Milwaukee County Labor Council AFL-CIO

August 20, 2014

In The News

Walker’s Medicaid refusal typical of his trickery

By Dominique Paul Noth
Editor, Milwaukee Labor Press
Posted February 15, 2013


Wisconsin has good public officials and goofballs (think Ron Johnson, whose foot resides permanently in his upper incisors). But right now popular attention is dominated by the damager in chief -- an adroit glibmeister of factual evasion, a news-clip commando rattling off stats that fall apart on logical investigation.

He’s already cost us tons. The slump to the bottom of the states (42nd) in job creation, the short-term gains and long-term loss for schools and municipalities in imposed coffer limits, the departure of some 20,000 public sector jobs and shriveling away the future of the thousands of other state workers. But nationally he can pimp himself as a GOP leader because the Wisconsin public hasn’t grasped the full consequence of his policies.

With a squad of well-paid protectors accompanying him everywhere, he raises big money for the right in posh hotels– a personality trip that seems to fascinate the media even though the pundits should drop a word or two about things like: His state administration is a disaster. Millions lost or squandered through an inept private-public agency to replace a real commerce department. Secret legal teams rotate space with incapable yes-men. Surrounding governors laugh openly at Wisconsin’s failure.

Do we scream? Do we call for the tar and feathers? No, blithely we succumb, fed by false hopes that journalists will wake up and return to the sort of intense scrutiny that used to justify the existence of journalism.

Perhaps we should all just bend over and praise Gov. Scott Walker for so slickly dodging responsibility, for this continuing ability to make supporters and the press look equally stupid -- for once again, as he just did Feb. 13, plunging into linguistic falsehoods that will take the evidence-based world months to unravel.

But this time, make no mistake, it is not just Democrats but Republicans, not just the left but the moderates and even the righteous in the health field – physicians, nurses, hospitals and insurance companies – that recognized quite quickly the disaster under the glibness. While some hospitals just wanted a better business base, using expanded Medicaid to pay for sick clients, there were many other groups praying that at last broadening health coverage would raise up the needy poor, the disabled, the low paid and their children to create more ladders of opportunity to climb into the middle class.

Walker on Feb. 13 did the dirty opposite -- again. He yanked those ladders out from under the hundreds of thousands of needy citizens, lied about his reasons and is probably laughing in private at our gullibility.

This is about Medicaid, which right now the federal government pays 60%, leaving the state a sizable amount to fill and a lot more citizens that need care but were ineligible under the rules. Believe it or not that “socialist” in the White House is actually a humanist. He cared about states’ rights and built Obamacare to help solve the state problems, not just generally slowing the growth of insurance costs under the complicated AHC law but finding a way to cut waste in Medicaid and free each willing state of cost impact in expanding coverage to help hospitals and providers as well as taxpayers.

Yet on Feb. 13 Walker announced that rather than accept the carefully worked out details and heavyweight fiscal lift, he had found a “middle ground” – details yet to come, of course -- to provide low-income working adults and needy children with health care through his own magical arithmetic and acumen. No one fully believes him, nor his math. In fact the Wisconsin Hospital Association, hardly a bastion of liberal think, has already objected that Walker is playing games with their future by falsely claiming his “middle ground” provides almost the same reach and less cost as expanded Medicaid would under Obamacare.

The association points out that rather than increase coverage as Walker advertises he actually leaves more folks to fend for themselves, reduces those with decent health coverage and increases uncompensated care that hospitals will be among those absorbing. To counter those charges, Walker has released a disjointed PowerPoint with generalities, data that even ET couldn’t parse, concepts that require federal waivers many think he has no chance in hell of getting and ideas of shifting costs onto the federal government that are likely unconstitutional. In other words, he still accepts the right’s vision of an Obamacare bogeyman and is willing to bleed Wisconsin citizens to prove his hatred – while pretending that he cares so much about the needy and about our money to carve a “middle ground.” It’s a farce.

When Walker renounced the federal government’s fully funded offer to expand Medicaid coverage, he refused to help at least 175,000 and probably 200,000 more needy adults and children into BadgerCare. He lied that the federal funding wasn’t fully appropriated though it was. He went against a deal so good that even Republican governors in Arizona, Michigan and Ohio took it. It would have saved Wisconsin $66 million in the first year (2014) and $4.38 billion in six years, by which time Walker would long be gone from the state picture.

The rules would have created 10,000 family supporting jobs right away while that idiot mining legislation that dominates the news wouldn’t even create one job sooner than in seven years at best and might produce 1,000 to 2,000 jobs overall – and even that is questionable.

