Vos Republicans could google the Truth about Medicaid Expansion, and stop lying?

Thanks to the legacy of Scott Walker's pretzel logic bashing Medicaid Expansion, gerrymandered Republicans still think his every lie and nightmarish fantasy will find new suckers today, to defend what is indefensible; Refuse Medicaid Expansion.  

Below, I'm hoping to clearly lay out why Medicaid Expansion is so simple (based on research), and then show you how the manufactured Republican excuses twist reality inside out (based purely on business special interests and right-wing think tank opinions).

Republicans convened and adjourned the governor’s special session within seconds Tuesday rejecting outright the governor’s call to expand BadgerCare. 

Keep in mind, Republicans are purposely exploiting and conflating Medicaid expansion with the difficulties of hesitant workers returning to work after the year long pandemic. Republicans really thought this was a plot by liberals to destroy Trump's economy by closing businesses.  

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Excuses to Turn Down Medicaid Expansion...

Excuse A: "Incentivize" Workers = Punishment, keep more people from getting Health Care:  That's what Sen. Chris Kapenga means by "incentivizing" people to work: 

Kapenga said GOP lawmakers should work to get more people off the state’s BadgerCare rolls by incentivizing them to work rather than expanding eligibility for the program.

Excuse B: Some people don't NEED health care? Impossible to imagine, isn't it? Note, many low wage workers aren't offered insurance from their employer so they enroll in Medicaid. But taxpayer paid health insurance recipient Chris Kapenga isn't concerned:

“There are currently a lot of people on Medicaid who don’t need it. Let’s get people working, let’s get people into the job market. We’ve got employers who are screaming for people right now.”

You get the idea that employer health insurance is both the carrot and the stick to get people to work at jobs they don't like? Now we know.

 

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The Medicaid Expansion Myth Creators: Republicans think tanks and business lobby studies coincidentally "prove" the evils of Medicaid Expansion. Both the Cato Institute and The National Federation of Independent Business (NFIB) advocated against Medicaid expansion:

Michael Tanner, a fellow at the Cato Institute, states that (MYTH) Medicaid expansion is costly for states and does not provide better access to healthcare for low income individuals. Tanner also argues that states will see greater costs.

The Common Wealth Fund study says that's not true. The odds greatly favor Wisconsin saving money with Expansion:

First, expanding eligibility allows states to cut spending in other parts of their Medicaid programs. Second, it allows states to cut spending outside of Medicaid — particularly on state-funded health services for the uninsured. Finally, expansion may increase state revenues due to taxes related to Medicaid expansion or taxes on the increased economic activity it triggers.

Myth: Medicaid Patients wait longer/Receive Worse Care? Really? Consider the source of the research; CROWE (The Center for Research on the Wisconsin Economy) is one of three Bradley-funded centers at the University of Wisconsin-Madison promoting the "free market." Health Care Finance:

Tanner also states that (MYTH) "Other studies show that, in some cases, Medicaid patients actually wait longer and receive worse care than the uninsured." (because doctors supposedly don't care about the patient because of lower fees, even though they are unaware of the patients insurance status)

Here's what those horrible wait times actually look like:

A Medicaid patient was 4.6 minutes past their scheduled appointment time, compared to 4.1 minutes  past for the privately insured. Plus, Medicaid patients compared to privately insured patients had wait times of 18 percent to 16.3 percent respectively. 

Myth: Fed will Reduce Reimbursement Rates: Nope. Another Walker myth. Where did he get that one? The gaslighting Right wing business special interests of course:

The National Federation of Independent Business (NFIB) "Our small business members have looked at this issue from every perspective and believe expanding an underfunded, cumbersome, and poorly administered program like Medicaid would be irresponsible. The bottom line is this: Does anyone really believe that Washington will continue to pick up 90 percent of new costs after 2020?

Kapenga said Republicans fear the federal government will reduce the amount of Medicaid reimbursement funds over time.

“There’s going to be a reckoning with all this spending. It has to be paid back. It’s really a ploy to try to get states to get to pull into the system, they want to suck them into the system, and then over time, it’s a win for the federal government because they reduce their reimbursement rates and they start saving money.”

Walker purposely lied (or amazingly never understood) there is a yearly adjustable Medicaid formula that makes reimbursement rates rise and fall. The irony? Republicans want to keep that Medicaid plan (state pays around 42 percent) a bit higher than paying just 10 percent:  

Myth: Assembly Speaker Robin Vos said it would make private plans more expensive.

Not really, since health care providers would have fewer uncompensated bills piling up. Yet Republicans here wanted to go back to "high-risk pools," which really did raise everyone else's premiums. 

By reducing the number of people without insurance, Medicaid expansion significantly reduces the amount of uncompensated care. Therefore, some states have chosen to reduce payments to health care providers for uncompensated care.

I'm not sure any of this is still happening, but spending more money has never stopped Republicans from saying they're saving money:

Walker is also doling out $30 million from the general fund so hospitals won't lose money caring for the uninsured (the fed is giving $30 million as well). 

Never ones to solve a growing social problem, especially after the pandemic exposed US's horrific health care shortfalls. Republicans will take a pass on this one... 

The health insurance trade association America's Health Insurance Plans, spoke in support of Medicaid expansion in September 2016, saying "Medicaid is going to become the bigger issue [from the] affordability perspective. Medicaid expansion would pressure the country to address rising health costs.

Vos-Republicans cynically hold Wisconsin's economy and jobs back to deny Gov. Evers a win.

The 20th century Republican mindset that Medicaid is "welfare" is the cruelest form of denial, and a ridiculous simplification devoid of supporting details. Yes, I've blogged on this topic before using just Wisconsin's Vos-Republican talking points.

A new study points out how deadly, misinformed, purely partisan, fiscally wasteful, and irresponsible Republicans have been just giving people life saving health care. 

