’ But I think Utah was a bit of a game changer and that, on top of Arkansas, I think we need to look at it.”

Testin said he was also investigating ways to spend more on health care without taking the Medicaid expansion because doing that was such a “tough sell.”

The fact that Republicans are at least looking at what other states have done shows a willingness to seek a compromise, said Democratic state Sen. Jon Erpenbach.

“If there’s a way for the Republicans to take it under the guise of something else, they’ll do it,” said Erpenbach, a member of the Legislature’s budget committee. “Even if it’s been floated or died or been talked about, it sounds like they’re trying to figure out a way to take the expansion.”

As the Republican Olsen said: “You never say never.”

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