The Expan[sion]
Published August 12, 2019 / Updated February 4, 2021

The Expan[sion]

A large and growing body of evidence shows that Medicaid expansion has produced large gains in health coverage and improved beneficiaries’ physical and financial health.

by Susan E. Stutz

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For those of us who are not fortunate enough to have employer-sponsored health care, we have very few choices: we can go without and hope for the best; we can purchase coverage through the Marketplace; or, we can look to the state for Medicaid coverage.

There’s A Right Thing To Do

Wisconsin Governor Tony Evers’ 2019–2020 budget proposal included the expansion of BadgerCare, which is 1 of Wisconsin’s 7 types of Medicaid coverage. BadgerCare is a program for individuals and families who are neither elderly nor disabled. Currently, applicant’s cannot have an annual income in excess of the federal poverty level (FPL) which is $12,490 for 1 person and $25,750 for a family of 4. This leaves thousands of residents who earn more that the FPL but not enough to pay for a private policy, out in the cold. They do not qualify for Medicaid and they cannot afford coverage through the Marketplace.

Not surprisingly, Wisconsin’s Republican legislature was opposed to the expansion saying that, “Medicaid will be expanded ‘over our dead bodies.’” They did not want to add 82,000 to the BadgerCare program. It was their position that it makes better sense for those 82,000 people to remain in the Marketplace where they will receive subsidies to pay their premiums.

And, lets talk about those premiums. The lowest cost of “silver tier” coverage through the Marketplace is $306 for a single 27-year-old individual (costs can triple for older people). That equals $3,673 per year. That may not sound exorbitant; however, if your income is at or near the federal poverty level, that premium is stratospheric. On a related note, what about the current Administration’s decision to discontinue the premium subsidies? The GOP wants to have their cake and eat it too. They want to leave 82,000 people in no-man’s land, claiming they can get subsidies in the Marketplace, while at the same time, wanting those subsidies to be discontinued.

Optimism for Earthers

Wisconsin democrats are not going down without a fight. Sen. Jon Erpenbach, D-West Point and Rep. Daniel Riemer, D-Milwaukee have stated that they intend to introduce stand-alone legislation to expand Medicaid. Similar to Governor Evers proposal, the bill will allow Wisconsinites whose income is 138% of the FPL to qualify for Medicaid based upon income alone. It is anticipated that at least half of the 82,000 newly enrolled will be individuals currently without any form coverage with the the other half being individuals currently enrolled through the Marketplace.

Wisconsin Democrats try again for Medicaid expansion

The Expanse

The point of the Affordable Care Act (ACA) was to reduce the number of Americans without health insurance. This was to be accomplished by giving individuals the ability to shop for affordable coverage in the Marketplace. And, to help pay our premiums, the ACA built-in a subsidy component. Additionally, for families who cannot afford traditional style coverage, the ACA was meant to fund the expansion of Medicaid coverage in each state. The decision to expand or not was left to the states who are tasked with administering their own Medicaid programs.

The expansion allows families to qualify for Medicaid based upon income alone, without the additional requirements of traditional Medicaid coverage such as family size, status, and disability, among others (some qualifying factors differ by state). Under the expansion, if your family’s income is less than 138% of the FPL— $17,236.20 for an individual, $35,535.00 for a family of 4— you qualify for Medicaid.

As of May 2019, Wisconsin had enrolled more than 1,000,000 people in their Medicaid program and while it may not have helped everyone, Governor Evers’ proposal would have expanded Medicaid eligibility to an additional 82,000 Wisconsinites. That is an almost 10% increase. In addition to providing coverage to tens of thousands more Wisconsinites, Medicaid expansion would have given the state access to an additional $1,000,000,000 — ONE BILLION — in federal funding. With the additional funding, 90% of the costs associated with Medicaid coverage would be covered, up from 60% currently. Sen. Jon Erpenbach and Rep. Daniel Riemer stand-alone legislation aims to accomplish the same goals that Governor Evers budget was meant to achieve.

Medicaid provides health care for 76,000,000 people — 1 of every 5 low-income Americans — nationwide. As of August 1, 2019, 37 states (including D.C.) have adopted Medicaid expansion under the ACA. Wisconsin democrats are looking to make their number 38. According to CBPP:

With dozens of scientific analyses spanning multiple years, the best evidence we currently have suggests that Medicaid expansion greatly improved access to care, generally improved quality of care, and to a lesser degree, positively affected people’s health.

Sometimes You Need to Exert Pressure

Although the 2019–20 budget has passed in Wisconsin without Medicaid expansion, healthcare remains a key issue as we take our first steps into the election cycle of 2020. If you live in Wisconsin, or one of the 14 states that hasn’t expanded Medicaid, send STATE to Resistbot to encourage your legislators to continue to fight for Medicaid expansion.

You can talk to Resistbot on Facebook Messenger, Telegram, or Twitter direct message. If none of those work for you, Resistbot also supports old fashioned SMS: text monthly to 50409 to get started. It takes 2 minutes to make a difference.

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