Another Wisconsin Case for Single Payer Healthcare

The story has always been…Wisconsin spent far more for Medicaid than it should have…if it had taken the Affordable Care Acts expansion and the attached federal funds…it would have saved money. Governor Scott Walker and the GOP legislature didn’t do that…they put their own little expansion in place and we paid and paid for it…Wisconsin supposedly lost out on nearly a billion dollars over a ten year period…an amount that no one has denied.

Governor Evers made healthcare part of his platform during the 2018 gubernatorial race and made expanding Medicaid and taking the federal funds a keystone. And it is one of the reasons that he won the election. Now of course the Republicans still control the legislature and they are still saying no way.

So in support of the GOP position, we recently saw a new study released that said expanding Medicaid would actually cost private health care plans that similarly same amount of one billion dollars.

There are all kinds of questions about the validity of this study…the methodology used…the data points…the years…etc. You would think by now that real world experience with the program would give us some real world data but apparently….well you know….science.

But this all goes to the heart of my position. Whether the state government left one billion dollars on the table…or insurers would have to pay an additional one billion dollars…or both numbers are wrong…or both numbers are right…should be inconsequential.

IF we had put comprehensive universal single payer health care in place ten years ago…this would all be a moot point. There shouldn’t need to be all of this sturm and drang over unintended consequences or fiscal decisions. Everyone should have health care paid for…all of the time…for every medical issue they ever encounter. No pre-existing conditions…no caps…no lifetime coverage limits…no worrying about keeping kids on your policy. Open, transparent, healthcare coverage…why are we the only ‘civilized’ country still acting so completely…’uncivilized’?

Scott Fitzgerald Supports Medicaid Expansion in Wisconsin or Maybe Not!

During the interview that provided the articles around the state outlining the Republican plan to undermine the state’s electorate and newly elected governor by keeping the governor out of the budget process…Senate Majority Leader Scott Fitzgerald let out a sigh and quick inhale about Medicaid expansion for Wisconsin. It caught a few by surprise including the Milwaukee Journal Sentinel who have this headline on their website: Wisconsin Senate Majority Leader Scott Fitzgerald isn’t ruling out Medicaid expansion

So has Sen. Fitzgerald seen the light and read the polls and absorbed why Wisconsin selected State School Superintendent Tony Evers over incumbent Governor Scott Walker this past November? Well maybe a little, but he doesn’t want to say, but he does, and he didn’t and he did, but he won’t. But here’s the very short story:

Senate Majority Leader Scott Fitzgerald signaled Thursday he wouldn’t rule out using federal dollars to expand Medicaid — a move long opposed by Gov. Scott Walker and Republican lawmakers and demanded by Democrats and Gov.-elect Tony Evers.  

Fitzgerald told reporters in a wide-ranging interview that there isn’t much support for accepting the federal money to make the expansion among his GOP caucus, but that it’s also too early to say he would oppose doing so. 

“I don’t see it right now, but there’s a lot of moving parts, as we know. So I don’t want to be presumptuous and rule it out,” he said. 

Accepting the Medicaid expansion that is provided as part of the Affordable Care Act was one of the key planks in the campaign platform that Tony Evers ran on…and was elected on. It certainly should come up for discussion irregardless of the legislature’s instincts on the subject. It should have a public discussion and hearing and should come to the floor for a vote. And this expansion would save the taxpayers a sizable amount of money while increasing the number of Wisconsinites covered by health insurance.

My guess is Sen. Fitzgerald is priming the pump in case shortfalls in the next budget become seriously problematic and he can fill some of them by accepting the Medicaid expansion. A trial balloon to his base while offering an olive branch briefly to the governor.

The plan would provide coverage to more people and free up about $280 million in state money over two years that could be used for other purposes, according to preliminary estimates.

But again, let’s let House Speaker Robin Vos have his last words:

In October, Assembly Speaker Robin Vos, R-Rochester, said he would refuse to expand BadgerCare Plus, telling reporters, “Not going to happen. No way. Never.”

So once again. These guys control both houses of the legislature. They can prevent Tony Evers from doing what he wants to do. What are they afraid of?