First, the overwhelming number of studies supporting Medicaid expansion, proving Republicans wrong (in green), while a few studies simply show little change (blue):

The Kaiser Family Foundation report shows how mindbogglingly bad Republicans govern our money and punish the people they don't think worthy. The freeloaders, the jobless, business creation, the rural-urban divide, unmotivated unemployed, the opioid epidemic, poverty, etc. collapse under expanded Medicaid. It's even kind of ridiculous. NOTE: Imagine if this were a national universal health plan, and not just Medicaid, and the increased benefits that would transform this nation:

1. Medicaid expansion states experienced large reductions in uninsured rates that significantly exceed those in non-expansion states.

2. Medicaid expansion reduced or eliminated disparities in coverage between adults living in rural vs. urban areas.

3. State-specific studies have documented significant job growth resulting from expansion. Louisiana found that in 2017, expansion funds created and supported 19,195 jobs (while creating and supporting personal earnings of $1.12 billion); in 2018, healthcare spending supported 14,263 jobs and $889.0 million in personal earnings. A study in Colorado found that the state supported 31,074 additional jobs due to Medicaid expansion as of  2015-2016.

4. Some studies found expansion was linked to increased employment.

5. Multiple studies showed that expansion supported enrollees’ ability to work, seek work, or volunteer.

6. Medicaid expansion may have significant effects on measures related to individuals’ political activity and views. Specifically, studies show associations between Medicaid expansion and increases in voter registration, ACA favorability, and gubernatorial approval.

 

7. Medicaid expansion has helped to reduce disparities in coverage by income, age, marital status, disability status, and, in some studies, race/ethnicity.

8. Effects of expansion on multiple state economic outcomes, including budget savings, revenue gains, and overall economic growth. There were no significant increases in spending from state funds as a result of Medicaid expansion. A study in Montana found positive financial effects for businesses due to infusion of federal dollars to fund health coverage for workers.

9. Expansion resulted in state savings by offsetting state costs in other areas, including state costs related to behavioral health services and crime and the criminal justice system.

10. Medicaid expansion supports the ACA Marketplaces and may help to lower Marketplace premiums. Two national studies showed that Marketplace premiums were significantly lower in expansion compared to non-expansion states, with estimates ranging from 7% lower in 2015 to 11-12% lower

11. Expansion resulted in reductions in uninsured hospital, clinic, or other provider visits and uncompensated care costs. Medicaid expansion cut every dollar that a hospital in an expansion state spent on uncompensated care by 41 cents between 2013 and 2015,

12. Medicaid expansion has significantly improved operating margins and financial performances for hospitals, other providers, and managed care organizations.

13. No evidence of Medicaid expansion coverage substituting for private coverage including employer-sponsored insurance … may also reflect people above 100% FPL transitioning from subsidized Marketplace coverage to Medicaid after their state adopts the expansion.

14. Medicaid expansion improves access to care among the low-income population … decreased cigarette and other nicotine product purchases and access to evidence-based smoking cessation medications post-expansion leading to a 24% increase in new use of smoking cessation medication … expansion is associated with increases in overall spending on medications to treat opioid use disorder and opioid overdose.

15. Confusion among beneficiaries, providers, and advocates in expansion waiver states around requirements for participation, as well as barriers to internet access and transportation barriers. These challenges have resulted in increased costs to beneficiaries, beneficiaries being transitioned to more limited benefit packages, low program participation, or programs not operating as intended in other ways.

16. Improvements in health outcomes in cardiac surgery patients and acute appendicitis. Significant improvements in relative disparities for black infants compared with white infants, decline in annual mortality among near-elderly adults, that translates to about 19,200 deaths that were averted during the first four years of expansion. A 6% lower rate of opioid overdose deaths; may have contributed to infant mortality rate reductions (this effect was particularly pronounced among the African-American population). 

17. Providers are meeting increased demands for care. Expansion results in significant reductions in out-of-pocket medical spending, and multiple studies found larger declines in trouble paying as well as worry about paying future medical bills. 

18. A 2.2 percentage point decrease in very low food security among low-income childless adults. Two 2019 national studies found expansion was associated with a reduction in the rate of poverty by just under 1 percentage point (or an estimated 690,000 fewer Americans living in poverty).

19. Expansion significantly reduced the average number of collections, improved credit scores, reduced over limit credit card spending, reduced public records (such as evictions, bankruptcies, or wage garnishments), and reduced the probability of a new bankruptcy filing, among other improvements in measures of financial security. One 2019 study found that Medicaid expansion was associated with a 1.15 reduction in the rate of evictions per 1000 renter-occupied households and a 1.59 reduction in the rate of eviction filings

Neanderthal Republicans sticking with failed 20th Century Health Care policies and theories, supported by lies!

Reminder: The following topic would not exist if we just had universal health care.

Locked in the 1900's: Republican Rep. Mark Born revealed the real reason our gerrymandered conservative legislature opposes life saving Medicaid expansion for 90,000 people, half of whom are not currently insured; profits! 

This was the whole point of Scott Walker's bastardized version of expanding (not really) welfare; Walker wanted to keep people in the private health care market so they could to pay high premiums and out of pocket costs that maintained insurer profits. He wasn't shy about that either.

WELFARE first: Notice how the Vos-Republicans are repeating the BIG LIE that health care for the poor is WELFARE. We're talking about a basic fundamental right to "promote the general WELFARE" of our civil society. Also, did you know access to medical care is a "life of poverty" trap?

Bad at Math? As for those "lower Medicaid reimbursement rates," the Republicans cruel and ghoulish health agenda is built on lying about that, because Governor Evers budget proposal subsidizes those rates:

"Expanding coverage and increasing Medicaid reimbursement for hospitals as well as primary care and specialty providers will reduce uncompensated care." 

