As Gov. Tony Evers renewed his call to expand Medicaid coverage in Wisconsin, Democrats in Washington, D.C., were doing some of the heavy lifting for him in the name of battling COVID-19.
Because of guidelines imposed by the CARES Act, the first coronavirus stimulus package, there are now more than 1 million Wisconsinites on Medicaid — an increase of nearly 217,000 in the past year, at an added cost to taxpayers of more than $883 million a year.
And until and unless the economy returns to something resembling normal, Medicaid’s enrollment and its cost will continue to balloon.
Medicaid, a program along with Medicare that didn’t exist until 1965, now devours roughly 25 percent of Wisconsin’s $41 billion in annual total expenditures.
Nationally, it is the third largest and one of the least accountable government programs in the country, a model of a program ostensibly state-based but chained to an unaccountable federal funding source. The unholy relationship has created a system so bureaucratically knotted as to defy all attempts at reform.
Even more concerning, according to the federal Centers for Medicare & Medicaid Services (CMS), more than $100 billion of all Medicaid payments made to keep the program running were improper or illegal.
Entrenched, expensive, painful
U.S. Sen. Ron Johnson (R-Wis.) made clear, in a December letter to then-CMS Administrator Seema Verma, there is no accounting for all of this waste and fraud by state Medicaid officials.
But when CMS attempted to require fiscal accountability guidelines created by specialists in the Trump administration last year, a coalition of state Medicaid officials, hospital administrators, medical vendors and politicians in both parties fought them.
“It’s insane. You have all of these health providers who have based their business model on a horribly complex and distorted marketplace controlled by the government,” Johnson told the Badger Institute. “How do you fix something so entrenched, that is way too expensive and way too painful to change?”
The steep cost of keeping record numbers of Wisconsinites on Medicaid may give added political leverage to Evers and Democrats who wanted the state to accept an expansion first offered in 2010 by the passage of the Affordable Care Act, or Obamacare, Johnson says.
Wisconsin is one of 12 states that have not yet accepted an offer from the federal government to pay 90 percent of the cost of new enrollees to Medicaid. CMS has for years reimbursed the state Department of Health Services (DHS) at a rate of between 58 percent and 60 percent.
Republican Assembly majorities have blocked the expansion out of opposition to Obamacare, federal spending in general and a fear that state taxpayers would be made to pay if the federal Medicaid commitment was ever slashed.
“This was the whole strategy of Obamacare, to break the willpower of the fiscally responsible states,” Johnson says. “The whole point of all of this money poured into programs like Medicaid is to get more Americans addicted to a single-payer system. It’s completely out of control.”
DHS administers Medicaid in two primary ways: a program for the elderly, blind and disabled and a program called BadgerCare Plus to underwrite primary and emergency medical care for low-income children, parents, other childless adults and pregnant women.
Read more at the Badger Institute.