After three years, the full federal cost coverage drops gradually, stabilizing on 90% by 2020. Analysis by the Kaiser Foundation and others suggests that by 2022 this cooperative Obamacare venture would (if allowed in Wisconsin ) cover 210,000 more people than are covered now – people whose unmonitored illness eat up state taxpayers by plunging the unprotected into emergency rooms and other costly crisis care.

Yet the expansion Walker turned down costs nothing now and down the road a huge savings in state outlay per participant. And in 10 years general health costs will be far lower – even now, before Obamacare is fully enacted, private companies have responded to its efficiency ideas and reduced the costs of Medicaid and Medicare by 10% according to just released reports.
So this expansion was bargain upon bargain financially but more important it provided essential health care for those making too little to participate in our current system.

What did Walker do instead?

Before he failed this Medicaid test, Walker heaved and moaned for months after the US Supreme Court declared Obamacare constitutional, figuring the court wouldn’t do it, then figuring Romney would win, but now was faced with either obeying the law or turning rogue without getting indicted. He’s familiar with dodging indictment.

So he abandoned Obamacare’s offer of a partnership in setting up the best required Exchange -- where people could find the lowest comprehensive policy. Instead as allowed under the law he let the feds control the whole thing. To some that flatly admitted the federal government could do a better job, spitting in the face of Tea Party beliefs and actually validating future efforts for a public option of even a single-payer plan.

But in refusing to participate, Walker kicked away the planning money received under Gov. Doyle to develop a state-specific Exchange concept and months of sophisticated planning by local medical experts and lawmakers. Why waste such good work? Perhaps because if the federal Exchange doesn’t work as well as it could without Wisconsin concepts, he can claim it’s the fault of the Obamacare mandate. (And if it does work, he can try to step in and take it over.)

That attack on Obamacare could also be his aim in refusing the Medicaid expansion. The US Supreme Court in ruling Obamacare constitutional said the US couldn’t force the Medicaid expansion on states no matter how good the deal – that states could decide on their own and many have.

If you examine Walker’s outline, most of his so-called “middle ground” comes from forcing thousands into the Exchange, though many won’t have the income to get insurance. The Exchange will be lower cost shopping centers but they can’t go as low as Walker is talking about – that’s why Medicaid and BadgerCare exist.

Moreover, he is playing a semantics game, pretending he’s expanding while actually narrowing BadgerCare. Letting into BadgerCare those at 100% of poverty income ($15,400 a year) rather than 138% will actually squeeze out many needy working adults and force them to look elsewhere. The concession of letting in “childless adults” rather than those with children is a sop. It also changes BadgerCare into a bottoms-only safety net for the least capable of speaking up about the gaps in their care.

Walker knows that BadgerCare, created by past governors, is too successful to dump, but he keeps making it a shadow of its former self while touting that he’s “helping” it.

US Rep. Gwen Moore, barely hiding her disgust, noted he “had once again allowed his Republican ideologies to interfere with what is best for the people. This decision will increase low-income families’ out-of-pocket health care costs, pricing needed care out of reach . . . His decision to leave this money on the table is baffling.”

But not that baffling when you think of how opposing Obamacare strengthens him in the Tea Party while announcing how he will “cover” 224,000 with his plan, though no one can prove it, softens the blow with foolish believers.

He has ever more reasons to disguise his extreme right wing feathers since he faces re-election in 2014 in a state where the majority of voters have clearly moved left of center, as last November demonstrated.

So he’s throwing out some bones to them. He kicks a few million dollars into mental health care, less than needed but every bit helps, and announces funding for a Family Justice Center in downtown Milwaukee to combat domestic violence.

He’s working hard behind the scenes to keep his natural allies in line so they won’t embarrass him and his friendly election face – please, no more women-hating bills or voter suppression laws. Please, don’t roll so obviously in the tubs of butter provided by corporate lobbyists. Please, work your Tea Party games around the edges.

(He must have flipped out behind closed doors when Sen. Johnson played the fool so crassly, attacking Hillary Clinton, then calling Democrats Marxists and then saying he rejected the Violence Against Women Act because it was an unconstitutional expansion of tribal court authority to prosecute white men who strayed on the reservation to attack native women. Dumb upon dumber.)

Walker is too politically savvy to say stuff like this even if he believes it. And the media has so far not pushed him to show his Johnson.

Such crumbs as the mental health and justice center support might make taxpayers forget the actual impact of his policy on the state’s economic freefall. But whenever a big ticket salvation comes along that smells too Obama for his sensibilities, he runs the other way. Again and again he forces the federal government to take back its good ideas, like $880 million to be part of a national train network. Now he’s playing games with the Exchange and Medicaid figuring that if things go poorly he can blame the overreach of Obamacare while the real culprit is the chronic under-reacher in Madison.

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