Credit WKOW's Capitol City Sunday host A. J. Bayatpour, for coaxing Rep. Mark Born to repeat the lie again and again:

Rep. Born: "We've got people right now covered on private insurance, through the exchange...we know that the private insurance gives them better coverage and better payments to our health systems... that (expansion is) going to have a negative impact on how these health care providers are paid...which then requires private pay and private insurance to make up the difference so we're going to see rates go up for other folks...but those people have coverage on our private insurance, which we know is better for our system, for our health systems."

Again, from Evers 2021-22 budget...

Republicans aren't really against premium increases. Only as far back as 2017 Republicans in Congress were okay with premiums going up to pay for state "high risk pools," even on seniors:  

1. State waivers would allow insurers to charge older customers higher premiums by as much as they'd like.

At the same time in Wisconsin, this bait and switch scam bubbled up:

Gov. Scott Walker, as part of his election-year health care plan, requires insurers to cover people with pre-existing conditions but allows the state insurance commissioner to alter protections, possibly by re-establishing a high-risk pool for such people.

"Re-establishing high risk pool..." and their losses! Think of these pools as a maze you're told to navigate if you want coverage bad enough. How effective were the high risk pools Walker wanted to revive? Hint-they lost money and raised individual insurance premiums:

Wisconsin's high-risk pool insured about 21,000 people, with critics saying high prices kept tens or hundreds of thousands of others from accessing it. Those applying for the program had to wait six months before they were allowed into it and a lifetime cap of $2 million. Health Insurance Risk Sharing Plan lost $6.9 million in 2011, roughly a third of which was offset by a federal grant, according to the Wisconsin Legislative Fiscal Bureau. The same year, programs in the 35 states lost a total of at least $272 million.

Recession Proofing Health Care: Times have changed, so with Medicaid expansion, future economic downturns are covered: 

Jason Stein, Research Director for the nonpartisan Wisconsin Policy Forum, said the debate has taken on a different look this year because more than 200,000 new enrollees have signed up for BadgerCare during the pandemic. "We've had an enormous expansion of the program just because you've had higher unemployment."

Party of Political Punishers...continues to continue, Rejecting $1.6 billion of our Tax Money!!!

Vos-Republicans want you to believe that Medicaid is a welfare program. But Medicaid is a major domestic program paid with our tax dollars. It helps Americans who can't afford coverage, and has a positive effect for state economies.

This is a series I call...Party of Political Punishers! also here...Party of Political Punishers...continues!

So Republicans want to punish the poor with...

Punishment # 10: Reject $1.6 Billion for Medicaid, and say it's "Welfare?": The Fiscal Conservative Myth-Exhibit A: It's our money, right? The party of punishment would rather walk away from $1.6 billion of our own federal taxes to expand Medicaid (BadgerCare). But it saves lives. No, it's "welfare!" Welfare to the undeserving. Roll the video...

You don't deserve the "privilege" of health care says Dumb Ron Johnson to a group of school kids. You can't make this stuff up...:

Vos-Republicans reject President Biden's $1 billion American Rescue Plan Act Relief Funding for Wisconsin: The thing is, this is such a massively irresponsible act of pure political idiocy, you gotta ask, where the hell are conservative voters? 90,000 more Wisconsinites could have health care!!!

The bonus provision: Wisconsin would receive an additional $1.025 billion over two years if it agrees to accept the expansion. Gov. Tony Evers’ proposed 2021-23 budget bill includes accepting the ACA Medicaid expansion subsidy, which by itself would save the state $635 million, according to the fiscal memo. The new $1 billion bonus is in addition to that amount.

Sen. Jon Erpenbach (D), added that rejecting the expansion would be “a costly missed opportunity and a slap in the face to every Wisconsin resident. It was already foolish for Republicans to reject the BadgerCare expansion in the last budget, but we cannot afford to lose out on a billion dollars in additional funding.”

How does providing health care "trap" people into poverty? It can't. Here's the direct quote:

 

Republican Idea? Dumb, Irresponsible, Simple, and Ridiculous: You can't just randomly tell insurers to include preexisting conditions. Insurance premiums will skyrocket, and there's nothing in the bill below preventing that from happening. Even worse, the bill only kicks in if the ACA is repealed: 

Assembly Majority Leader Jim Steineke (R-Kaukauna) issued a statement promoting a group of health care bills that the Assembly Rules Committee put on the Assembly schedule. 

Assembly Bill 34 relates to maintaining coverage of individuals with preexisting conditions should the Affordable Care Act be struck down by the courts. 

Hey Reporters, Medicaid is NOT a Welfare Program!!!

Just to be clear, Medicaid is NOT a welfare program. It's a federal insurance program.

Medicaid provides health coverage to low-income adults, children, pregnant women, elderly adults and people with disabilities.

Would you call the money an insurance company pays out to you for a car accident or damage to your home...welfare? Medicaid is a federal insurance program.

For decades, Democrats protected the federal Medicaid insurance program from making changes that mirrored a typical welfare program. That ended with Trump and Scott Walker. Just by adding a work requirement, they believe they have turned Medicaid into a "welfare" program. It's magic.

Is it pro-life to deny people health care? No. Do our lives have value if we're not working? No.

Incredibly, Republican Rep. John Nygren isn't even afraid to boldly admit to replacing the word "Medicaid" when talking to constituents with...are you ready..."welfare!" Surprise, constituents were against expanding welfare. It's a push polling trick Republicans aren't even trying to hide anymore.

Note: Nygren wrongly claims Medicaid is a welfare program:

Nygren: "He (Evers) often times touts polls, right, the Marquette Poll, 70 percent. Actually, Assembly Republicans actually asked all of our constituents the same question, but we asked it a little differently, we asked them about expanding welfare. You know, I mean, some people cringe at that but Medicaid was designed as a welfare program for the impoverished...so we asked that question, the overwhelming results were 80 percent were against expansion."

