Key parts of the state's plan to trim $554 million from Medicaid over two years will be sent to the federal government, after the Legislature's budget committee approved the proposal Thursday.
The Republican-controlled Joint Finance Committee voted 11-4 along party lines after debating a new finding by the nonpartisan Legislative Fiscal Bureau: The measures would cause nearly 65,000 people to leave or be turned away from BadgerCare Plus and other Medicaid health programs for the poor.
More than 22,000 would leave because of higher premiums, nearly 28,000 would be required to shift to employer insurance, and thousands more would become ineligible due to income or residency requirements, the fiscal bureau said.
That is in addition to more than 200,000 people who would be shifted to a lower cost plan with fewer benefits. Democrats said the fiscal bureau figures show Republican Gov. Scott Walker's administration would force tens of thousands off insurance and shift the cost of their care to others.
"It appears to me we are leaving people without choices," said Rep. Tamara Grigsby, D-Milwaukee.
"It's a hidden tax to businesses and consumers when people aren't covered and they go into emergency rooms," said Rep. Cory Mason, D-Racine.
Dennis Smith, secretary of the Department of Health Services, said increasing premiums and co-payments for those who can afford it would bring Medicaid more in line with private insurance. The disabled, the elderly and the poorest enrollees largely would be protected from cuts, he said.
A single parent with two children who makes $28,000 a year — 50 percent above the federal poverty level — would pay a monthly premium of $116, up from $10 now. That's still less than the $201 state employees will pay for similar coverage next year and a third of what most families pay for private employer coverage, Smith said.
"We believe our approach is much more equitable to the families of Wisconsin," Smith told the committee. "What we are trying to do is bring Medicaid into the modern era."
Sen. Alberta Darling, R-River Hills, said the state can't keep increasing enrollment in Medicaid, which has grown by about 10 times the rate of state's population the past two decades.
The $6.7 billion program — roughly 60 percent is federal money and 40 percent state money — covers 1.2 million people, or one in five Wisconsin residents.
"It's unsustainable," Darling said, telling Smith "I applaud you for what you've done. You're trying to protect the most vulnerable."
The state soon will submit its plan to the federal Centers for Medicare and Medicaid Services, said health services spokeswoman Stephanie Smiley.
If the federal agency doesn't approve the proposal by Dec. 31, the state will instead drop Medicaid coverage next year for 53,000 adults who earn more than 33 percent above the federal poverty level, or about $30,000 for a family of four. The deadline was included in the budget law passed this year.
Many of the 53,000 people would be poorer and potentially have less access to other coverage than the 65,000 people mentioned in the fiscal bureau analysis.
Democrats and BadgerCare advocates said the federal government usually takes 90 days to review state requests. They accused Smith of dragging out the process so the federal Medicaid agency couldn't meet the deadline.
"This is a very unfortunate timeline," said Sara Finger, executive director of the Wisconsin Alliance for Women's Health and coordinator of the Save BadgerCare Coalition.
Bethany King and her husband Justin Robbins hope they don't lose BadgerCare. The couple from DeForest, who have two young children and run a maintenance business, were among several families the Save Badger Coalition invited to speak at the Capitol before the budget committee hearing.
Robbins, 37, said that if the couple's business has a good year, the income could cause them to lose BadgerCare under the state's proposal. They can't find affordable private coverage, he said.
"It encourages us not to be successful," Robbins said.
King, 30, said that after developing abdominal pain in May, she went to the emergency room because she had health insurance. Doctors discovered a serious intestinal disorder and operated right away.
"If I didn't have insurance, I would have waited," King said. "Had I waited, I would have died."