Jason Stein

Milwaukee Journal Sentinel

MADISON - With the GOP's repeal of Obamacare stymied in Congress, Gov. Scott Walker is still rejecting the federal law and instead asking the Trump administration to let Wisconsin drug test applicants for state coverage.

Even though federal money remains available for providing health care to more Wisconsin residents, the GOP governor says he's not reconsidering his decision to skip that and forgo hundreds of millions of dollars from federal taxpayers.

Instead, Walker is asking officials in President Donald Trump's administration to sign off on the governor's proposals to move more single adults off state BadgerCare Medicaid coverage and into the workforce. The centerpiece of those measures is the governor's plan to screen childless, able-bodied BadgerCare recipients for drugs.

In a telephone interview Monday with the Milwaukee Journal Sentinel, Walker offered an advance look at his federal request, which if approved would affect tens of thousands of recipients at a cost of tens of millions of dollars per year.

"Obviously, we were going to do it no matter what," Walker said of his plan. "But yes, the more we can push reforms that work for Wisconsin ... the more we can control our own destiny."

Walker's move takes on greater importance following Friday's failure of House GOP legislation to replace Obamacare and House Speaker Paul Ryan's admission that the Affordable Care Act will remain in place "for the foreseeable future."

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Walker and aides think the governor's proposal is likely to be approved by the Trump administration because it loosely mirrors some actions taken in Indiana under that state's former governor, Vice President Mike Pence, and Seema Verma, a former consultant to Indiana who is now head of the federal Centers for Medicare and Medicaid Services.

But Democrats have taken a different lesson from the failure of the Obamacare repeal — they think Wisconsin should also follow Indiana's lead in using federal money to expand Medicaid. State Rep. Gordon Hintz (D-Oshkosh) told lawmakers on the budget committee Monday that Wisconsin has already missed out on the chance to save $690 million since 2014 and cover more people on BadgerCare.

"We have left hundreds of millions of dollars on the table," he said.

But the governor again rejected the idea of expanding BadgerCare to people with somewhat higher incomes, saying it could make people more dependent on the government.

"My goal is not to put more people on Medicaid. My goal is to get people off," Walker said.

Walker's proposals

Instead, Walker is sending a proposal to the Centers for Medicare and Medicaid Services that could affect tens of thousands of childless adults in Wisconsin with incomes below the federal poverty level — $12,060 a year for single adult and $16,240 a year for a couple. Here's what Walker wants to do starting in April 2019:

Screen these Medicaid applicants with questions about illegal drug use and actually test some of them for it. Refusing the test will mean the applicants go at least six months without state coverage. If they test positive, the individuals could receive treatment. Toward that goal Walker is asking federal officials to allow for residential substance abuse treatment for childless adults within Medicaid.

Charge sliding scale premiums of $1 to $10 a month for single adults making $2,533 to $12,060 a year. BadgerCare recipients would have a 12-month grace period to pay past due premiums but if they don't eventually catch up, they'll lose their coverage for six months or until they start paying. Emergency visits would also start having copays of $8 for the first visit and $25 for those afterward in a year to nudge people toward cheaper forms of care.

Give premium breaks to recipients who complete a health risk assessment and who don't engage in risky behaviors such as smoking, obesity, illegal drug use, not using seat belts and alcohol abuse. Recipients can also get the premium breaks if they are working to manage their risk in those areas.

Limit the amount of time on Medicaid for able-bodied workers between 19 and 49 years old to 48 months. After that they would lose coverage for six months. But if recipients are working or getting job training at least 80 hours a month, they could stay on the program for as long as they meet the other requirements.

Walker is also moving forward with similar drug testing and work requirements for other state programs such as food stamps and unemployment insurance. These Medicaid changes won't be cheap — when fully phased in they would cost an estimated $48 million a year in state and federal money and affect about 49,000 childless adults a year, according to the Legislative Fiscal Bureau.

Walker will release his full proposal to the public April 19, take public comment for a month and then send the request with any revisions to federal officials for their consideration.

Jon Peacock, research director for the Wisconsin Council on Children and Families, questioned whether this new red tape is worthwhile, noting that a $1 premium would take effort to collect and won't have much effect on anyone's behavior.

"It's incredibly inefficient and also I think pretty punitive," he said.

Walker said the proposal is a tool to get more people into a labor market where employers are having a more difficult time filling open positions. Addressing drug problems, requiring work and making people familiar with practices like health risk assessments will help do that, the governor said.

"Now more than ever when we’re down to 3.7% unemployment … I just can’t afford to have anybody on the sidelines," he said. "What we’re trying to do is to get people accustomed to transitioning into the workforce."