Governor Walker and the Legislature have consistently refused to fully expand BaderCare under the ACA. Instead, the Legislature approved the Governor's recommendation to set the BadgerCare eligibility limit for childless adults at 100% of the FPL. This decision cost the state enhanced federal Medicaid funding that is offered to states that expand their Medicaid programs to previously ineligible people. As a result, Wisconsin taxpayers pay 42% of the costs of covering the approximately 148,000 childless adults covered by the program. A full BadgerCare expansion under the ACA would have resulted in substantial savings for Wisconsin taxpayers by substituting federal for state expenditures. Under this scenario, the federal government would pay 100% of benefit costs for newly eligible enrollees in 2015 and 2016, 95% in 2017, 94% in 2018, 93% in 2019, and 90% in 2020 and subsequent years.
Even more importantly, the full BadgerCare expansion would cover 81,000 more people who currently are without health care coverage. Many of these people are working but do not earn enough income to afford private health insurance and are likely to delay necessary health care services.
Alternative Proposal Introduced
At the same time the new information about full BadgerCare expansion was released, some Democratic legislators introduced a compromise expansion proposal based on the model recently implemented in Iowa that uses federal Medicaid money to provide a subsidy to childless adults earning between 100-138% of the FPL so they can afford to purchase private health insurance plans in the federal health insurance Marketplace. According the LFB estimates, the "Iowa Model" would still cover an additional 81,000 childless adults, but would only result in savings of $241 million because it is more expensive to subsidize private plans than to simply enroll people in BadgerCare. The federal government would have to approve a state waiver in order for the Iowa Model to be implemented in Wisconsin.
The Governor's proposed budget does not include any proposals to expand BadgerCare under the ACA and Republicans who currently control the Legislature seem reluctant to pass any form of Medicaid expansion. However, whether to expand BadgerCare in one form or another is likely to be a hot topic of discussion as the budget process continues to unfold.