Walker, health execs: State shouldn't lose from Obamacare repeal

Madison — Gov. Scott Walker and state health care executives are pushing to ensure that an Obamacare repeal doesn't disadvantage Wisconsin compared with states that embraced the law — an issue with hundreds of millions of dollars at stake.

The GOP governor has resisted making full use of the tax dollars available under the federal Affordable Care Act to do a full expansion of state Medicaid health coverage for the needy. Now, the Republican-controlled Congress and President-elect Donald Trump need to ensure that states that did take the federal money don't end up with a permanent advantage, a Walker aide said. 

"The governor wants to ensure that the states that were fiscally responsible won't be punished for going that route," spokesman Tom Evenson said. 

As governor, Walker adopted an unusual approach to Obamacare, avoiding the typical responses by states to either fully expand Medicaid programs or not expand them at all. The state instead dropped some Medicaid recipients from coverage and then added some additional extremely low-income recipients by relying more on state tax dollars.

Eric Borgerding, chief executive officer of the Wisconsin Hospital Association, backed a similar position to Walker's on Thursday, saying that the state shouldn't be stuck for good receiving fewer federal tax dollars to cover those patients.

"Why should Wisconsin be penalized for ... using state dollars to expand Medicaid?" Borgerding asked at a panel of health care executives organized by the website Wisconsin Health News. 

The dollars at stake are massive — an estimate last year by the nonpartisan Legislative Fiscal Bureau found that by June 2017 the state will have spent $679 million more in state tax dollarsthan it would have if it would have accepted the full Medicaid expansion. 

But the good news, Borgerding and other panelists said, is that Wisconsin Republicans should have enough influence to ensure the state isn't disadvantaged. They pointed to the fact that Janesville Republican Paul Ryan is the speaker of the U.S. House, Walker is the chairman of the Republican Governors Association, and Kenosha native Reince Priebus is the incoming chief of staff for President-elect Donald Trump. 

"I think we are as well positioned as ever to influence this," Mike Wallace, chief executive officer of Fort HealthCare, said of Wisconsin. 

In 2013, Walker opted to move adults making more than 100% of the federal poverty level — currently $11,880 a year for a single adult without children — out of Medicaid and into the subsidized private insurance exchanges created by Obamacare. 

At the same time, he and lawmakers added childless adults earning less than the poverty level into the Medicaid program, which didn't go as far as the Affordable Care Act required. So Wisconsin taxpayers had to pay their usual share of these Medicaid costs — currently 42% for Wisconsin — rather than the 100% that federal taxpayers initially paid for added Medicaid enrollees in some other states. 

Many states under Democratic control and some states under Republican control did a full expansion of Medicaid under the Affordable Care Act, while many Republican-controlled states did not. Wisconsin was the only state in the nation to use Obamacare to do some Medicaid expansion but not take any extra federal money to pay for that.

Borgerding said that one of the crucial questions within an Obamacare repeal is how much federal taxpayers will pay going forward to states like Wisconsin for the people already on their Medicaid programs. 

The politics will be tricky — Republican governors in states such as Ohio and New Jersey opted to accept the Medicaid expansion. They won't be eager to see their funding reduced and budgets disrupted so money could be sent to states like Wisconsin.

In an interview Thursday, U.S. Rep. Gwen Moore, a Milwaukee Democrat, said she was surprised at Walker's position. She said it was the governor's own choice to reject extra federal help repeatedly for years. 

"If he wanted to take the Medicaid expansion, he could do it," Moore said. 

Evenson didn't say Thursday what specific changes Walker wanted Congress to make to avoid penalties for Wisconsin, adding that the governor would work with federal lawmakers and Trump.

"There's a new leadership in Washington and he has a shot to do things that he couldn't do with the Obama administration," Evenson said.