Speaker Robin Vos Joins The Resist Movement

To my Dem friends: “as ye sow, so shall ye reap”

Less than 24 hours after Governor Walker’s concession speech in the 2018 Wisconsin governor’s race, a very disheartened and apparently bitter Wisconsin Assembly Speaker Robin Vos reached for his personal inner Mitch McConnell and threatened to take power away from the incoming governor.

But before all of you Democrats get all snarky and outraged about that, I don’t see a whole lot of difference between Speaker Vos’ reaction and the RESIST movement that started November 9, 2016. Just chill out a little bit for now.

Assembly Speaker Robin Vos (R-Rochester) said Wednesday he would discuss whether to look at limiting Evers’ power with Senate Majority Leader Scott Fitzgerald (R-Juneau). FItzgerald is open to the idea, according to an aide.

“If there are areas where we could look and say, ‘Geez — have we made mistakes where we granted too much power to the executive,’ I’d be open to taking a look to say what can we do to change that to try to re-balance it,” Vos told reporters.

“Maybe we made some mistakes giving too much power to Gov. (Scott) Walker and I’d be open to looking at that to see if there are areas we should change that, but it’s far too early to do that before I talk to Scott Fitzgerald.”

One of the things that Speaker Vos will need to do is learn how to actually govern. He will need to work with Governor-elect Evers and actually get the things done that Wisconsin needs. Will that actually happen? I hope so. Mr. Evers is pretty easy to work with and has experience working with the legislature and the GOP from his years as head of Wisconsin’s Department of Public Instruction. Let’s let this thing work its own way out.

Now that doesn’t mean we shouldn’t watch Speaker Vos and Senate Majority Leader Scott Fitzgerald like hawks! They still control the majorities in both houses of the legislature. But please keep in mind that most of the authority vested in the governor’s office and the legislature itself is defined in the state constitution. And despite the checks and balances nature of our form of republican and federal government, I am not sure how much control the legislature has on the ‘power’ of the governor. For now I am just writing this off to Speaker Vos voicing his frustration out loud.

And certainly, I expect the GOP majority to block every possible bill and initiative put forth by the Democrats. It would be totally out of character for them to do anything else. But I also expect that the Democrats will propose every measure that they ran on. That they will spend the time and visit the state selling their ideas directly to the electorate…and rinse repeat…as Speaker Vos and Senator Fitzgerald obstruct them. Govern on what got you elected. And govern on how you got elected. Grass roots interactions…on education…healthcare…clean environment. Don’t let anyone distract you in the short run!

Now…on to the media. It would be nice if you would explain what powers allocated to the governor the legislature thinks it can limit or control…instead of just publishing Speaker Vos’ rant. After all from what we’ve seen in 2016 and now in 2018, an understanding of civics isn’t America’s strong suit even at the level of the presidency.

Scott Walker Wouldn’t Be Doing These Silly Things IF

we had comprehensive universal single payer health insurance. Instead he is vilifying poor and possibly handicapped Wisconsinites who are currently on Badgercare (Medicaid). But really, the state and federal government co-pay for Badgercare, so removing users from the plan would save money…although I don’t think that’s totally the impetus behind this. If saving money was truly in the plan, Gov. Walker would have accepted the Affordable Care Act Medicaid expansion instead of sitting back on his ideology and refusing it…thereby being dogmatically pure in preparation for his presidential campaign. What’s the current number on that? $1 Billion that Wisconsin lost?

But let’s back up a second. If we had a comprehensive universal single payer health insurance plan there would be NO Badgercare…there would be no cost to the State of Wisconsin…and every Wisconsinite would be covered…period.

But here’s the story:

Federal officials signed off Wednesday on Gov. Scott Walker’s plan to require some people to work to receive health insurance through the BadgerCare Plus program, drawing attention to one of the governor’s initiatives less than a week before the election.

The requirement would apply to healthy people who have no dependent children, who are under 50 and who haven’t worked for four years.

