Gov. Scott Walker's formal request to the Trump administration last year to overhaul Medicaid included provisions that were more aggressive than those sought by other GOP states. | Scott Bauer/AP Photo Health Care Scott Walker, in fight for political life, slow-walks Medicaid work rules The delay comes as many Republicans have retreated from health care on the campaign trail.

Wisconsin Gov. Scott Walker sought for years to put Medicaid recipients to work. Now federal officials have given him most of what he wanted, but he's delaying the process for fear the changes will doom his flailing reelection bid, say three federal officials familiar with the deliberations.

“Wisconsin's been stalling,” said one official, adding the Trump administration has been ready to formally approve and announce the state’s new work requirements for weeks. “It’s ended up being a lot of hurry-up-and-wait.”


The Walker administration disputed the governor is slow-walking the process, saying that the state is actively pursuing approval and instead blamed the Trump administration for delays. "There are ongoing conversations," said Julie Lund, a spokesperson for Wisconsin's Department of Health Services. "We've felt it's close for a while."

“The idea that Wisconsin’s been stalling is unequivocally false,” said Tom Evenson, the communications director for Walker, after initial publication of this article.

The delays around implementing Wisconsin's strict Medicaid work rules come as many Republicans have retreated from health care on the campaign trail — and as Democrats hammer the message the GOP is working to strip health protections from millions of people. Democrats have an 18-point national advantage on health care, according to a Washington Post/ABC News poll released on Sunday.

Those who criticize Walker for hesitating contend that focusing voters’ attentions on health care is likely to hurt him with independents who are expected to decide the election. The two-term governor is effectively tied with or trailing Democratic candidate Tony Evers in multiple polls ahead of the Nov. 6 election.

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Democratic messaging on health care has already resonated with some voters in Wisconsin, where Walker supports a lawsuit to overturn the Affordable Care Act and has aggressively reined in spending on social programs — the focus of some Democratic attack ads.

Walker's formal request to the Trump administration last year to overhaul Medicaid included provisions that were more aggressive than those sought by other GOP states — part of the governor’s effort to roll back Wisconsin’s safety-net programs.

“We fundamentally believe that public assistance should be a trampoline, not a hammock,” Walker said in January 2017, laying out an ambitious plan for more cuts under the Trump administration.

Some of Walker’s Medicaid requests were deemed impermissible by the administration. For instance, Walker sought to drug-test beneficiaries, which the federal health department rejected; Federal Medicaid officials instead will permit Wisconsin to ask beneficiaries about their illegal drug use. But other measures, like requiring beneficiaries to pay toward their care, were approved by the Trump administration, which finalized the work requirements weeks ago.

Medicaid’s top official effectively teased the announcement last month.

“I’m happy to share with you today that we have finalized the terms for our next innovative community engagement demonstration, which we expect to deliver to the state very soon,” Seema Verma, administrator for the Centers for Medicare & Medicaid Services, said in prepared remarks on Sept. 27. “So stay tuned!”

Nearly three weeks later, CMS has yet to identify the state, although multiple officials told POLITICO that Verma was referencing Wisconsin and the holdup has been on Wisconsin’s end. A spokesperson did not respond to questions Monday about which state Verma was referencing or about Wisconsin's request.

"We are finalizing the terms of a few innovative community engagement demonstrations and we expect to have official announcements soon," the CMS spokesperson said.

In Wisconsin, Walker has gestured toward health care issues in recent days, taking credit last week for falling premiums on the ACA marketplaces and on Monday vowing to protect patients with pre-existing conditions, although he has supported a lawsuit to eviscerate the ACA.

But the health care issue has mostly flown under the radar in both his and his rival's campaign. Wisconsin’s gubernatorial candidates instead have battled over infrastructure and education; Evers is the state’s schools superintendent, providing a focal point for his campaign and for Walker’s attacks.

Here, as elsewhere around the country, though, voters are interested in health care, even if neither candidate is talking about it much, say election-watchers.

“When we’ve asked voters to identify their ‘most important’ issues, health care has been No. 2, right behind K-12 education, and ahead of roads and highways,” said Charles Franklin, who runs the Marquette Law School poll — which last week found that Walker was ahead by 1 point over Evers, 47-46.

The close race, and pitched camps, has meant that Walker and Evers are fighting over a thin slice of the electorate, said Brandon Scholz, a GOP strategist in the state.

“Any issue that comes up has to move the independents in the middle,” Scholz added. “The question is which issue is going to drive them most? Is it health care? Is it education? Is it the gas tax?”

In this context, Scholz thinks that Medicaid work requirements could help Walker, arguing that the state’s independent voters — "a mixture of working-class families [like] Joe Lunch Bucket and college grads" — would be receptive to a message about personal responsibility, he said.

Franklin, the Marquette pollster, is less sure if Walker’s plan would boost or undermine his campaign. “It's hard to tell,” he said. “We haven’t polled on Medicaid.”

Democrats believe that Walker is vulnerable on health care issues. Evers’ first campaign ad criticized Walker for failing to expand Medicaid through the ACA, and the Democratic Governors Association followed up with a similar ad campaign last month.

If new Medicaid issues emerge, “the Evers campaign plans to keep the focus on health care as a top issue for Wisconsin voters,” a campaign spokesperson said.

Meanwhile, health care organizations have loudly denounced Walker's proposed changes to Medicaid, with the Wisconsin Council on Children and Families arguing the plan could hurt local health — as well as the state’s booming economy — because tens of thousands of residents could lose health coverage. “With more people uninsured, Wisconsin’s workforce would be less healthy,” the council concluded.

The health care groups also signaled they’d mobilize if Medicaid appears to be threatened — which could be a fight Walker doesn’t need a few weeks before Election Day.

“It’s not a hot topic right now,” said Stephanie Harrison, head of the Wisconsin Primary Health Care Association, who criticizes Walker’s plan because she expects residents to lose coverage. “If we got action from CMS, I think it would rise up to become a hot topic again during the election.”