Jason Stein

Milwaukee Journal Sentinel

MADISON - Gov. Scott Walker Thursday will urge his fellow Republicans in Congress to overhaul Obamacare but also caution them about going too far in the process.

On the invitation of U.S. House Speaker Paul Ryan of Janesville, Walker is meeting Thursday with the House Republican Conference to talk about how he dealt with massive labor demonstrations in 2011 and how they can deal with contentious town hall meetings over Obamacare. The Wisconsin governor is also meeting with other high-level Republicans in Congress.

Walker has long supported making bedrock changes to funding Medicaid health programs for the needy that cover more than 1 million people in this state and 73 million nationally.

But the chairman of the Republican Governors Association said he and other governors also are finding potential pitfalls to this "block grant" approach.

It particular, it must account for the challenges of caring for certain high-cost groups such as the elderly, blind and disabled, he said. Leaders should be looking less at cutting Medicaid and more at making it manageable in the years to come, he added.

"A pure block grant doesn't work. ... The focus shouldn't be immediate savings. It should be how do you reform this?" Walker said in an interview.

In general, block grants move federal aid to states to a looser model that comes with greater flexibility but also the likelihood of much less money over time.

Walker's trip to Washington, D.C., comes as Republicans try to work through the challenging task of replacing the Affordable Care Act.

"Nobody knew that health care could be so complicated," President Donald Trump told Republican governors on Monday.

Walker said that Republican members of Congress could win respect — if not agreement — if they show up and listen respectfully to critics and didn't trash them.

"You don't run from it. You run through it. ... Talk about what you're doing and why you're doing it," Walker said.

"If they give you the finger, give them the thumbs up."

The governor said he wasn't aiming his advice at Trump — who embraces conflict with his critics — just those in Congress, saying that Trump is a "unique person" with his own style.

On substance, the Wisconsin governor will point to the way his state did a limited expansion of Medicaid and made a greater use than many other states of Obamacare's subsidized private insurance markets.

Walker has hammered the point in recent weeks about how Wisconsin shifted people with incomes above the federal poverty level — $11,880 a year for a single person — into federal insurance exchanges.

Data from the Kaiser Family Foundation shows that Wisconsin's uninsured rate dropped from 9% in 2013 to 7% in 2015, a decrease that was smaller than states that fully expanded Medicaid but larger than states that didn't expand Medicaid at all.

All that worries Jon Peacock, research director for the Wisconsin Council on Children and Families.

Peacock said Walker's system has mostly worked in Wisconsin so far for those who are on the insurance exchanges because they make too much money to qualify for Medicaid.

But top Republicans like Ryan are trying to get Republicans to coalesce around a basic framework to replace Obamacare that includes offering tax credits to help offset the cost of health insurance for those now in the exchanges.

Their plan doesn't say how big those credits would be or how the effort would be funded — which leaves Peacock wondering whether they will be enough for the poorest workers.

"I have huge concerns about that," he said. "I don't think there's any way the untargeted tax credits they're proposing will be sufficient for low-income people."