Under the Affordable Care Act, states have had big choices to make. Some -- mostly so-called "blue" states -- have fully embraced the law. Others -- mostly so-called "red" states -- have resisted its implementation.
But Wisconsin's Republican governor and majorities in the state Legislature took a unique approach: They publicly turned down parts of the law while using the legislation to expand state-run health care at the same time.
Gov. Scott Walker refused to set up a state-run health insurance exchange and turned down a federally-funded expansion of BadgerCare, the state’s Medicaid program. That may sound like Wisconsin is dragging its feet, but the Walker administration has embraced the Affordable Care Act in a few key ways. First, the governor expanded Badgercare to those making less than $11,000 a year.
State Department of Health Services Deputy Secretary Kevin Moore said nearly 82,000 new people will now be covered by the state, and they’re counting on the new health exchange to pick up around 77,000 who are losing their Badgercare coverage.
"Because of the governor’s reforms," Moore said, "people that live in poverty will have access to Medicaid and those above poverty will have access to affordable health insurance through the marketplace or exchange."
There are, however, tradeoffs. Since Walker expanded BadgerCare while turning down the federal expansion money, it will cost the state nearly $340 million over eight years. Moore said it ensures the state won't get stuck with the bill if the federal government break their funding promise.
However, critics like David Riemer, of Community Advocates, are concerned about more than just the money. He said he's worried many people losing Badgercare won’t sign up on the federal exchange.
"My prediction is that unless we do something quite dramatic and clear to make it a lot easier for them to sign up, I think that 50 percent of this group that’s supposed to transition into the Obamacare exchange are just going to drop out," Riemer said. "They’re going to disappear and be uninsured again."
To keep that from happening, Walker did what many Republicans are hesitant to do: He expanded government by adding 88 employees and is spending nearly $78 million on health care education to help transition people to and from BadgerCare. Most of the staff will work in Milwaukee, while 18 workers will be based in Madison to assist county health departments.
Walker said his administration has also been training non-profits and others on how to help make their health care decisions.
"We worked diligently over the past several months to make sure that we’ve got over 1,500 partners across the state. We’ve been working with stakeholders -- from hospitals to healthcare providers to non-profit groups to public health department -- to make sure that the people of this state who are eligible for the healthcare exchanges know what they are, know what their options are," he said.
Perhaps, it’s ironic then that even though an opponent of the Affordable Care Act like Walker added dozens of state employees and is spending tens of millions to make it work for Wisconsin, the success of it all now rests on a glitchy federal website, healthcare.gov .
Wisconsin Hospital Association Vice President Eric Borgerding calls it a waiting game.
"The proof will be in how many people actually enroll in coverage through the exchange. At this point we could have the best enrollment network in the country, but if you can’t actually get enrolled that doesn’t really matter.”
Borgerding is hopeful that the website will be fixed, but he said there's another looming concern for hospitals as well as the state and the federal governments. That's whether people who haven't had health insurance before will keep up with payments.
"Getting people enrolled is one thing -- and clearly that is a daunting task -- (but) people maintaining that coverage is going to be a whole other ball of wax," Borgerding said. "And we’re as concerned about that as we are about enrollment."
Though the federal website might be stuck, the clock is still ticking for the state to get more than 160,000 people signed up for BadgerCare or private insurance on the new exchange.