Advocates for the 1.2 million Wisconsin residents enrolled in Medicaid programs say they got exactly what they thought they’d get from Gov. Scott Walker’s budget speech Tuesday: not much.
Walker’s speech devoted only a couple of vague paragraphs to what he intends to do with the state’s public health programs, which he called “an unsustainable budget challenge…in need of a serious and long term solution.”
That solution? The state needs to “refocus” services and “find efficiencies where possible,” Walker said in his speech. Some recipients must start to pay “modest co-pays and premiums,” as they “begin to transition to a time in the future when they will no longer need government support.”
And that was about it.
Walker's brief remarks about the programs that serve one out of five Wisconsin residents, and one out of three of the state's children---left advocates guessing. Did the language he used imply that he intends to limit the time people can remain on the public health plans -- an idea he has raised in the past? Who’s going to pay what premiums? Where will these “efficiencies” come from? What does he mean by an “efficiency,” anyway?
“There were very few numbers or nuts and bolts,” said Jon Peacock, research director for the Wisconsin Council on Children and Families, and a veteran at reading budgets. Usually, he said, budgets are presented with much more hard data. “Without more information it’s hard to know what it all means.”
Advocates found just a few clues in the executive summary of the budget plan, released shortly before the speech. On page 61 of the 73-page document was a figure that gave advocates their first sense of the scope of savings the Walker administration plans to squeeze from the public health programs over the next two-year budget cycle: $500 million in cuts to projected costs.
Part of those savings would come from requiring participants in SeniorCare to also enroll in Medicare Part D.
The budget summary also said “centralizing and automating” the Medicaid income eligibility system would save $48 million and cut 270 full-time jobs.
But again, how the state will save the $500 million, which other programs will take the hit, and who out of the hundreds of thousands of babies and children, the disabled, the elderly, the mentally ill, the pregnant moms, and the poor and middle class in the plans will lose what coverage, remains unknown.
Also, what the heck does “centralizing and automating” the system even mean? In the past, such efforts have often been sneaky ways to add red tape, leading to enrollment drops, says Bobby Peterson of ABC for Health, an advocacy group for consumers.
“We have even more questions than before,” said Lisa Pugh of Disability Rights of Wisconsin Wednesday morning after she got off a conference call with other frustrated advocates.
And so people on Medicaid and those who work with them remain in what has been a state of high anxiety ever since Feb. 11, when Walker released a legislative bombshell -- his “budget repair bill.”
That bill would have cleared the way for the changes and cuts announced -- or, in this case, only vaguely alluded to -- in Tuesday’s speech. In terms of Medicaid, controversial provisions in the budget-repair bill would hand the Walker administration sweeping new powers to circumvent current legislative processes and state law in revamping plans like BadgerCare, Family Care, and SeniorCare.
As many people in Wisconsin and even the entire country know, the budget-repair bill has been held up for nearly three weeks now by the flight of the state’s 14 Democratic senators to Illinois, where they are scurrying around from cheap hotel to cheap hotel to avoid having to vote on the bill, including the Medicaid changes, that Walker has claimed could make him the next Ronald Reagan.
Reagan was known as a charmer and a master-communicator. But advocates saw little charm and little communication in Walker’s poker-faced delivery of bad news to a Capitol in a virtual state of lockdown.
“There were just a lot of public pronouncements devoid of any substance. A lot of gimmicks,” said Kelda Helen Roys, D-Madison, a legislator who was still seething Tuesday night because, she said, she was among the thousands of Wisconsin people locked out of the Capitol before the governor’s speech. Roys ended up having to bang on a colleague’s window and climb in that way, she said.
What Roys and other advocates for Medicaid recipients are most angry about is what they see as a deliberate strategy by Walker and other conservative Republicans to blame the poor and the sick, and programs set up to help them like Medicaid, for the state’s financial troubles. “He is absolutely scapegoating people,” Roys says.
But the governor says that Medicaid faces a state budget deficit of $1.8 billion over the next two years, which accounts for roughly half of the state’s entire budget gap. His spokesman, Cullen Werwie, has said repeatedly that changes and flexibility are needed to balance the budget.
The $500 million in anticipated cuts Walker proposes would help to plug this hole, Roys said, is “devastating,” because the total damage will be at least twice that since state Medicaid funds are matched by federal allocations of an equal or sometimes much greater amount. “I’m very concerned that we will have tens of thousands of people thrown off the rolls.”
If the budget-repair bill is eventually passed, that decision will be most likely left up to Walker’s new health secretary, Dennis Smith, who also remains a mystery to advocates. On the plus side, several advocates say, they have met privately with him, and he has been “friendly” and “cordial” and even “warm.”
But on the negative side, he has divulged little about the direction he intends to take the programs if Walker gets his way and is able to hand him the reins. And it gets them downright nervous that Smith, a former fellow with the conservative think tank The Heritage Foundation, has advocated that states might be better off walking completely away from Medicaid.
Still, nothing in Walker’s speech or the budget documents he has released so far suggests he has any intention of going that far, at least right now. He does plan to push the federal government for a waiver allowing the state to ignore provisions in the federal health care reform law forbidding it from dropping people from Medicaid rolls or changing eligibility standards.
Without such a waiver, the Walker administration claims, Medicaid expenditures will exceed the budget by more than $100 million during the biennium. And the administration, in what Peacock called “strong-arming,”says it will be forced to drop more than 60,000 adults from Medicaid programs right around the time Obama would be up for re-election.
In a sign that this battle has become a national one, by Wednesday morning my mailbox was flooded with reactions to Walker’s budget speech not just from local and state organizations, but from national interest groups, including a San Francisco-area based union association of registered nurses. “It is time for Wisconsin legislators and officials in other states to stop trying to balance budgets on the backs of working families and the poor, and to fix fiscal problems by requiring corporations to pay their fair share in taxes,” said Jean Ross, co-president of the 160,000 member National Nurses United, in one of these press releases.
Which brings me to a paragraph on page 61 of the executive summary of the budget. Under a data table showing that enrollment in the state's Medicaid and Badgercare programs jumped from 834,027 in fiscal year 2006 to 1,149,452 in the first half of fiscal year 2011, is a statement that pronounces the rate of growth in these programs to be "unsustainable."
Why? Medicaid spending has grown over that period by 50 percent, the report says, while collections of state general fund tax collections have remained flat and individual income taxes and sales taxes have even dropped. As a result, the report says, "the increase in Medicaid costs must be offset by reductions elsewhere, squeezing funding for education, public safety, property tax relief and other essential government functions."
It is interesting to see funding for Medicaid being pitted so starkly against "other essential government functions," which in the Walker administration include not just education and public safety, but "property tax relief."