Republican leaders of the Legislature's budget committee on Tuesday approved spending $200 million more in state money for Medicaid over the next two years without expanding eligibility for the program as Democratic Gov. Tony Evers proposed.
With the $200 million investment approved by a 11-4 vote split along party lines, the total spending for health services is $187.5 million less than in Evers' plan.
Evers has said his plan would have saved the state $324 million in 2019-21 and brought in $1.6 billion in additional federal money to greatly boost spending on health care and increase rates for providers.
The Republicans' $200 million investment will increase funding for hospitals, nursing homes, personal care workers, direct care givers and aids, helping to offset a workforce shortage and prevent nursing home closures, said Rep. John Nygren, R-Marinette.
"This investment is not solving the problem completely, but it's taking significant steps in the right direction," Nygren said.
Instead of expanding Medicaid and bringing in more federal money, "we're going to take the balances, the success that's been built over the last eight years (in Wisconsin), and reinvest them," Nygren said.
Sen. Alberta Darling, R-River Hills, said "what we're doing is investing in people, not programs ... We're not expanding welfare."
The $200 million includes $30 million more for nursing homes, $37 million for personal care workers, $27 million for direct care givers and $30 million for aids to children and families.
The investment also increases payments to hospitals, including those in rural areas, and funds 25 to 30 mental health workers.
Some of the increases, such as for nursing homes, Family Care direct care givers, personal care workers, some behavioral health services, Food Share's work requirement program and some hospital payments, are greater than what Evers called for.
Others, including for crisis intervention services, lead abatement, post-partum care, dental services, SeniorCare, dementia initiatives and other hospital payments, are less.
Democrats decried the Republicans' rejection of Medicaid expansion, saying Wisconsin taxpayers, who also pay federal taxes, would benefit from bringing more federal money into the state. "We're paying twice for something we're getting once," said Sen. Jon Erpenbach, D-West Point.
"We will not stop fighting for Medicaid expansion for the people of this state," said Rep. Chris Taylor, D-Madison.
Medicaid expansion would increase the Medicaid-eligible income level from 100% of poverty to 138%. The federal government would pay at least 90% of the cost, up from its regular 60% share for most people on Medicaid.
Taking Medicaid expansion in 2014 would have saved the state $1.1 billion through 2019, according to the Legislative Fiscal Bureau.
About half of the 82,000 people who would newly qualify are uninsured, and the other half have insurance through subsidized plans sold through the Affordable Care Act marketplace, according to Evers' administration.
A Marquette Law School Poll in April found 70% of respondents favor expanding Medicaid. Nygren said that in a survey of his district, when people were asked if they want to expand welfare, more than 80% said no.
Republicans have said Medicaid expansion could increase the cost of private insurance, weaken the individual market and put the state at risk for paying for more people on Medicaid if the special federal funding falls through.
Wisconsin is among 14 states that have not taken the federal funding available for the full Medicaid expansion allowed under the Affordable Care Act.
It is the only one of those states that has no gap in coverage for people with low incomes. Wisconsin's Medicaid program covers people up to the poverty level, unlike those in the other states, and the subsidized private insurance on the Obamacare exchange is available for people who make more.
State Journal reporter Riley Vetterkind contributed to this report.
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