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Wis. governor advances Medicaid expansion, but Republican support still needed

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Gov. Tony Evers touted Medicaid expansion as a key issue throughout Wisconsin's 2018 governor race.
Source: Associated Press

Wisconsin Gov. Tony Evers used his first full day in office to advance his goal of expanding the state's Medicaid program, but the Democrat still has to win over Republicans in the state legislature to make his campaign promise a reality.

Evers on Jan. 8 signed an executive order directing the state's Department of Health Services to develop a Medicaid expansion plan, which could expand the U.S. health insurance program for low-income Americans to as many as 80,000 Wisconsinites. Expansion would extend eligibility to low-income residents who make an annual income up to 138% of the federal poverty level.

While the new governor has made Medicaid expansion a top priority of his administration, he alone does not have the authority to enact it. A new law will need to be passed by the Republican-controlled state legislature, which has opposed expansion in the past.

Britt Cudaback, a spokesperson for Evers, said the governor is focused on getting expansion legislation passed this year, and the new administration has seen some movement among Republicans in the state legislature. Evers also noticed more support for Medicaid expansion in Wisconsin while on the campaign trail in 2018, according to Cudaback.

Kate Constalie, a spokesperson for Senate Minority Leader Jennifer Shilling, expects to see some Republican support for expansion in the Senate, but the state Assembly could prove more difficult.

Constalie said Assembly Speaker Robin Vos remains strongly opposed to expansion. Vos said in October 2018 that he would never consider a Medicaid expansion plan, according to an article from the Capital Times.

Senate Majority Leader Scott Fitzgerald did not return a request for comment as of publication.

Should Wisconsin expand Medicaid, more funding would flow in as expansion costs are jointly funded by the state and federal government under the Affordable Care Act. Former Gov. Scott Walker partially expanded Medicaid coverage to individuals who make up to 100% of the federal poverty level in 2014. But because Walker did not fully expand Medicaid in line with the ACA, Wisconsin receives a much lower contribution from the federal government than the states that expanded to 138% of the poverty level.

Jon Peacock, research director for Kids Forward, a Wisconsin-based non-partisan policy organization, said Medicaid expansion could save the state as much as $180 million dollars every year. Peacock believes expansion legislation has a good chance of passing but said Evers still has a challenge ahead of him.

"It's not going to be an easy lift for the governor, but he's made it very clear that it's a priority," Peacock said.

Deep partisan divides

Evers plans to include expansion in his first budget proposal, which Peacock said should provide some leverage because the predicted $180 million in savings will be built in. Republicans will therefore have a tough time politically to vote against the measure.

Nevertheless, given the recent tension between the two political parties, Peacock believes that the legislature could delay passing the budget, which typically moves through at the end of June. In the waning days of Walker's term, the outgoing governor signed legislation implementing a work requirements program on the state's Medicaid expansion that includes a clause preventing Evers from eliminating the measure.

"I think there's a very distinct possibility [passing the budget] would drag out into the fall," Peacock said. "There are such deep divides between the Republicans and the governor, and the actions the Republicans took in the fall show that they are really digging in their feet."

In addition to the Medicaid expansion executive order signed by Evers on Jan. 8, the governor signed another that directs state agencies like the Wisconsin DHS and the Office of Commissioner on Insurance to provide recommendations to protect patients with pre-existing conditions. More than 850,000 people in Wisconsin are living with pre-existing health conditions, according to the executive order.