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Gov. Scott Walker's budget repair bill proposes sweeping changes to the state's Medicaid programs, changes that could affect many of the 1.2 million state residents enrolled in public health programs like BadgerCare, Family Care, and SeniorCare. The provisions would allow the administration to revamp and even gut the programs without following state laws or the normal legislative processes. 

But not many people seem to know or care, judging by the protests in the Capitol this week.

Tens of thousands of protesters in Madison, including children, teachers, firemen, police officers, and other union workers, have jammed the Capitol's marble corridors and hung banners from balconies. But the issue that has captured the attention of the entire country is workers' rights. Hardly any of the signs or the slogans have had anything to do with Medicaid programs. In one week of covering the rallies, Capital Times reporters found only one protester, a self-employed worker named Frank Church from Shorewood, who said he showed up because he worried the bill might threaten his health benefits.

"Everybody who is controlling the message is only controlling it to be about the unions," says Molly Cisco, director of Grassroots Empowerment, an advocacy group for people with mental illnesses. "I have been screaming about this. I've been sending letters to the editor and calling the Democratic Party every hour. It's been so frustrating. I don't want us to be pitted against the unions, but they've been so loud we haven't been able to find our niche or get our voices heard."

Cisco and many other advocates say they appreciate the media coverage and public support for workers' rights, but that their constituents, from infants and mothers in poor neighborhoods to the disabled and the elderly, deserve a share, too.

The first local story to delve into the bill's impact on state Medicaid programs was our piece last Monday on how provisions in the measure would hand sweeping new powers to the Walker administration to circumvent normal legislative processes, state rules, and public vetting, but for the rest of the week there was scant other local coverage. (I did another piece Wednesday reporting that the attorney who drafted these provisions raised constitutional issues about them, and the Wisconsin State Journal has a story on the state Medicaid programs today.) Even the New York Times, usually so thorough, has in most articles totally ignored the fact that the bill is not just about labor, or the budget---that it is also about changing how Medicaid is administered in this state.

Many politicians have been as mum as protesters and reporters on this issue, though not all. "Every time I have a reporter willing to listen to me I bring it up," says Rep. Sandy Pasch, D-Whitefish Bay, who got an column on the topic published in the Milwaukee Journal Sentinel  last week. And are the reporters interested? "No, they're not," she sighs. "There isn't that same indignation." Even many of the Democratic senators who have fled the state to stall a vote on Walker's bill have rarely used the M word in their recent media interviews, including, surprisingly, Sen. Jon Erpenbach, D-Middleton, long a champion for expanding health care coverage.

By the end of the week, frustrated providers and advocates had formed a coalition of more than 30 organizations called the Medicaid Matters Alliance. They have also organized a press event Sunday aimed at grabbing their share of the spotlight. "We have been muted. We have been overshadowed by a lot of really important issues that have to do with employee wages and benefits," says Lisa Pugh, communications director of Disability Rights Wisconsin. "But citizens concerned for their children's teachers need to be aware that one of their elderly neighbors down the street, or a child they know with a disability, probably uses a program with Medicaid and will be equally affected by this bill."

Advocates are lobbying the Democratic Party and unions to bring up their concerns when they talk to the press and public. Hugh Davis, executive director of Wisconsin Family Ties, sent an e-mail to Democratic party officials typical of the thousands of e-mails advocates have been forwarding to legislators and other power brokers: "Lost in all the media coverage about worker rights is the fact that SB11/AB11 would grant unprecedented power to the administration to change Medicaid in Wisconsin without going through the full legislature. Allowing an unelected official (Department of Health Services Secretary Dennis Smith) to essentially make law in the state, is in my opinion, an egregious violation of the separation of powers. Making law is the province of the legislature. As state democratic leaders are being interviewed by members of the media, please don't forget this onerous provision of the budget repair bill."

But what took so long for these pleas to go out, and why have so few taken up the cry?

I posed that question to more than a dozen people last week including politicians, legislative aides, political party spokesmen, union demonstrators, advocates, and policy experts. It has been an exhausting week, they say, so a big reason people haven't been talking more about Medicaid is that the bill is being moved so quickly through the Legislature that it took them some time to catch up to its implications. "We're just trying to keep our heads above the water," says one Democratic staffer who hasn't slept for several days. Graeme Zielinski, communications director for the state Democratic Party, says the party is having trouble keeping up as well. "It's like we have gunshot wounds to the head, to the belly and to our front. We're doing triage to a very, very bad bill," he says.

