The Joint Finance Committee (JFC) took up the Medicaid-related programs Tuesday evening and approved most of the Governor’s proposals. In doing so, the committee cleared the way for deep cuts in Medicaid and BadgerCare and a sharp increase in the number of uninsured state residents.
As the Governor recommended, the bill will require the Department of Health Services (DHS) to make $466 million of “unspecified” cuts over the next two years, beyond the enumerated cuts in areas like Family Care and public health. The committee did make a few positive changes in the bill, while other changes relating to the future process for changing current health policy leave us perplexed.One improvement to the bill is that the committee approved most of the funding that the Legislative Fiscal Bureau (LFB) estimated is likely to be needed to address cost increases that DHS did not account for. As we noted in a Budget Project Blog post yesterday, the committee’s work was made more difficult by the LFB’s estimate (in Budget Paper #340) that the cost to maintain the Medicaid related programs will exceed the DHS projections by $63.6 million GPR and $180 million from all revenue sources. The JFC addressed that problem with the “base reestimate” by adding $154.7 million (all funds), including $53.6 million GPR.
As a result of that change, the unspecified cuts that DHS is directed to make might stay in the $466 million range, though the amount could still climb for a number of reasons, including the fact that the committee didn’t fully fund the LFB base reestimate. We expect the department to make changes like increasing cost-sharing for BadgerCare to 5 percent of income, for families with incomes as low as the poverty level. Since many of those families can’t possibly afford significant premiums for their insurance, tens of thousands of Wisconsinites are likely to lose their BadgerCare coverage, as a new study from the Center for Children and Families at Georgetown Univerisity shows.
We’re still trying to figure out the changes the committee approved Tuesday relating to the Act 10 (“budget repair bill”) provisions that for the next few years transfer much of the legislature’s authority to write Medicaid and BadgerCare policy to the Department of Health Services. According to the motion, the committee is removing the provisions in Act 10 that require DHS to use administrative rules to make policy changes that supersede state statutes. The motion seems to allow such policies to be adopted even without rulemaking, subject only to an opportunity for the JFC to review the proposed change before DHS seeks federal waivers to implement them — though that interpretation of the committee’s intent is debatable.
Until we’ve seen the actual language of the bill, the motion raises more questions than it answers regarding how health care policymaking will work, whether there will be any opportunity for public involvement, and whether the transfer violates constitutional principles about the separation of legislative and executive branch power.
Jon Peacock