Scott Walker Gets it Right
Wisconsin Gov. Scott Walker (R) announced yesterday that his state will not participate in the Medicaid expansion under the Affordable Care Act, but he proposed an alternative plan to help reduce the number of uninsured state residents. Wisconsin currently allows childless adults with incomes of up to 200% of the federal poverty level to enroll in Medicaid. Walker’s plan would roll that back to 100% and move those with incomes above 100% of FPL into the federal health insurance exchange. more
As we pointed out in this NCPA report, insurance in the exchange will likely be much better than Medicaid, it is almost all paid for by the federal government, and it will pay higher fees to doctors and hospitals, who would otherwise be inundated by patients paying Medicaid rates.
In my analysis, many states could move uninsured residents earning above 100% into the exchanges where they would qualify for highly-subsided private coverage. For uninsured individuals earning below 100%, states could decide which populations (and which services) to cover. The US Dept. of Health and Human Services has indicated states who do this will not qualify for the enhanced matching rate (i.e. 100%, falling to 90% in 2019). But these states should still qualify for the standard matching rate, which is probably 60% or better.
In my previous searches, I found a lot of cost-effectiveness studies but no cost-benefit analyses of Medicaid expansion. A fair CBA would look not just at the economics of expanding or not expanding Medicaid but also the social costs and any impacts in secondary markets. Such an analysis, thought ultimately subjective, would be useful in framing the debate. From a state perspective, Scott Walker’s move makes a lot of sense and shifts the burden from Wisconsin taxpayers to all taxpayers.
It will be interesting what other states end up deciding on. In terms of cost-effectiveness, seems like the Wisconsin Governor is making the right decisions for his state.
Being from Wisconsin, I am very happy so see this.
I don’t understand why states see this money as “free” money from the government. The people still pay for it – either from taxes or from higher inflation.
There is no such thing as a free lunch.