But replacing "Medicaid" with "welfare" wasn't they only trick. Nygren is also not telling constituents about research that contradicts the effects of expanding Medicaid...or as he likes to call it, "welfare:"

In May, the Kaiser Family Foundation published a review of 202 studies of Medicaid expansion, and found it had “positive or neutral” effects on work:

1. No state-level studies found negative effects on employment or employee behavior.

2. In Ohio, Medicaid expansion was found to be beneficial to those who were unemployed and looking for work.

3. Several state-level studies predicted job growth following expansion, and Kentucky’s former governor had produced a report linking expansion with economic benefits.

Say Medicaid is Welfare, Repeat: Below snarky wise-ass Rep. Robin Vos couldn't stop driving the "welfare" point home. Well then, it must be true. Tip to reporters, don't let them get away with it, ever. And don't repeat it for them:



Throwback Republican Ideas: There's no question our economy has dramatically change from the 50's, but Republicans want us to continue using a social and economic philosophy, or platform, a half century old. The cartoon below reflects mid century thinking that oddly hasn't changed a bit:

Let's take a look at frail seniors who no longer have the ability to pay their health care bills:

Medicaid is the largest insurer of long-term care, also known as Long-Term Services and Supports (LTSS). Medicaid coverage for the elderly and disabled comprises a greater percentage of overall spending than coverage for low-income adults and children.

Severing the link between Medicaid eligibility and welfare in 1996 and enacting the Children’s Health Insurance Program (CHIP) in 1997 to cover low-income children above the cut-off for Medicaid. 

Medicaid is not Welfare, point by point: 

1. Medicaid is the nation’s public health insurance program for people with low income, health and long-term care for millions of America’s poorest and most vulnerable people, acting as a high risk pool for the private insurance market; 

2. Principal source of long-term care coverage for Americans in the home or community that enable seniors and people with disabilities to live independently rather than in institutions.

3. 48% of children with special health care needs and 45% of nonelderly adults with disabilities (such as physical disabilities, developmental disabilities such as autism, traumatic brain injury, serious mental illness, and Alzheimer’s disease); 

4. And more than six in ten nursing home residents; 

5. Providing significant financing for hospitals, community health centers, physicians, nursing homes, and jobs in the health care sector; 

6. Help pay for premiums and cost-sharing for low-income Medicare beneficiaries and allowed states to offer an option to “buy-in” to Medicaid for working individuals with disabilities; 

7. Severing the link between Medicaid eligibility and welfare in 1996 and enacting the Children’s Health Insurance Program (CHIP) in 1997 to cover low-income children above the cut-off for Medicaid. 

And when GOP treats Medicaid insurance like a welfare program, a maze of regulations and requirement are created to knock people off the program:

The study, based on a phone survey of about 6,000 people late last year and published in the New England Journal of Medicine on Wednesday, cast doubt on the effectiveness of the CMS-approved Arkansas demonstration to get more non-disabled Medicaid enrollees into health-enhancing jobs, training or volunteer activities. Nine Republican-led states have gotten similar waivers. 

"We didn't find any employment changes and instead we see Medicaid coverage rates dropping and more people without health insurance," said Dr. Benjamin Sommers, a Harvard University health policy professor who is lead author of the study. "Based on our results so far in Arkansas, it doesn't appear that this particular policy is accomplishing its goals."

By the end of December, Arkansas had disenrolled more than 18,000 people for noncompliance. In March, a federal judge halted the work requirement programs in Arkansas and Kentucky, ruling that the HHS secretary did not adequately consider the impact of the waivers on providing coverage, which is one of Medicaid's central objectives. The same judge is set to rule on New Hampshire's work requirement waiver.

But J.R. Davis, a spokesman for Arkansas Gov. Asa Hutchinson, said nearly 15,000 Medicaid expansion beneficiaries found jobs from June 2018 through April 2019, though the state doesn't know how many are the same people who lost coverage due to non-compliance with the work requirement.

GOP makes Wisconsin a Throwback Island in a sea of Midwest States.

As long as Wisconsin is locked into GOP gerrymandered control, our state keeps falling further and further behind. We're trying to get people to come and work here while keeping the federal minimum wage of $7.25 an hour? Good luck. 

Wisconsin is lagging behind most of its Midwest neighbors in attracting highly educated workers.

Plus this story just happened, taking out of the mix even more job creation:

Three out of the four states that border Wisconsin — Illinois, Michigan and Minnesota — have now legalized marijuana use and two of them allow residents to purchase and consume cannabis for any reason.

While more and more state legislatures are embracing legal marijuana for medical or recreational reasons — 33 in all — Wisconsin isn't likely to anytime soon.

Pot is causing problems in other States? Yeah, I guess,...

"Some of the results of legalization in other states have been troubling," said Senate Majority Leader Scott Fitzgerald, a Republican from Juneau. "It would be wise for Wisconsin to take a more measured approach and wait to see how it plays out in other states in the Midwest before rushing any kind of legalization here."

All 33 states have apparently rushed blindly ahead of Wisconsin, who finally approved agricultural hemp?  

It was no accident that Tony Evers became governor. The public is ready for progress no matter how many suck-ups stroke the egos of our gerrymandered Republican "winners" in their districts.

Wisconsin supports Gov. Evers' Clearly Articulated Vision for State:  This new poll I hope means a few GOP seats are in danger:

A new Public Policy Polling survey finds that Wisconsin voters support Governor Evers’ 2019- 2021 budget provisions. The majority (60%) of voters believe in ensuring more Wisconsinites have access to affordable healthcare and prescription drugs.

62% of statewide voters prefer the elimination of minimum markup while raising the gas tax by 8 cents per gallon.

Broken down by districts: Senate District 13- Majority Leader Scott Fitzgerald:

63% in SD 13 believe that Republican leaders should work with Governor Evers

53% favorability for Evers

62% of voters agree with increasing the gas tax and eliminating minimum markup.

12% prefer raising vehicle registration fees.

83% of voters believe Gov/Legislature develop a long-term solution for state’s roads.

69% of voters believe the minimum markup law should be eliminated.

Assembly District 63- Speaker of the Wisconsin State Assembly Robin Vos:

65% of voters believe Republican leaders should work with Gov. Evers.

