IE 11 is not supported. For an optimal experience visit our site on another browser.
Image: A sign for a polling place near the state capitol in Madison, Wis., on Nov. 6, 2018.
A sign for a polling place near the state capitol in Madison, Wis., on Nov. 6, 2018.Nick Oxford / Reuters file

Why it matters that the Wisconsin GOP rejected Medicaid expansion

Biden thought he'd come up with a Medicaid expansion offer that states couldn't refuse. Republicans still don't care.


For most of the country, it was obvious years ago that Medicaid expansion through the Affordable Care Act is a good deal, but as regular readers know, there are still 12 holdouts. As a consequence, there are more than 2 million low-income Americans who don't have health security, simply because Republicans in their respective states refuse to do the right thing.

One of those 12 states was handed an opportunity to act yesterday. As the Associated Press reported, it did not go well.

Republicans who control the Wisconsin Legislature on Tuesday convened and within seconds ended a special session called by Democratic Gov. Tony Evers to expand Medicaid, dashing chances for the state to receive a one-time bonus of $1 billion in federal coronavirus relief funding. The Senate and Assembly gaveled in and adjourned the special session in mostly empty chambers with only a handful of lawmakers in attendance.

The process was remarkably efficient. After Wisconsin's Democratic governor called a special session on the matter, officials in the Republican-led state Assembly showed up, banged the gavel, and left after 40 seconds. In the Republican-led state Senate, they moved with even greater speed: the session wrapped up in less than 10 seconds.

GOP legislators not only refused to vote on Tony Evers' Medicaid expansion plan, they also refused to even debate it.

There are two angles to this that matter, and not just in the Badger State. The first is that, in theory, Republicans in the Wisconsin legislature are risking a fierce public backlash by expressing such callous indifference toward struggling families and their own state's finances. But in practice, GOP state lawmakers assume they're free to act with impunity, and they're almost certainly correct: Wisconsin Republicans have rigged the state's district lines to such a degree that the GOP keeps power, even when Democrats win more votes.

In other words, Wisconsin Republican legislators can make unpopular and irresponsible decisions, comfortable in the knowledge that, despite operating in an ostensible democracy, there's little voters can do about it.

But let's also not lose sight of the financial incentives GOP lawmakers in Wisconsin rejected out of hand. In the Democrats' COVID relief package, called the American Relief Plan, President Joe Biden thought he'd come up with an offer that states couldn't refuse.

As we discussed in March, the policy may sound a little complicated, but the offer was straightforward: under the ACA, the federal government already covers 90% of the costs of expanding Medicaid. As Vox explained, the Democrats' relief package ups the ante: "[N]ewly expanding states would also receive a 5 percent bump in the federal funding match for their traditional Medicaid programs for two years. Because the traditional Medicaid population is significantly larger than the expansion population, the funding bump is projected to cover a state's 10 percent match for expansion enrollees and then some over those two years."

It led Jon Chait to joke, "Now states taking the Medicaid expansion would have more than 100 percent of the cost covered by Washington. They would literally have to pay for the privilege of denying coverage to their poorest citizens."

Nearly three months later, how many states did the obvious thing? None. Literally, not one of the 12 holdouts has budged.

To be sure, Republicans were made aware of the incredibly generous offer, but they nevertheless said no in Wisconsin. And Texas. And Wyoming. And Florida. And Tennessee.

Meanwhile, in Missouri, voters added Medicaid expansion to the state constitution last year, but GOP officials said they don't care and still won't approve the policy. A new lawsuit intends to force Republicans' hands. Watch this space.