The federal agency also approved:

Collecting premiums from some adults without dependent children. The proposal has raised questions on what it will cost the state to collect premiums that could be as low as $4 a month and how it will affect people who don’t have checking accounts or credit cards.
Charging some adults an $8 co-payment for unnecessary visits to hospital emergency departments. That proposal could be difficult to implement given that hospitals will not know if a visit is unnecessary until after a patient has been treated. The Wisconsin Hospital Association has said it is “highly likely” that most of the co-payments won’t be collected and that the change essentially will result in a rate cut for emergency department visits.

The state also won approval to allow its BadgerCare Plus program to cover short-term residential treatment for substance abuse in freestanding behavioral health hospitals. Those hospitals have been barred from billing Medicaid programs for residential treatment.

This is getting wa-a-a-ay more complicated than it needs to be!

BTW: I will give kudos to Gov. Walker for expanding BadgerCare Plus for substance abuse treatment.

Is West Virginia Leading The Nation Towards Single Payer Health Care?

Earlier this week the Milwaukee Journal Sentinel reprinted an article in their Ideas Lab from Kaiser Health News reporter Julie Revnor. I have the hard copy but online I found it on the NPR site. The article wrangles with the notion of who is really protecting the Affordable Care Act’s clause to cover Americans with pre-existing conditions. It includes some discussion on the senatorial race in Wisconsin between incumbent US Senator Democrat Tammy Baldwin and her opponent State Senator Republican Leah Vukmir. It is worth the read.

But what caught my attention was the last paragraph where Ms. Revnor is debunking a statement made by the US Senator from West Virginia, Joe Manchin.

Meanwhile, Democrats who are chastising their Republican opponents over the issue are sometimes going a bit over the top, too.

An example is Manchin’s claim about the threat to coverage for 800,000 people in West Virginia. West Virginia’s population is only 1.8 million and more than 1 million of those people are on Medicare or Medicaid. That would mean every other person in the state has a pre-existing condition. A recent study found West Virginia has a relatively high level of pre-existing conditions among adults, but it is still less than 40 percent.

I am not going to fact check Senator Manchin’s claim…the fact that any American might lose coverage because of a pre-existing condition is enough of an issue on its own (full disclosure: I have a pre-existing condition, I had a heart attack in 1999 and am being treated for heart issues to this day). But what I found more interesting was Ms. Revnor’s assertion (and I didn’t fact check that either…she does this for a living so I am taking her at her word here) that over 1 million out of 1.8 million West Virginians are on Medicare or Medicaid. Fifty five percent plus of West Virginia is on federally sponsored single payer health care already. So apparently it works and works fine. So it wouldn’t be much of a push to get those other 44+% of West Virginians on Medicare for All (yes I hate that name because it isn’t factual but I am going to use it because it’s become the vernacular for comprehensive universal single payer health care that I support).

Maybe we should just make West Virginia a test bed and set up a universal single payer plan in just that state. I would think the population would be amenable seeing how the majority are already on similar plans. (just another aside: those on Medicare and Medicaid don’t have to worry about pre-existing conditions. Medicare can’t deny anyone who is old enough to be eligible and Medicaid can’t either and parts of it are essentially designed to cover pre-existing conditions). And it probably won’t be hard to convince the estimated 267,000 previously uninsured West Virginians using the Affordable Care Act to move either.

To me there should be a national move to a comprehensive universal single payer health care system in the United States…but since there is nothing but argument around it…let’s go with a test in West Virginia. It’s a small population…55% are already on a federally run single payer program…and they are close enough to Washington to be a decent social laboratory. Too bad their ‘good neighbor’ to the West (Senate Majority Leader Mitch McConnell) wants to cut back on Medicare and Medicaid. But that might make it easier for WV to volunteer to be the guinea pig here.

BTW: West Virginia’s electoral votes in 2016 went to President Donald Trump who pulled in 68.5% of the vote with only 57.45% turn out.

And this late breaking tidbit. While researching a few of the items above, it looks like Sen. Manchin might not be so far off. This Kaiser Family Foundation chart (from 2015) shows West Virginia having about 35% or so residents with pre-existing conditions that could have been denied coverage pre-ACA. Interesting.