54% favorability for Evers.

60% of voters agree with increasing the gas tax and eliminating the minimum markup.

13% agree more with raising vehicle registration fees.

75% of voters believe the Gov/Legislature should act on a long-term solution for roads.

61% of voters believe the minimum markup law should be eliminated.

GOP makes Wisconsinites pay and pay again for Medicaid and all Transportation Funding

UPDATE-JUNE 7, 2019: Finally, Dems got the message...from the JS:

Democratic Sen. Jon Erpenbach of West Point said raising the gas tax would be better than increasing fees to make sure all drivers — not just those from Wisconsin — were paying more to maintain the state's roads.

"It lets out-of-state drivers off the hook," Erpenbach said. "Registration fees aren't the fairest way to go. That's not going to get the Illinois drivers, the Iowa drivers, the Minnesota drivers."

Echoing that sentiment, Evers spokeswoman Melissa Baldauff said the measure “isn’t the long-term solution Wisconsinites are asking for,” in part because out-of-state drivers wouldn’t be required to pay more for Wisconsin’s roads.

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Are you seeing a pattern too? Sadly, I'm not sure Democrats have caught on yet. If they have, why haven't they said anything publicly, or tried to beat this thing into the ground in the media?

It's pretty simple really, Drain Wisconsin Taxpayer Revenues; Republicans have killed infrastructure and social service spending so they could fulfill their tax cut obsession, that's not a mystery. But, they can't keep progress, innovation, and upkeep from happening statewide, making reality and real world problems...a problem for Republicans. 

The Scott Walker Scheme: Walker figured tight budgets would make it easy to cut spending, so he decided to ignore federal funding and instead use Wisconsin tax dollars to pay our bills. It's crazy but true. And it's on purpose. Walker and GOP leaders artificially created tight budgets.

CASE #1: Making Wisconsinites Pay for Everything...so it Hurts: Now thanks to Sen. Fitzgerald and Rep. Robin Vos, were going to drain Wisconsin's general revenues just to pay for Medicaid, skipping our very own federal dollars. The scheme continues...:  

Republican lawmakers voted Tuesday to add $588 million in new state funding for health care programs in Wisconsin under a spending plan that won't include ... plan to expand Medicaid by tapping into $1 billion of federal funds.

Say good-bye to freeing up a massive "$324 million in state funds to spend elsewhere" and putting 82,000 more people living in low-income households on BadgerCare. 

Taxpayers Pay, so Insurance Companies can Money?: With insurance premiums going up all the time, the phony claim below is almost laughable. Oh, but it does increase hospital costs treating the uninsured. You can't make this stuff up:

Republicans have opposed Evers' plans to accept more funding through the Affordable Care Act because they believe doing so will drive up costs for those with private insurance. 

Then there's this...

Rep. John Nygren, R-Marinette, said the committee was "taking some of the Medicaid surplus based on the fact that our enrollments and growth in the program have gone down."

And about that supposed "surplus"...

Republicans Waste $69 Million of Taxpayer Money just to Penalize the Unemployed, hopefully Deny Them Benefits: What Walker Republicans said was urgent still hasn't been funded or implemented. $69 million is the estimated cost of job training for BadgerCare and Foodshare. And that's just for 2 years, imagine that as a reoccurring bill:   

Republicans lawmakers approved the job training programs under former Gov. Scott Walker but have not yet implemented them ... recipients can lose their benefits if they aren't working or participating in job training. Republicans must now consider earmarking funds to provide job training to BadgerCare Plus ($33 million) and FoodShare ($36 million) recipients over the next two years.

You can kick to the trashcan the myth Republicans don't like government bureaucracy and red tape: While Republicans streamline regulation for business, they're piling on a maze of regulation for people, their constituents, making their lives a living hell:

Work Requirements: Wisconsin is the fourth state to get approval for a Medicaid work requirement ... Adults under age 50 who do not have children would have to be employed 80 hours a month, undergo job training or do community service to be eligible for health care benefits ... charging premiums to low-income childless adults who are making as little as $6,070 per year, and many people in that income range do not have checking accounts or credit cards that they can use to pay monthly premiums. No other state has gotten federal approval to completely remove people below the poverty level from Medicaid because they are unable to pay premiums."

In Arkansas, thousands lost health coverage when that state implemented work requirements. Democrats in Wisconsin say the same will happen here.

CASE #2: Making Wisconsinites Pay for Everything in Transportation: This is a major pet peeve of mine, because this is so simple yet so odd: Republicans want to make taxpayers pay for road funding so out-of-state drivers don't have too??? They must know they're doing this, right? This should be the first thing blaring out of the mouths of Democratic lawmakers...but isn't. Do Democrats have a messaging problem or what? Someone, anyone?

The plan introduced by members of use (one time) state surplus funds to direct about $72 million to counties and $62 million to towns. Fitzgerald said GOP lawmakers were considering raising registration fees, title fees and heavy truck fees, but he didn’t say by how much. Tolling could also be an option.

And every once and awhile mentioned under their breath so as not to upset anyone...

Evers' transportation secretary, Craig Thompson noted under the GOP plan Wisconsin wouldn't be collecting additional sums from out-of-state visitors, as it would under Evers' plan.

"The reason we put together the package the way we put ours is we thought it would be the most affordable and the fairest to everybody. If you do it via the gas tax, we get everybody that's driving into the state that fills up to help pay for it. If we do it with registration fees, we're only charging Wisconsinites."

Walker falls for Wall Street Journal opinion spin on Business Tax because of Medicaid Expansion.

Well if you believer everything you read in the opinion section of the Wall Street Journal, like Scott Walker, than you're not just a sucker and easily mislead, but you're more likely to post this ill conceived Tweet:

Can't believe he was governor...

This fits into Walker's one-sided view that businesses, not people, come first.The flaw in Walker's "thinking" is this; money, not people, come first for business. So employees lose both ways, kind a what we're seeing in Wisconsin right now.