The Republican Party, for its part, was quick to respond to my questions about the issue by claiming that the focus on workers' rights proves Democrats are controlled by special interests. "There are all these serious issues, but when it comes to priorities the unions are most concerned about their own pocketbooks and how does it affect them specifically," says GOP state director Mark Jefferson.

Workers' rights is a simpler and more appealing message, too, than the complexities of Medicaid policy and process. Take this pitch from Move as a typical example of how last week's political spin stuck to one theme only: "Dear Wisconsin MoveOn member, Madison is electric right now. Tens of thousands of middle-class Wisconsinites---teachers, nurses, firefighters---are demonstrating at the capitol today. They're trying to stop the new, tea-party governor from ramming through one of the worst union-busting bills in recent history..." Why mess that up with the complications of public health programs and attitudes about the poor?

And explaining exactly what this bill does to Medicaid is complicated, since the bill is not yet calling for actual cuts to the program, it is laying the groundwork to make such cuts easier for Walker and Health Secretary Smith, who as I reported last month advocated that states walk away entirely from Medicaid when he was a senior fellow at the conservative think tank The Heritage Foundation. "They're going after these programs in a backdoor way by changing the process," explains Lisa Lamkin of AARP. "The impact and the implications are almost worse because you can rally people around a cut. But when you try to get people jazzed up over changes in the rule-making process, their eyes glaze over. It's not an easy sound bite."

Unions are well-organized with a big war chest and workers ready to mobilize. The same isn't true for the one out of five Wisconsin residents who relies on Medicaid programs, and that makes it hard to, say, bring thousands of them to the Capitol. "Part of the that Medicaid recipients are recipients by virtue of being very, very poor," says Paula Buege, a patient advocate. "Awful hard to arrange a rally, organize a bus and be prepared when you have no money to do it."

The difficulty in getting many of these people to be heard, says Lisa Pugh, communications director with Disability Rights Wisconsin, is one reason her organization opposes a clause in the bill that would do away with the legislative process and public hearings now required to make changes in the Medicaid programs. "It's hard to get the elderly and people with disabilities to a march in Madison," she says. "So when you take away the public and legislative process, you're taking away the voices of a very vulnerable population."

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There remains some stigma about receiving Medicaid (some farmers Pasch asked to speak out on the issue were too embarrassed) and even resentment toward recipients, advocates say. "When I walked into the Capitol and went into the Rotunda, and saw it jam-packed at all levels," Davis recalls, "the first thing that went through my mind was wouldn't it be great if one day we could get this kind of response and support for children with mental health problems?"

That is what advocates hope their press conference today can start to accomplish. The delay over the measure caused by the senators who fled town to avoid a vote will also give them much needed extra time to spread the word about this overlooked aspect of the bill, they say.

Several legislators are busy drafting up what will be a raft of amendments aimed at forcing the Assembly to at least look at and discuss the Medicaid provisions, legislators say. "By slowing down the Republicans' rush to ram this bill through to a vote, we hope the public will have more time to understand all the varied impacts of this complex bill, particularly the negative effect it could have on health care for our children, seniors, and most vulnerable citizens," says Minority Leader Peter Barca, D-Kenosha, in an e-mail response to a request for comment. "An ever greater hope is that after hearing from the public, Republicans will be willing to make changes to this dangerous legislation."

But that would seem to be a slim hope indeed, based on what Republicans have done so far and the speed with which Walker is trying to get the legislation pushed through the Capitol. Which gets us to one last reason we haven't heard much about the Medicaid provisions. Maybe we never were meant to.

Walker's staff buried this stuff deep in a budget-repair bill that claims to be about fiscal matters, advocates say, not major policy changes, which makes some of them allege that the noise over workers' rights was intended all along to be a sort of decoy. "One of my fears is that this might be a way of keeping our attention on something else while they sneak something by," Cisco says.

Last Friday, Assembly Republicans convened their floor session before its scheduled start and took a voice vote to push the bill past the amendable stage and toward final passage before Democrats even entered the chamber.

After outraged Democrats protested the action was illegal, members returned the bill to its amendable stage. The Assembly will meet again on Tuesday. Whether this means the Medicaid provisions will finally get some kind of attention nobody knows.