On the day he officially launched his re-election campaign, Gov. Scott Walker unveiled a folksy sort of TV ad contending that many things in Wisconsin have improved since he took office.
One claim about health care caused a number of readers to contact us.
The ad, released April 15, 2014, begins with the narrator saying:
"It had gotten pretty bad four years ago. Over 130,000 jobs lost. A deficit over 3 billion. And taxes going up. Wisconsin's future looked dark."
Then come the claims.
"But it's different now. Wisconsin has turned around. The deficit is gone. Taxes are lower. And more people have gone back to work.
"Kids are going to college. Families are planning vacations and more are going to sleep knowing they have access to health care."
Walker has famously opposed Obamacare. On the other hand, he expanded Medicaid eligibility in Wisconsin.
So, just how much credit does he deserve for more Wisconsinites having access to health care?
The lay of the land
We’ll start by acknowledging there isn’t a universally accepted definition of "access to health care," although the phrase carries a presumption that the care is affordable -- another vague term.
To take it to an extreme, people could technically have access to health care even if all they could afford is private insurance with premiums that ate up half of their paychecks. But that would be nothing to brag about.
At the same time, there is little debate that access has increased since President Barack Obama signed the Affordable Care Act in March 2010, some 10 months before Walker took office.
Among other things, under Obamacare:
No one can be turned down for health insurance coverage because of a medical condition; children can be covered under a parent’s policy until age 26; subsidies are available for low- and middle-income people who don’t get insurance from an employer; lifetime caps on health insurance benefits are eliminated; and, quite simply, the law carries a mandate that nearly all Americans carry at least a basic level of coverage.
In Wisconsin, according to an actuarial firm that did a report in 2011 for the state, the Obamacare premium subsidies and mandate are expected to increase the number of residents with health insurance by 340,000 by 2016.
So, where does that leave Walker?
The Republican governor fought Obamacare in court. And he refused what was termed a full expansion of Medicaid under the law that would have been paid for 100 percent initially, eventually declining to 90 percent, by the federal government.
To back Walker’s claim, his campaign cited a report by the Kaiser Family Foundation, a respected national authority on health care, and an October 2013 news release from the state Department of Health Services about the report.
The news release said that -- even though Wisconsin would not expand Medicaid eligibility as provided under Obamacare -- all Wisconsin residents nevertheless "will have access to affordable health care" as a result of the way Walker "reformed" Medicaid.
So, what was the reform?
Walker expanded Medicaid (known as BadgerCare Plus in Wisconsin) to cover adults who previously were not eligible for the program – basically those below the poverty threshold and without dependent children.
(The federal government will pay about 60 percent of the cost, just as it does for other adults covered by the state’s Medicaid programs.)
But adults with incomes above the poverty threshold previously covered by BadgerCare Plus are now required to buy subsidized private insurance on the marketplace set up by the Affordable Care Act. Even after the federal subsidies, they will have higher premiums and cost-sharing – arguably, less access to health care – than they had with BadgerCare Plus.
In other words, Walker is financing his Medicaid expansion with the money the state will save by moving the less-poor adults from Medicaid to the subsidized private plans sold in the Obamacare marketplace.
The catch is, Wisconsin could have opted to expand the Medicaid program through the Affordable Care Act at a lower cost to the state – roughly $100 million lower in the first two years – and a lower cost to many of the people who are losing their coverage under BadgerCare Plus.
The upshot of Walker’s move?
We don’t know yet.
But an estimated 83,000 more people became eligible for Medicaid, while 77,000 were removed from Medicaid -- a net gain, of sorts, of 6,000 people, according to the liberal Citizen Action of Wisconsin, a group that is a frequent Walker critic and which advocated for the full Medicaid expansion under Obamacare.
Walker said that under his leadership as governor, more people in Wisconsin "have access to health care."
He can take some of the credit, given that everyone living under the federal poverty line is now eligible for Medicaid.
But far more people are getting access to health care, whether from the government or private carriers, as a result of Obamacare.
We rate the statement Half True.