If your physician graduated from medical school with a C average, you might not want him or her to treat you. The good news is that such a low score would never happen. Medical schools, as a rule, require at least a 3.5 (or B+/A-) average for students to graduate into the residency phase of their training. Only the very best practitioners proceed and ultimately become licensed to care for patients.

The bad news is that health care delivery systems are altogether different beasts. They may stumble or break down due lack of personnel, absence of appropriate federal and state funding and legislation, or a misalignment between patient communities and the providers and resources that should be serving them. According to the 2021 Wisconsin Population Health and Equity Report Card issued by the University of Wisconsin Population Health Institute, part of the UW School of Medicine and Public Health, the state last year earned a paltry C based on key healthcare measures like length and quality of life for its citizens.

Granted, Wisconsin is not the worst state and shares the middle ground with neighbors Iowa and Illinois, which also earned Cs, but falls behind Minnesota. At the top end sit Hawaii (length of life) and Colorado (quality of life) both graded A, while at the bottom are Mississippi (length) and West Virginia (quality), each earning an F grade. You can probably guess which population segments and educational levels tilt the scale either upward or downward in each of the states.

One trait the Badger State does share with one of the F states (Mississippi and West Virginia) is that it’s also one of 13 states (including Alabama, Florida, Georgia, Kansas, Missouri, North Carolina, South Carolina, South Dakota, Tennessee, Texas and Wyoming ) that refused expanded Medicare funds as part of the Affordable Care Act.  Even very conservative states like Mike Pence’s Indiana and Mitch McConnell’s Kentucky have chosen the Medicaid expansion, but not Wisconsin. In other words, rather than increase services to reach underserved populations, Wisconsin’s Republican legislature went its own way, leaving various population groups to suffer under C-grade care, or worse, depending on who they are and where they live.

If we’re grading state legislatures on the healthcare decisions they make, Wisconsin’s may deserve a D or perhaps less.

Gone in 60 Seconds

The idea of turning down additional federal health care funding of more than $1.3 billion for just 2022 in the midst of a worldwide pandemic seems thoughtless at best, but it’s also a political move that can be especially destructive to low-income communities and individuals—both urban and rural—who could most benefit from the additional care such funding would support. Most of these very red rural counties would benefit greatly. It would help keep rural hospitals from going under. Wisconsin’s Republican legislature on May 25, 2021, not only deftly dismissed Gov. Tony Evers’ recommendation, but did so in record time just to add an extra little sting to their legislative slap.

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Acceptance of the funding, which reaches back to 2014, would have extended healthcare benefits to an additional 91,000 Wisconsin residents by raising the income gap from 100 percent of the poverty level, then $26,500 for a family of four, to 138 percent, or $36,570. Evers’ proposals offered various ways to spend the money, including broadband expansion, lead pipe replacement and other public needs. No thank you, the state assembly and senate said, both convening and adjourning their sessions in less than a minute between the two groups without holding any debate or counting votes. Instead of joining 38 other states and Washington, D.C. who already have benefited from such funding, Wisconsin found itself relegated to a group of more conservative states not necessarily known for their progressive public service policies.

Moreover, health care providers have noted that BadgerCare Plus, the state’s Medicaid program, is not as foolproof as its Republican supporters claim. “Many of our friends, family and neighbors are falling through the cracks and going without adequate coverage through no fault of their own,” Dr. Madelaine Tully, a family physician in Milwaukee County, told Wisconsin Public Radio in the wake of the legislative decision. “As a doctor, I’ve seen what happens when people go without coverage.” 

Tully also argued that expanded Medicaid coverage would allow for more preventive care, saving taxpayer money by avoiding more costly and invasive procedures down the line. 

Medicaid money not only provides health care and save lives of low-income Wisconsinites, but also saves money for all of us. How? When individuals without health insurance begin to get ill, they wait before going to a doctor or hospital because medical care is costly. Their conditions get worse. They may resort to emergency rooms often with conditions that have worsened from lack of care, such as a stage four cancer instead of stage one or stage two cancer. Emergency rooms are much more expensive. 

So, who ends up paying the bill? The hospitals must initially eat the expense. Then they cost shift and spread much of the “charity care” expenses to those who have insurance or are paying out of their pockets. Insurance companies then raise their rates to cover the costs of the care that has been shifted. This means higher rates for employers who provide health insurance to their employees or those who are paying out of their pockets. Some employers then lower the percent of the premium they pay for their employees. Basically, we are all paying for these higher costs because Assembly Speaker Robin Vos and the Republican majority in the legislature are willing to let people get seriously ill, and in some cases die, so they can try to gain political points with the extreme wing of their base. At the same time, Wisconsin legislators have excellent health insurance for themselves and their families.

So What Does This All Mean?

According to a report by independent healthcare analyst KFF – the firm’s preferred acronym to its full name of Kaiser Family Foundation – states that accepted expanded Medicaid funds saw positive results in many medically related areas. Needless to say, Wisconsin wasn’t part of its positive reporting.

Results from KFF’s study, Building on the Evidence Base: Studies on the Effects of Medicaid Expansion, February 2020 to March 2021indicated that Medicaid effectively has served as a safety net especially during the pandemic and resulting economic crisis. Coverage options for adults from low-income areas are limited in states that turned down the expanded funds. Think Wisconsin’s C grade at this point.

The report analyzed data culled from 200 different studies of various states’ programs, which built on a prior report which analyzed earlier results from 400 different studies. Analysts concluded that Medicaid funding expansion is linked to gains in health care coverage, including improvements in access, financial security, and some measures of health status/outcomes, and economic benefits for states and providers. Specific highlights include the following:

• Medicaid expansion has led to a 3.6 percent reduction in overall mortality, and a 1.93 percent improvement in mortality rates connected to specific health conditions. 

• Fund expansion has led to largely positive results in treating people with cancer, chronic diseases and disabilities. Cancer patients, especially, seem to have benefitted from earlier and improved diagnoses, treatments and outcomes.

• Increased funding also led to better outcomes for adults and teens with diabetes, including increased affordability for preventive care and treatment.

• Access to care for substance abuse disorders also improved under increased funding.

• Additional funding also helped improve access to health care in rural areas, where providers and facilities are fewer and farther between.

• Surprisingly, perhaps, expanded Medicaid funding had a net positive impact on financial expenditures, including net savings in costs of other areas, such as substance abuse initiatives, mortality reductions, and significant annual health and welfare gains.

In the end, the KFF study points out positive results from its analysis of nearly 600 studies, which may help states who still haven’t accepted Medicaid expansion funds take another look at the possibilities. With any luck even states like Wisconsin—with grade D health care and, apparently, a grade D legislature—might learn something useful about improving health and saving lives of its citizens.

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Medicaid Expansion Funds Could Help Raise the Quality of Wisconsin’s Healthcare – and Legislature – Shepherd Express