Here & Now

Medicaid Expansion: Non-Starter vs. Issue to Fight For

Frederica Freyberg:

One proposal that is no longer in the budget is Medicaid expansion. But that doesn’t mean the debate is over. Governor Evers has said he will continue to fight for expansion which would provide coverage for 82,000 people and bring in $324 million in additional federal dollars to help pay for other healthcare programs. “Here & Now” reporter Zac Schultz explains what Medicaid expansion would mean for healthcare providers and why not everybody is sure expansion is in their best interest.

David Mertens:

Okay. Once again. Good.

This is an opportunity to contribute and to pay back.

Zac Schultz:

Dr. David Mertens is retired, but two or three Thursdays a month, he volunteers at the Chippewa Valley Free Clinic.

David Mertens:

But you realize that you’re serving a population that really does have a need.

Zac Schultz:

The clinic provides medical, dental, and vision care for anyone without insurance. Dr. Mertens says his patients have similar stories.

David Mertens:

They cannot afford insurance, or they’re not eligible, or maybe next year when I get back to work.

Maribeth Woodford:

Right now, we’re serving those that are considered amongst the working poor.

Zac Schultz:

Maribeth Woodford is the executive director. Anyone under the federal poverty level would qualify for BadgerCare, Wisconsin’s version of Medicaid.

Maribeth Woodford:

Past that, there are many who fall through the cracks. Can’t quite afford the insurance plans that are out there.

Jo Conklin:

This is Jo Conklin at the Chippewa Valley Free Clinic and you wanted to make an appointment?

Zac Schultz:

Woodford says expanding Medicaid eligibility to 138% of the federal poverty level would mean about 20% of her patients would gain coverage. And she’d be happy to see them go.

Maribeth Woodford:

So we keep things going, especially with chronic disease treatment, but we aren’t available every day to them. They would have that with advanced or increased Medicaid.

Zac Schultz:

Some of them would likely end up at Marshfield Clinic.

Susan Tierney:

We’re all about access to patient care, certainly having coverage is important.

Zac Schultz:

Susan Tierney is the CEO and says while they’ll serve whomever walks through their doors, they’re not ready to endorse Medicaid expansion.

Susan Tierney:

Until we know the impact, it’s hard for us to come forward and support something. We want to be very cautious about it.

Zac Schultz:

Tierney says part of the problem is Medicaid’s reimbursement rate, the amount of money the government pays the healthcare provider vary based on the service, but in general, it’s quite low.

Susan Tierney:

We know what the cost of care is, and we know that Medicaid does not cover the cost of care.

Zac Schultz:

Tierney’s other concern is a flood of new Medicaid patients might not even be new patients. Currently, anyone earning between 100% to 138% of the federal poverty level, under $35,000 a year for a family of four, can buy private health insurance on the Affordable Care Act marketplace. And much of the insurance premiums are subsidized by the federal government. If they gain coverage under Medicaid expansion, those subsidized premiums will stop. Marshfield Clinic has a health plan called Security Insurance, that is part of the ACA marketplace. Tierney says about 5,000 Security Insurance customers would qualify for Medicaid under the expansion.

Susan Tierney:

So when you have a fully insured patient and they move to a government funded program that pays much less for the care, the math would suggest that you’re going to get less reimbursement.

Zac Schultz:

Tierney says those 5,000 patients cost more than other patients.

Susan Tierney:

That core 5,000 people are very important. And we know that they are a little bit sicker population than what one might expect on the exchange. They are a little older, a little sicker, and are utilizing more services so there are pretty vulnerable populations.

Tony Evers:

I’ve said all along we need to expand Medicaid in Wisconsin, and according to a recent Marquette Law poll, 62% of Wisconsinites agree.

Zac Schultz:

Governor Tony Evers’ budget says Medicaid expansion would cover 82,000 people. Donna Friedsam is the director of the University of Wisconsin’s Population Health Institute and an expert on health care.

Donna Friedsam:

I estimate about 39,000 of those people would be coming from a current status of uninsured and gaining new coverage under this expansion. And then additional, about 35,000, 36,000 of them would be coming from currently participating in the Affordable Care Act marketplace.

Zac Schultz:

So would Medicaid expansion and up costing healthcare providers? A recent study by a UW economist and a conservative interest group says yes. It could cost $600 million a year, but a second study by UW researchers using the same data says the first study used flawed methods. They determined Medicaid expansion will save healthcare providers $100 million a year. Mostly by avoiding the uncompensated healthcare they provide the uninsured.

Donna Friedsam:

I think many people believe that that first study was bad science.

Zac Schultz:

Tierney says Marshfield Clinic is still analyzing the data and may not reach a public conclusion before the budget debate is over.

Susan Tierney:

It’s hard to stay out of the political arena when it impacts your patients, but right now, we just don’t know what the impact will be.

Zac Schultz:

Both the Wisconsin Association of Health Plans and Wisconsin Hospital Association declined to comment on Medicaid expansion, but Donna Friedsam says they’re not silent at the Capitol where they spend a lot of money lobbing the Legislature for increased Medicaid reimbursement rates.

Donna Friedsam:

They’re not sitting it out. I guarantee you they are not sitting it out.

Zac Schultz:

Back at the Chippewa Valley Free Clinic, Maribeth Woodford keeps the doors open with the help of 200 volunteers and donations. So in some ways, she’s not involved in the economic argument of Medicaid expansion, but she doesn’t want people to lose sight of another part of the debate, the moral argument over access to health care.

Maribeth Woodford:

I think the moral component is being put aside while we talk about dollars.