Wisconsin Governor Scott Walker at the 2017 Conservative Political Action Conference. Gage Skidmore, via Flickr

CJR recently invited contributions from journalists whose work focuses on the healthcare challenges specific to their communities. We asked each reporter the same question: “As the nation anticipates passage of the Better Care Reconciliation Act, what are the health stories that are most urgent for journalists to tell in your region?” As the Senate moves towards a vote, read more dispatches from CJR’s series here.

IN 2014, WISCONSIN IMPLEMENTED a partial Medicaid expansion. The state limited Medicaid coverage for adults to those whose incomes are at or below the federal poverty level. As a result, Wisconsin enabled 130,000 childless adults to sign up for Medicaid, but removed roughly 63,000 parents and caretakers from the program.

The removals were a conscious choice. The Affordable Care Act permitted a full Medicaid expansion plan, but the state chose only a partial one. Republican Governor Scott Walker, along with members of the Republican-controlled state legislature, argued that those 63,000 people could obtain private coverage on the Obamacare exchange. However, some of those people make less than 133 percent of the poverty level—a group for whom the exchange was not intended.

Therefore, Wisconsin residents are more vulnerable than many others when it comes to proposed changes in government subsidies for insurance. Under the bills before Congress, subsidies could shift from people with lower incomes to those who make more, making it even harder for the poorest of those 63,000 former Medicaid recipients to afford coverage

Meanwhile, Walker has asked the Trump administration to allow Wisconsin to mandate drug screening for poor, childless adults who seek Medicaid, and to impose a time limit on such coverage unless recipients work. Wisconsin could be the first state to implement such requirements, but other states are expected to follow.

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Health reporters throughout the country would do well to look at Wisconsin as a case study in Medicaid restructuring, and to anticipate how they might cover such changes in their own communities.

There is a narrative for each individual implicated by Wisconsin’s proposed Medicaid requirements for childless adults.

At the Wisconsin State Journal, where I have been the health reporter since 2005, we anticipated the significance of health reform and published two front-page Sunday stories after the November election. Since Trump’s inauguration, we have tracked details of state and federal proposals, partly by covering forums and hearings. We have also written about particular services that could be cut: birth control, cancer screening and testing, and treatment for sexually transmitted diseases at Planned Parenthood clinics.

Those approaches have helped readers understand the importance of what Congress might do. But because specific details of the legislative plans have been limited, the articles lacked personal stories and narratives, which can help readers consider policy changes in light of who those changes affect.

There is a narrative for each individual implicated by Wisconsin’s proposed Medicaid requirements for childless adults. Those who refuse drug screenings would go without coverage; those who test positive could enroll in Medicaid and receive addiction treatment, if it is available. Enrollees would face a four-year limit on benefits unless they worked or trained for a job, and many would also have to pay premiums.

Whether such welfare reform-like rules should be applied to health care is a key point of national debate, even within conservative circles. “Public assistance should be a trampoline, not a hammock,” Walker has said.

If Congress passes the Better Care Reconciliation Act, reporters in the Midwest and elsewhere can localize the story by focusing on their state’s Medicaid program. Advocates can help reporters identify patients whose lives could be altered by eligibility changes and capped federal payments to states. With one in five Americans covered by Medicaid, it’s a story that deserves significant attention.

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David Wahlberg has been the health reporter at the Wisconsin State Journal in Madison since 2005. He previously covered health and other topics at the Atlanta Journal-Constitution, Ann Arbor News, San Bernardino Sun and Wausau Daily Herald. His projects on cancer research, organ transplants, doctor discipline, rural health care, and patient safety have won national awards.