Frederica Freyberg:

This week the Walker administration released a draft of the application to the federal government requesting a waiver to make changes to the state’s Medicaid or BadgerCare Plus program. This is healthcare for able-bodied childless adults aged 19 to 64 who are at or below the poverty level. Wisconsin is asking to require drug screening to be eligible, limit benefits to 48 months if the person isn’t working or training for work, establish premiums up to $10 a month, reward healthy behaviors and increase co-pays for ER visits. The waiver wants to allow for full coverage of inpatient substance abuse treatment. The administration expects to submit its application next month. No one from the administration would join us to talk about the sought after changes. Medicaid advocate Robert Kraig, executive director of Citizen Action of Wisconsin is here. Thanks for being here.

Robert Kraig:

Great to be with you Frederica.

Frederica Freyberg:

In particular I understand you don’t like the drug testing piece of this. Describe why not.

Robert Kraig:

Yeah, we’re opposed to most of it, by the way. The drug testing part, forced drug testing, has gotten the most attention. In general we think this is designed to set up barriers in order to force people off of BadgerCare at a time when more people need healthcare, not fewer. And the drug testing provision will do that as well but also the work requirements do that. The premium increases do it as well. Quite frankly the motive is to force people off healthcare and spend less money. We think that’s clear. But as far as the drug forced drug testing part it’s the opposite of what medical experts and medical science tells us we should do about the scourge of the opioid epidemic in this state and other substance use. It plays well politically. It may be good for the governor’s re-election in some circles but actually sets us back as far as understanding the causes of drug addiction and how best to address it.

Frederica Freyberg:

I want to ask you a little more about that in a moment. I understand at least 15 states have laws requiring drug testing of people on public benefits. More states are proposing it. Is there a large number of people who have lost benefits as a result of these drug testing requirements as you have suggested is the motivation?

Robert Kraig:

They’re relatively new and have not been approved for Medicaid before. But in a lot of states that have tried them, actually they’ve not even caught very many people with drug addictions. In fact medical experts say it’s fairly easy to avoid these things and the only people who really get caught are people who are so addicted they can’t even not use the drug for a couple of days in order to avoid detection. So they’re not even effective. They’re also very expensive.

Frederica Freyberg:

For people who might have a drug addiction, a piece of this is the state says it wants to help them get clean and is asking for fully funding inpatient treatment. That sounds like a good piece of this.

Robert Kraig:

We’d go even further as far as treatment. There are huge waiting lists right now that the governor could have, over the whole term, actually done something about. But in particular forcing someone, even if they go through this whole process, to get treatment is not the way to go. The way to go as far as medical experts concerned is to make treatment and everything else, prevention. It’s better to prevent the addiction before it happens and catch it early. It’s just like a medical disease like flu. That’s what the medical science says – or cancer or anything else – you prevent it. You try to catch it early. Then if it’s far along you do heroic intervention which is treatment. We should certainly do that but the way to do that is to make it available, publicize it and make sure people who are doing it are motivated to do it want to be cured. Not a forced drug testing regime which sounds like red meat to people who think that those on BadgerCare are doing the wrong thing and just are immoral when in fact, someone with a substance abuse problem has a disease. It’s that simple.

Frederica Freyberg:

Other elements of Wisconsin's waiver request limiting Medicaid to 48 months if the person isn’t working or training for work. What is your reaction to that?

Robert Kraig:

We think it’s appalling because it again plays off the idea that people on BadgerCare are people who just are refusing to work when we don’t have enough family-supporting jobs. When so many jobs don’t provide health benefits at all or people work part-time and want to work full-time can’t find a good full-time job when in fact medical care and health insurance is so expensive even middle and upper middle class people can’t afford it on their own which is clear in the current health care debate. It’s a way to force people off quite frankly and it’s not looking at reality of the economic economy we have right now for people and the cost of healthcare, which even middle and upper middle class people can’t afford, let alone very low income people.

Frederica Freyberg:

Just briefly in a few seconds left, if people are forced off Medicaid, then what?

Robert Kraig:

Well, it costs us a lot of money, quite frankly, because their only recourse is to wait until they’re very, very sick and then go to the emergency room where they’re stabilized and sent on their way. Whereas giving them access to primary care prevents the diseases in the first place and is much cheaper in the long term. They’ll be a lot of uncompensated care at hospitals which will raise everyone else's health insurance premiums and quite frankly something like a substance abuse issue for example, better they’re seeing a primary care physician who helps them deal with it and gets them to want to deal with it rather than having this punitive approach where you force them to take a drug test then you throw them off BadgerCare if they don’t comply with each part of the standard.

Frederica Freyberg:

We need to leave it there. Robert Kraig, thank you very much.

Robert Kraig:

Always great to join you, Frederica.