Kelli Simpkins and Mickey

Kelli Simpkins of Madison is worried that Medicaid cuts in the Senate and House versions of bills to roll back much of Barack Obama's health care law could threaten services for her son Mickey, 14.

Kelli Simpkins

The Senate bill to undo much of Barack Obama’s health care law is better for Wisconsin than the House bill in some ways, health care experts said, but is worse in other ways, particularly with Medicaid funding.

Subsidies to help people buy private insurance on the federal exchange are based more on income in the Senate bill, while in the House bill they are tied to age. In both versions, the tax credits are less generous for most people than under the Affordable Care Act, or Obamacare.

Gov. Scott Walker shifted about 63,000 adults with incomes just above the poverty level off Medicaid, saying they could afford coverage on the exchange. That approach relies on income-based subsidies like those the Senate bill includes, said Eric Borgerding, CEO of the Wisconsin Hospital Association.

“That’s positive,” Borgerding said.

But the Senate measure would bring additional Medicaid cuts to states including Wisconsin, which is penalized in both bills for not fully expanding Medicaid under Obama’s law, he said.

By reducing the growth of Medicaid spending more than the House bill does, the Senate version adds $2 billion to the $37 billion the state would lose in coming years compared to states that fully expanded Medicaid, Borgerding said.

“It has only gotten worse in the Senate version,” he said. “We’re more concerned today.”

The Senate bill, which could be voted on next week, doesn’t let states allow insurers to charge more to people with pre-existing conditions, as the House bill does. But both versions permit states to say insurers can reinstate caps on coverage and stop paying for essential health benefits, such as prescriptions, maternity care and substance abuse treatment.

That could make coverage unaffordable for many people with medical conditions, said Donna Friedsam, health policy programs director at UW-Madison’s Population Health Institute.

“Insurers could be offering a much thinner set of benefits for less cost and price the more comprehensive benefits at a much higher cost,” Friedsam said.

As for Medicaid — the state-federal program for the poor, elderly and disabled, which covers more than 1 million people in Wisconsin — the Senate bill “is substantially worse than the House version,” said Jon Peacock, research director for the Wisconsin Council on Children and Families.

Both bills would convert Medicaid from an entitlement program, in which federal payments are based on what states spend, to one with capped federal contributions, per-capita or lump-sum. That would likely require states to pay more, reimburse providers less, cover fewer people or reduce benefits.

The Senate bill’s lower inflation adjustment for federal Medicaid payments would ratchet up the pressure on states, Peacock said.

Wisconsin’s spending per Medicaid participant is already near the bottom among states, and the federal caps would “lock that into place,” he said. “It’s worse in the Senate bill.”

Kelli Simpkins, of Madison, is concerned the Medicaid cuts could jeopardize services for her son, Mickey, 14.

Mickey, who will enter ninth grade at West High School this fall, was born with a brain abnormality and has seizures and limited speech. Medicaid pays for part of his prescriptions, including a $1,900-a-month anti-seizure drug, along with school therapy and home supports that allow Simpkins to work full time.

“I’m worried that with such deep cuts to Medicaid, there will be unintended consequences for families like mine,” she said.

Borgerding said he hopes the bills in Congress are altered so they don’t hit Wisconsin as hard for not fully expanding Medicaid.

Instead of enrolling childless adults with incomes up to 133 percent of the poverty level, almost entirely at federal expense, Walker and the Republican-controlled Legislature limited Medicaid coverage to adults at or below the poverty line.

That left no coverage gap for poor people, unlike in the 18 other states that didn’t do the Medicaid expansion. But it also left Wisconsin paying its regular 40 percent share for about 130,000 poor childless adults who signed up.

The state is paying $280 million a year to cover those people, instead of the $28 million it would have paid under a full expansion, Borgerding said. Ironically, in the Senate and House bills getting rid of Medicaid expansion, the state would lose an additional $37 billion, compared to states that did the full expansion, he said.

“This is what happens when you didn’t expand, in the bill that’s trying to repeal expansion.”

Meanwhile, $2.6 billion in Medicare cuts over 10 years to Wisconsin hospitals would remain in both bills, Borgerding said. The cuts helped pay for expanded coverage in Obama’s law.

“Everywhere we turn, we’re being penalized in this legislation,” he said.

“I’m worried that with such deep cuts to Medicaid, there will be unintended consequences for families like mine.” Kelli Simpkins, of Madison
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David Wahlberg is the health and medicine reporter for the Wisconsin State Journal.