It's the free market version of socialism. In other words, Walker is blaming Medicaid expansion for raising taxes on big businesses...who shifted the cost of insuring employees to state taxpayers all the while Republicans make it harder to get Medicaid. This is convoluted enough where your typical low information Republican voter won't bother thinking about it. Here's what happened:     

Provindence Journal: The report estimates the cost to the state of ensuring the Rhode Islanders working for the companies on the list is $44.4 million per year. Many of the biggest corporate names in Rhode Island ... has the most workers on public insurance. 

Gov. Gina Raimondo’s proposal to charge large companies a 10-percent tax (up to $1,500 per worker) on the wages of each employee receiving Medicaid. Nonprofit organizations and government employers would be exempt from the charge.

Pharmacy chain CVS, big box retailer Walmart, school bus company First Student and supermarket chain Stop & Shop. Rhode Island Hospital has more than 300 workers on Medicaid, as does Burger King, Krispy Kreme and Newport Creamery restaurants, (and) staffing agency Employment 2000.

"Free Market" Businesses Also Reacting to Skyrocketing Cost of Employee Insurance: Walker's narrow purely ideological focus prevents him from seeing the big picture, the real market pressures on business and their struggle paying for employee health plans year after year. Businesses have to increase deductibles just to hold onto employee insurance policies. From the looks of it, employer insurance is also on the verge of collapsing. From NPR:

A quiet revolution that's happened with health coverage for the tens of millions of Americans who have coverage through an employer. These are the people who've seen deductibles rise astronomically — rising four times in the last dozen years from about $350 on average to $1,350 on average. In some cases, people are seeing $4,000, $5,000, even $6,000 deductibles that they have to pay out of their own pocket before their health insurance kicks in.

We talked to a 27-year-old chef in western Virginia trying to start a family with his young wife. His wife had a miscarriage. They got such huge medical bills he had to take two extra jobs and was working from 5 a.m. until 11 p.m. some days. These are people with health insurance.

The growth of online charities and crowdfunding sources like GoFundMe is being driven in large part by people seeking to pay medical bills. And one of the amazing things about those people is that many of them have health insurance.

While Walker is backing up Sen. Scott Fitzgerald's and Rep. Robin Vos' refusal to take Medicaid expansion, Republican Rep. John Nygren has now dusted off the racially charged claim that health care is "welfare?"

Rep. John Nygren, R-Marinette, asked, “Why would we want to grow our welfare rolls? It makes no sense to me.”

But if the headline above doesn't change your mind, maybe the following will. It was no coincidence Republicans had a partisan report released just when Governor Evers took office claiming private insurance would increase. A clever trick since most research didn't include the private sector rates. Well...

A new report by an independent actuarial firm says expanding Medicaid in Wisconsin would lower premiums on the individual health insurance market between 7 percent and 11 percent.

ACA Inusrers give back after Excess Premium Increases: The following is a result of the "badly written" Affordable Care Act:

Individual market insurers are expecting to return to consumers a record total of about $800 million in excess premiums for 2018, a year in which the insurance companies posted their best annual financial performance, finds a new KFF analysis.

The rebates to more than 3 million eligible individual market consumers must be issued by September 30. They are the result of the insurance companies not meeting the ACA’s medical loss ratio threshold, which requires insurers to spend at least 80 percent of premium revenues on health care claims or quality improvement activities. On average, premiums per enrollee in the individual market grew 26 percent from 2017 to 2018, to $559, while per person claims grew only 7 percent, to $392. 

 A final few notes;

Claims that the costs of Medicaid expansion have far exceeded expectations are overstated, misleading, and substantially inaccurate, based on a review of the credible evidence from either academic or government sources. Initially, states expected more “pent up demand” for delayed care than they actually experienced, and thus they paid Medicaid managed care organizations (MCOs) substantially more than was necessary. These excess capitation payments produced an initial jump in costs, but the government subsequently recouped almost $9 billion of that excess through contractual provisions with their Medicaid MCOs, and the federal government now estimates that per person costs for newly eligible recipients will decrease almost 20 percent from their 2015 payment levels. Newly expanding states will be able to contract based on this more solid actuarial data, and can learn from the contracting techniques piloted by other states.

Medicaid maze of GOP hoops just a ruthless way to save money for tax cuts.

For me, the idea that Republican's want to deny people Medicaid coverage because someone said it should be more of a trampoline instead of a hammock is profoundly cruel and morally bankrupt. Sure, go ahead, make your argument, but it won't make you any less sociopathic. Admit it you will hurt others to save a few bucks.

The fact that Republican voters were okay with Wisconsin expanding Medicaid but not expanding eligibility and NOT taking our own federal dollars back to pay for it (losing over $1 billion) is not just inexcusable but it also trashes the idea that they're good stewards of taxpayer money.

Work Requirement Bureaucracy vs Streamlining Business Regulations: It never made any sense. But Republicans have successfully gotten away with burdening the very people they're elected to serve while bragging about removing burdensome red tape and regulation on business.

While the courts have determined states are doing little to no research on how their draconian regulations like work requirements are hurting adults and children who qualify but don't fulfill one of the so many hoops they're required to jump through, media reports are raising red flags hoping everyone will finally notice. Here's one such report:

Burdensome state eligibility redetermination processes have pushed down Medicaid enrollment in a number of states, raising questions about whether eligible adults and children are being wrongly dropped from coverage, according to a new report.

1. Enrollment dipped last year by about 1.6 million, including 744,000 children, according to the report by the liberal advocacy group Families USA. It fell most sharply in states like Tennessee, Arkansas and Missouri, which have established tougher new eligibility redetermination processes ... new Medicaid work requirements established by the Trump administration and Republican elected officials in a number of states.

