The American College of Physicians Wisconsin Chapter, the medical society that represents internists, is encouraging its members to actively support non-binding referendums that endorse the state's accepting additional federal dollars available through the Affordable Care Act to expand its Medicaid program.
"It's supporting a policy that we think is important for the health of the state," said Ian Gilson, co-chair of the health and policy committee of the Wisconsin chapter and a staff physician at the Medical College of Wisconsin. "This is a big priority for those of us who take care of patients."
The referendum will appear on the ballot Tuesday in 19 counties, including Milwaukee.
The Legislative Fiscal Bureau estimated in August that the state would have saved $206 million in the current budget and would save an addition $261 million to $315 million through June 2017 by accepting the federal dollars available through the Affordable Care Act.
Accepting the federal money also would require the state to expand its Medicaid program to cover all adults with household incomes up to 138% of the federal poverty threshold — $16,104 for an individual this year.
Under the approach taken by Wisconsin, adults with incomes between 100% and 138% of the federal poverty threshold — $11,670 to $16,104 for an individual — now can buy subsidized private health coverage through the marketplaces set up under the Affordable Care Act.
The Department of Health Services has estimated that about 27,000 people are in this group.
"The exchanges really weren't designed for those people," said Tom Jackson, co-chair of the health and policy committee of the Wisconsin chapter and an emeritus professor at the University of Wisconsin-Madison School of Medicine and Public Health.
People with low incomes who buy health plans on the marketplace receive additional subsidies to help offset deductibles, co-pays and other out-of-pocket expenses.
But even with the additional subsidies, the plans still have deductibles, which can cost $250 or more, and costly co-pays for insulin for patients with diabetes and for inhalers for patients with asthma, said Jackson, who volunteers at Bread of Healing Clinic, which operates three free clinics in Milwaukee.
Those are covered by BadgerCare Plus, the state's largest Medicaid program.
Gilson also stressed that the health plans sold on the marketplace were not designed for people with very low incomes.
The hope is to send a message to the Legislature if the referendums pass by a large margin, Gilson said.
The counties with referendums include Dane, LaCrosse and Eau Claire as well as the City of Kenosha. The drive to get the referendums on the ballot was led by Citizen Action of Wisconsin, a liberal political action group.
The wording of the referendums varies slightly in each county, but a "yes" vote in all of them supports the state accepting the additional federal dollars.
Gov. Scott Walker proposed and the Legislature approved expanding the state's Medicaid program for adults with incomes below the poverty threshold who previously were not eligible for coverage while rejecting the federal dollars available under the law to pay for the expansion.
More than 100,000 adults have obtained coverage through BadgerCare Plus under this approach.
Under the Affordable Care Act, the federal government would pay 100% of the cost of the expansion through 2016, eventually declining to 90% in 2020.
The federal government instead is paying about 58% of the cost. This is the share — the exact percent can vary by a few percentage points — that the federal government historically has paid toward the program's cost.
Adults with incomes above the poverty threshold can buy subsidized private health plans on the marketplace set up under the Affordable Care Act.
Walker has contended that the federal government eventually will renege on its commitment to pay for at least 90% of the cost of expanding Medicaid, given the federal budget deficits and fiscal challenges facing the country. A "no" vote on the referendum would back Walker's stance.
People who buy subsidized private health plans on the marketplaces also get a choice of private plans. In addition, what Medicaid pays doctors and hospitals typically doesn't cover their costs while the private health plans sold on the marketplace pay doctors and hospitals higher rates.
But Jackson said accepting the additional federal money could enable the state to increase Medicaid reimbursement rates or have more money for other programs.
"It would be more money for the Medicaid program," he said, "but it would cost the state's taxpayers less."
