Diane Acosta, who is uninsured, is treated at a free clinic in Wisconsin by registered nurse volunteer Mary Ann Ihlenfeld
Diane Acosta, who is uninsured, is treated at a free clinic in Wisconsin by registered nurse volunteer Mary Ann Ihlenfeld

MADISON, Wisc. (WOMENSENEWS)– The implementation of the Affordable Care Act in a state where the Republican governor, Scott Walker, is refusing to expand federal aid for Medicaid could mean stay-home moms in families just above the poverty line are left out of the U.S. health coverage push.

"Many of the uninsured are women whose children are on BadgerCare," says Dr. Tom Hirsch, referring to the name the state gives to Medicaid, the low-income health insurance program.

Hirsch has a good eye for who’s dropping through the complicated patchwork of policies and programs because he’s a volunteer rheumatologist at a clinic for people who aren’t covered; the Benevolent Specialists Project Free Clinic in Middleton.

He says the clinic’s overall caseload is lighter thanks to Obamacare, which began to take effect five years ago.

In addition to low-income mothers, the clinic’s patients tend to be undocumented or young. "We’re seeing more young adults who are not covered; they’re younger and healthier and need less medical care," he says.

Because of the many complications and uncertainties surrounding the Affordable Care Act, almost 10 percent of Wisconsin‘s population is still uninsured.

State Rep. Chris Taylor, a Democrat who previously lobbied for Planned Parenthood, says Walker’s promise to refuse Medicaid expansion for people in the state will not go unchallenged.

"It’s harmful to our economy and the health and well-being of Wisconsinites," she said in an email interview. "The Medicaid expansion would bring in around $345 million over the next two years. After creating a $2.2 billion deficit, Gov. Walker does not have the luxury of turning down this kind of funding."

Taylor adds that timing is critical because budget negotiations will be underway for the next several months.

"The Committee will hear from Wisconsinites all over the state in a series of public hearings," Taylor says. "We will hear about how expanding health care coverage improves the lives of Wisconsin‘s residents. Hopefully these stories will resonate with my colleagues and open up a discussion around Gov. Walker’s decision to deny Wisconsinites a chance to improve their health care coverage and their quality of life."

Being Left Out

Katherine Gaulke is executive director of the Wisconsin Association of Free and Charitable Clinics, in Dodgeville, which was created in 2014. She also sees low-income women getting left out.

Gaulke recalls the case of a woman who made $2,300 a month, married to a man covered by disability insurance, who couldn’t find a policy for herself with a deductible of less than $11,000 a year. "That was obviously not affordable for her. We’re seeing a lot of cases where one spouse is covered and the other isn’t," she says.

Like this woman, many of the uninsured in Wisconsin are just above the poverty level but unable to find affordable coverage in the state’s federally-operated marketplace.

The idea behind the federal government’s offer of Medicaid expansion is that people with incomes 100 to 400 percent of the poverty level could go to the marketplace and receive subsidies to help pay for insurance.

Had BadgerCare been fully expanded in Wisconsin, it would have covered those whose incomes were up to 133 percent of the federal poverty line.

Gaulke explains how another scenario can develop and work against a stay-home mother. The spouse employed outside the home — usually the man — will decide against family coverage because even "affordable" family premiums can eat up 50 percent of the family income. In many cases, family coverage is not affordable by any reasonable standard. So the man takes individual coverage from his employer.

Since BadgerCare is integrated with a program for children in need of protection and health care –the children get covered that way.

But when the stay-home mom starts looking at individual policies offered through the various exchanges, she discovers they are prohibitively expensive.

"Affordability" is defined by IRS rules as individual premiums that are no more than 9.56 percent of a person’s salary. But if the individual premium is less than 9.56 percent of the family income, federal subsidies are no longer available.

So while the employed spouse and couple’s children are covered, the unemployed spouse in many cases remains uninsured. Buying costly family coverage through the spouse’s employer is unaffordable and the alternative, buying individual marketplace coverage for the unemployed spouse, sometimes comes with deductibles as high as $11,000 a year.

Alarming Stats

Walker’s opponents are armed with alarming budget statistics about his promise to reject federal money to fully expand Medicaid in the current budget.

In the state’s last budget cycle, Walker’s decision to turn away federal dollars for the low-income public health insurance program cost Wisconsin taxpayers $206 million, according to the nonpartisan Legislative Fiscal Bureau. In the budget that is currently being hammered out, Walker’s decision would cost $345 million, the bureau calculates.

As a result of declining to expand Medicaid, 87,000 Wisconsinites are currently being denied BadgerCare because of Walker’s action, according to Kevin Kane, the lead organizer of Citizen Action of Wisconsin.

Those still covered are most of the poorest citizens, who qualify for BadgerCare because their income is at or below the poverty line.

Adults who miss out as a result of the governor’s refusal to accept Medicaid expansion are just above the federal poverty level of $22,811 for a family of four, sometimes by just a few dollars.

Had BadgerCare been fully expanded in Wisconsin, people earning up to 133 percent of the federal poverty level would have been eligible for coverage.

Walker’s rationale to refuse the money, as he has said on many occasions, is that "federal money is insecure." For each state that decides to expand Medicaid under the new law, the federal government will pay the entire cost through 2016, but gradually lower its portion to 90 percent by 2020.

But Robert Kraig, executive director of Citizen Action of Wisconsin, calls that a red herring. "Walker’s argument about not taking federal money for Medicaid because it’s insecure is absurd because he’s taking $14 and a half billion for other things. His budget is full of federal funding."

Kraig noted that Wisconsin is the only Great Lakes state to still reject the money.

"The initial wave of states accepting the federal money for Medicaid were blue," he said. "Since then some Republican states have accepted the money via negotiated waivers and the states can offer different models."

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