2. State waivers eliminating 90-day retrospective Medicaid eligibility.

3. Onerous eligibility processes ... may violate federal rules requiring state Medicaid agencies to use all available data to renew a beneficiary's eligibility before requesting any additional information from the person. "The failure of some states to correctly implement the law—and the failure of the Trump administration to effectively enforce the law—is driving a drop in Medicaid and CHIP enrollment that shows no sign of slowing down."

4. In Tennessee, Medicaid and CHIP enrollment dropped last year by nearly 149,000, including 55,000 children ... some beneficiaries have repeatedly mailed in their lengthy renewal application, only to be dropped from coverage when the state said it never received the packet.

5. The head of the state Medicaid program recently told lawmakers that out of 218,000 Tennesseans who have appealed an eligibility denial since 2015, 159,000 people subsequently have been found eligible.

6. "Tennessee has created as much red tape as possible to see if families can run the gantlet," said Michele Johnson, executive director of the Tennessee Justice Center. "But if you lose that many kids from coverage, someone should be raising a red flag and saying, 'How can we fix that?' "

7. Timothy McBride, a Washington University health economist who chairs the oversight committee for the Missouri Medicaid program, said employment gains couldn't account for 67,000 children losing coverage over the past year. A Missouri family's income level would have to rise from 100% of the federal poverty level to 310% for a child to become ineligible for CHIP coverage. "I'm having a hard time believing that's happening." It's far more likely that the enrollment decline is driven by the state Medicaid program's "notoriously bad" computer system and a troubled call center system that puts people on hold for an hour and then cuts them off.

Republican right-wing funded "institutions" float fear and resentment with fabricated Medicaid Expansion report now being laughed at by experts.

Shocker? It looks like Scott Walker and the Republicans actually did expand Medicaid, but they just didn't take the federal money...the reality is just settling in:

JS-Guy Boulton: Former Gov. Scott Walker and the Republican-controlled legislature already expanded the Medicaid program. They just didn’t take the federal money available to states to offset much of the cost.

Wisconsin is the only state in the country that expanded eligibility for its Medicaid program — the change made in 2014 ... That decision will have cost the state an estimated $1.1 billion in federal dollars through the current fiscal year, according to the Legislative Fiscal Bureau.

Just as outrageous, although many suspected this all along, Republicans made a decision after Evers election that they would collude with right-wing groups and "institutes" to spew out phony research just to muddy the waters and call into question any "liberal" Democratic policies coming out of the Evers administration.

It almost worked.

The Wisconsin Institute for Law & Liberty (backed with millions in grants from the Bradley Foundation (and) member of the State Policy Network, a web of right-wing “think tanks”) and UW economics professor Noah Williams (also funded by the Bradley Foundation) defended their phony study. They claimed "cost shifting" to everyone else's private insurance premium? It just wasn't possible. You can't make this stuff up:

There’s also a question about the study’s time frame. The study ended with data from 2014 — before any purported cost shift to private health plans could have occurred in most states. This means that any costs shifted to private insurers wouldn’t have appeared in the cost of health plans until 2016 at the earliest.

The expanded eligibility for Medicaid programs under the Affordable Care Act didn’t begin until Jan. 1, 2014. Insurers typically negotiate three- to five-year contracts with health systems and other providers ... the price increases would not have been set until the following year, 2015. Insurers and employers who self insure, in turn, set premiums for their health plans for the following year in September or October.

Remember when Walker thought the federal government would end up not paying the 90 percent of the cost of expanded Medicaid? What study informed in of that? The federal government never missed a payment before that. Walker had mistaken the yearly federal changes to the percentage on the fed side as reneging on their promise. Walker is not a smart man, as we're finding out from his now clueless tweets.

But wait, there's more proof the report was pretty damn phony; hospitals most affected financially disagreed with the conclusions:

But studies show that expanding eligibility for Medicaid significantly improved hospital operating profit margins, according to an issue brief from the Kaiser Family Foundation, which does health policy research.

Further, hospital associations have pushed to expand eligibility for Medicaid in states that didn’t — and they presumably wouldn’t take that position if they thought it would increase their costs and force them to raise prices.

Then there's this caveat...

Neither Flanders nor Williams contend the study is perfect. “There are invariably assumptions that have to be made in every econometric analysis,” Flanders said.

...which embolden Republicans to claim the study as factual proof. A study by the way, that will make the rounds in other conservative states now. They don't do this stuff for nothing:

The study’s conclusions didn’t evoke any skepticism by the legislators — Rep. Joe Sanfelippo, R-New Berlin; Sen. Duey Stroebel, R-Saukville; Sen. Chris Kapenga, R-Delafield; and Sen. Dave Craig, R-Big Bend, — who held the news conference to tout them.

Here's what I've been saying since this "study" came out:

Robert Laszewski of Health Policy & Strategy Associates, a health care consultant and Wisconsin native who has been a sharp critic of flaws in the Affordable Care Act:

“Why are we even having this discussion? The data is there. The studies are there. The practical information is there. When are these people going to give up and finally admit that forcing Wisconsin taxpayers to pay something the federal government has been begging to pay for is not smart policy?”

Wisconsin Republicans embarrassingly clueless about Medicare-for-All and Medicaid Expansion!!!

UPDATE-March 17, 2019: Shocker, it looks like Scott Walker and the Republicans did kind of expand Medicaid, but just didn't take the federal money...our money by the way:

Former Gov. Scott Walker and the Republican-controlled legislature already expanded the Medicaid program. They just didn’t take the federal money available to states to offset much of the cost.

Wisconsin is the only state in the country that expanded eligibility for its Medicaid program — the change made in 2014 covered 147,000 adults without dependent children as of January — while not accepting the federal money available to states through the Affordable Care Act.

That decision will have cost the state an estimated $1.1 billion in federal dollars through the current fiscal year, according to the Legislative Fiscal Bureau.

Walker didn't think the federal government would be good on their word about paying 90 percent of the cost, odd since they've always paid their portion before that. Walker may be under the ridiculous and wrong impression the yearly federal changes to the percentage in the rules was the federal government going back on their payments. Walker is not a smart man.

