Opinion - Look to Wisconsin for Medicaid reform
Medicaid was created to help people living in poverty have access to health care. Under ObamaCare, it was expanded to include able-bodied, working-age adults without children. That was wrong.
When I was governor of Wisconsin, we opted not to take the expansion. First, we could create our own plan for covering everyone living in poverty. We did — and it worked.
My predecessor had raised the income requirements for Medicaid, but did not fund the gap. That left many impoverished people on a waiting list.
Once I was in office, we restored the limits to cover those living in poverty and eliminated the waiting list. Today, my state is the only one in the nation to have no gap in insurance coverage despite not having taken the expansion.
Second, I did not want to put more people on government assistance. For those who are able, public assistance should be more like a trampoline than a hammock. True freedom and prosperity do not come from the clumsy hand of the government. They come from empowering people to control their own destiny through the dignity of work.
When I first took office, the Cabinet member who oversaw labor issues asked what my priorities were for the agency. He told me that the prior administration said their goal was to bring in as much federal assistance as possible to the state. I told him my goal was the opposite. I wanted to receive less federal funding because more people were working.
During my tenure as governor, we pushed for work requirements for those who were able. We funded worker training and addiction recovery programs to get people into the workforce. It was a success. More people were employed during my years in office than had been at any point in our past.
Third, I was concerned the federal government would not be able to sustain its commitments to the states. Unlike Wisconsin, which had a budget surplus each year I was in office, the federal government continues to have massive deficits and debt issues. Things have only grown worse since my early warnings.
Initially, opposition to expanding Medicaid under ObamaCare was strong. Over the years, however, the appeal of 'easy money' from the federal government became too tempting for many state leaders — saddling private payers with higher costs as well. Thankfully, Republican lawmakers in Wisconsin remembered my concerns. With federal cuts increasingly likely, the Badger State will be one of the few not facing a major budget crisis.
One of the proposals being circulated by congressional leaders is a plan to cut the rate of reimbursement to the states for the Medicaid expansion population from 90 percent to less than 60 percent. States that looked to the federal government to balance their budgets in the past will now experience significant shortfalls due to these reductions in federal funds.
The reduced reimbursement rate being considered by Congress would have cost Wisconsin taxpayers an additional $154 million each year had the state taken the expansion funds according to a recent study by the Wisconsin Institute for Law & Liberty. This is for a program that already represents about 30 percent of the state budget.
Overall, Medicaid is a program that should provide assistance for children, families and seniors living in poverty. It should not be a barrier to able-bodied, working-age adults entering the workforce. These reforms will help provide true savings while ensuring the program serves the population it was intended to serve when it was established 60 years ago.
Looking ahead, officials in the federal government as well as states would be wise to look at the Wisconsin model as they consider reforms to Medicaid. We showed that conservative reforms work.
Scott Walker was governor of Wisconsin from 2011 to 2019. He is currently president of Young America's Foundation.
Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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