The $1.7 billion question: Will Wisconsin finally get a stronger BadgerCare system for families?

Republicans have rejected billions of dollars over the years—federal funds that could provide stable health insurance coverage to many and ease premium pressure on everyone else by improving rates for providers.

Wisconsin stands to gain $1.7 billion in federal funds that could be used to provide stable, affordable health insurance coverage to tens of thousands of families through Medicaid—and to improve reimbursement rates for hospitals, clinics, doctors, and other providers, according to new reporting from a nonpartisan research group in the state.

But despite benefits outlined by the Wisconsin Policy Forum, Republicans controlling the Legislature have turned down billions of dollars in a string of budget cycles since the Affordable Care Act (ACA) became law.

Healthcare advocates are hoping new maps that break a 12-year Republican gerrymander will lead to an Assembly and a Senate more in tune with issues like Medicaid expansion that have broad bipartisan public support. 

The ACA offers subsidized premiums for private sector health insurance plans. The law also set up a mechanism for expanding Medicaid, the federally-supported, state-based health insurance program for lower-income and disabled Americans (known as BadgerCare in Wisconsin). A conservative-controlled US Supreme Court changed the law in a way that gives states the ability to accept or reject the federal incentives to cover more people through Medicaid—and Wisconsin is one of the handful of remaining states refusing to accept the federal expansion dollars.

“Expanding Medicaid during the 2025-27 state budget would cover more state residents and provide a total net benefit to state taxpayers of just over $1.7 billion over the two years,” according to the report, citing an annual savings of $212 million and a one-time incentive payment of $1.3 billion designed to raise the reimbursement rate to providers. The group does not advocate for or against expanding Medicaid as it outlines the history and fiscal impacts surrounding the debate.

Extending Medicaid coverage means fewer people in the state would be uninsured, a condition that makes their health care more expensive and drives up premium costs for everyone else. But providers note that if state governments’ reimbursement to them for taking care of Medicaid recipients is too low, it puts pressure on them to raise prices for patients on private insurance—which is what led to the federal incentive payment for higher reimbursements.

“States that expanded eligibility for Medicaid currently receive a 90% federal reimbursement for the cost of the newly added population,” said State Senate Minority Leader Dianne Hesselbein (D-Middleton). “Because Republicans in Wisconsin have consistently rejected opportunities to fully expand eligibility for Medicaid, Wisconsin currently only receives about a 60% federal reimbursement for these costs.”

Most Beneficial to ‘Red’ Counties

The Wisconsin Policy Forum report calculated how a Medicaid expansion would provide better access to affordable healthcare coverage in specific parts of the state, based on the portion of each county’s population with annual incomes between 100% and 138% of the Federal Poverty Limit (FPL)—the population most likely to qualify for expanded Medicaid coverage. Of the 290,000 residents who fall into this range, there are 10 counties where 7% or more of their population falls into this group. One is Milwaukee County while the other nine are rural counties, including Monroe, Rusk, and Forest, where more than 8% of the population could benefit from Medicaid expansion. 

Emergency physician Dr. Chris Ford of Milwaukee recognizes the ongoing reduction in the number of completely uninsured patients since adoption of the ACA—but that’s all the more reason, in his view, to protect Medicaid’s lifeline to Wisconsin families.

“Low income families rely on this program just to have basic medical care,” Ford said on UpNorthNews Radio. “The basics to have their daily medications for hypertension, insulin, and things of that nature. There’s room to grow, in order to push for more access to care for many of the patients I see daily.”

“Many of the patients that I see don’t want to be in the emergency department,” Ford said of the advantage to having Medicaid coverage instead of relying on ER care. “They wish they could be at their primary care doctor’s office. They wish they could have access to insulin, have access to heart failure medications that could prevent them from needing to see me in the emergency department, needing to be admitted to the ICU (intensive care unit).”

As part of a recent Democratic Party of Wisconsin event to promote Medicaid expansion, former Wausau school board president Tricia Zunker summarized the frustration felt by those who have watched as 40 other states, including many under Republican control, move ahead of Wisconsin.

“It is absurd and frankly infuriating that Wisconsin Republicans want to continue to play politics with people’s lives,” Zunker said. “Health care is a basic necessity, and the Medicaid expansion would continue to make healthcare more accessible for vulnerable populations.”

Former President Donald Trump said at the last presidential debate that he has “concepts of a plan” to replace the Affordable Care Act, but past actions indicate a willingness to scrap the ACA and expanded Medicaid whether a replacement is ready or not, as well as ending the ability of Medicare to negotiate bulk prices with big pharmaceutical companies, remove coverage protections for reproductive rights and preexisting conditions, and allow the return of so-called junk plans that feature high deductibles and high rejection rates when policyholders try to get coverage approved.

“The bottom line is that Democrats care about one another,” Zunker said. “We care about our families. We care about our neighbors. We care about strangers on the street and want to see good for everybody. Whereas the Republicans continue, time and again, to want to just dig their heels in the ground and not work across party lines for the benefit of all.”