But wait, there's more, and proof the report was a phony:

There’s also a question about the study’s time frame. The study ended with data from 2014 — before any purported cost shift to private health plans could have occurred in most states.

The expanded eligibility for Medicaid programs under the Affordable Care Act didn’t begin until Jan. 1, 2014. 

Insurers typically negotiate three- to five-year contracts with health systems and other providers ... the price increases would not have been set until the following year, 2015.

Insurers and employers who self insure, in turn, set premiums for their health plans for the following year in September or October.

This means that any costs shifted to private insurers wouldn’t have appeared in the cost of health plans until 2016 at the earliest.

_______________________________________________________________________________________
Republicans not only didn't know what health care was like before ObamaCare, but they haven't even bothered to educate them about health care in general. Yes, even after all this time, the ACA and expanded Medicare is still a mystery to them!

Insurer Profits over Medicaid Expansion: It sounds like a cliche, but seriously, Republicans only care about insurance company profits, as pointed out in the video clip below. Forget about giving every American the right to health care. Profits first, said Republican Sen. Aberta Darling, who wants to keep the poor in the private-for-profit insurance system. From UpFront:

Darling: "And if we say, okay we're going to take you off that insurance and put you on government insurance, we're really going to change the private marketplace and shift a lot of the Medicaid expenses to the private insurers like you and me." 

Meaning our private insurance rates will go up! Not quite, as I described later below.

Oh by the way, and it "gets a little wonky," Darling apparently hasn't even bothered to get the facts right...it's not 33 percent...

The Affordable Care Act (ACA) expanded eligibility to all individuals earning less than 138 percent of the federal poverty level.

Watch out, Republicans will Cost Taxpayers More...the conservative Wisconsin Institute for Law and Liberty (WILL) missed this...:

States that don’t expand Medicaid are going to be in an increasingly tight spot, especially as the federal Disproportionate Share Hospital payments are reduced and phased out (because Medicaid expansion was intended to be universal, so there wasn’t supposed to be much uncompensated care to offset with DSH payments).

Duffy-Dumbing-Down: I had to include the following mindless rant from Rep. Sean Duffy on Fox News the other day.

Duffy: "This Medicare-for-All is Medicare for none. What happens is if you have your health care plan through your union, you're a welder, your a teacher and you have your health care plan through your teacher plan, GONE...there is zero private insurance. So if you have Medicaid in your state, in Wisconsin we have BadgerCare, it would be a watered down BadgerCare. So instead of shooting for the stars and have a better plan for people, improving the plans in the coverage, they go to the lowest common denominator. And they're crappy plans, for everybody, but they're all the same. 

Don't laugh, voters were dazzled by this numb nuts, and just reelected him. Duffy switched from Medicaid-for-All to...Medicaid, like these programs are interchangeable. Duffy claimed  "private insurance" (with its hefty premiums, copays, and deductibles) is much better than no premiums, copays, or deductibles? Oh, and with Medicare-for-All you still get to keep your doctor, forever, even if you get a different job. No networks to stay in, no surprise bills to pay. Crappy plans for everyone indeed.

Desperately Trying to Kill Medicaid Expansion: A laughably inaccurate "study" by the conservative Wisconsin Institute for Law and Liberty (WILL) on Medicaid expansion was pure propaganda, aimed directly at right wing resentment and victim-hood, claiming that those paying for insurance right now will end up paying higher premiums, most likely from additional fees.

But I would also like to point out how some states chose to charge hospital and insurer fees to pay the states share; and you can blame Trump for that. Fake outrage Alert: The Republican plan for high risk pools would have charged hospital and insurer fees, just like the ones they hate so much now, so this complaint rings hollow:

The Trump administration has now increased the flexibility for states to add elements in their expansion programs that will help to better control costs going forward.

Also...

Contrary evidence from opponents suggesting official regret comes from expansions that occurred prior to the ACA, when the states bore a much greater share of expansion costs. 

The Wisconsin reality...

A September Wisconsin LFB report showed taking full Medicaid expansion beginning in 2020 would give the state an additional $280 million to work with over the next two-year budget cycle. Wisconsin has missed out on $1.1 billion in federal money since 2014, according to the nonpartisan Legislative Fiscal Bureau. The state would save about $513 million over the course of the next two-year budget, which runs from July through June 2021, if it accepted federal money for full Medicaid expansion, the Fiscal Bureau said.

I found these additional facts that should put an end to this nonsense:

This Brookings Issue Brief reviews (the) evidence, and evaluates continuing claims by Medicaid opponents that expansion is a “proven disaster” for state budgets. The strong balance of objective evidence indicates that actual costs to states so far ... are negligible or minor, and that states across the political spectrum do not regret their decisions to expand Medicaid.

1. Claims that the costs of Medicaid expansion have far exceeded expectations are overstated, misleading, and substantially inaccurate, based on a review of the credible evidence from either academic or government sources.

2. Expanded Medicaid pays for various costs that states previously were absorbing outside of Medicaid. Accordingly, several credible and expert evaluations (including one in the New England Journal of Medicine) show that states such as Arkansas, Indiana, Kentucky, Louisiana, Michigan, Montana, New Mexico, Ohio, and West Virginia (among others) have actually reduced, not increased, state spending as a result of expansion.

3. Contradicting the ultra-conservative Foundation for Government Accountability claim that “each and every state that opted into ObamaCare expansion is facing a surge in Medicaid enrollment far higher than ever anticipated,” officials or agencies from Indiana, North Dakota, and Ohio (here and here) have flatly stated (and documented) that expansion enrollment, or overall enrollment, has either fallen short of, or not substantially exceeded, expectations.

4. the federal government now estimates that per person costs for newly eligible recipients will decrease almost 20 percent from their 2015 payment levels. Newly expanding states will be able to contract based on this more solid actuarial data, and can learn from the contracting techniques piloted by other states.