By John Lundy

Forum News Service

WISCONSIN -- Although it’s nonbinding, a referendum in Douglas, Bayfield and 17 other Wisconsin counties on expanding the state’s BadgerCare program is far from meaningless, supporters say.

“I hope it will get the attention of the leadership in the state of Wisconsin,” said David Conley, a Douglas County Board member from Lake Nebagamon who sponsored a resolution to place the referendum on the Nov. 4 ballot.

“There’s a lot of people who really can’t afford medical care in our state,” Conley said.

The referendum appears on the Douglas County ballot as Question 1: “Shall the next State Legislature accept available federal funds for BadgerCare to ensure that thousands of Wisconsin citizens have access to quality and affordable health coverage?”

Placing it on the ballot was approved unanimously in Douglas County, Conley said. In Bayfield County it passed by a large majority but with some opposition, said board member Fred Strand, who sponsored the measure there.

The Affordable Care Act expanded Medicaid coverage for most low-income adults up to 138 percent of the federal poverty level. But a Supreme Court ruling in June 2012 left it up to the states whether to adopt the expansion. Minnesota is among 27 states plus the District of Columbia to implement it.

But Wisconsin’s Republican governor, Scott Walker - whose re-election bid is much higher on the ballot - rejected the full expansion, favoring a separate strategy to expand health care coverage. The state Legislature’s Joint Finance Committee agreed, voting against the full federal expansion in June 2013.

The advocacy group Citizen Action of Wisconsin is working to reverse that decision. Walker’s Democratic opponent, Mary Burke, supports expansion. But even if Walker and a Republican legislative majority were re-elected, solid support for the referendum could send a message, said Robert Kraig, executive director of Citizen Action of Wisconsin.

Altogether, the 19 counties (and the city of Kenosha) that placed the referendum on the ballot comprise nearly half of the state’s population and about a million likely voters, Kraig said.

“We think that whoever wins the governor’s race, whoever controls the Legislature, that a million voters having a say on this - it can have a large impact and it can help persuade lawmakers to take the money.”

The federal government initially is picking up the tab for full Medicaid expansion, although states will have to pay 10 percent by 2020.

“So it is literally a self-inflicted wound,” Kraig said. “You’re literally leaving money on the table for health care.”

Citing Legislative Fiscal Bureau numbers, Citizen Action said federal money lost to Douglas County because the state did not adopt the full BadgerCare expansion amounted to $5.2 million over two years with 800 fewer residents receiving coverage; in Bayfield County, the numbers were $112,000 and 17 residents.

But Nick Novak of the MacIver Institute, which advocates free-market solutions, said proponents of Medicaid expansion present “a much rosier picture” than the reality.

“If you do accept the Medicaid expansion, it’s not just free money that’s coming from the federal government,” Novak said. “It’s all taxpayer money.”

Walker’s strategy has been effective, Novak argued, making access to health insurance available either through BadgerCare, private coverage at workplaces or the health insurance exchange set up under the Affordable Care Act.

“For the first time in the state’s history, every single person living in the state of Wisconsin has access to some type of affordable health care coverage,” Novak said. “The way that Wisconsin reformed Medicaid is actually working for this state.”

But only one in three Wisconsin residents who lost BadgerCare coverage has obtained health insurance from other sources, the Milwaukee Journal Sentinel reported in August.

The referendum is likely to be more popular in Douglas and Bayfield counties than in some other parts of the state, said Alisa Von Hagel, an assistant professor of political science at the University of Wisconsin-Superior.

The 7th Congressional District, which includes both counties, is the poorest in the state, with an average household income of $47,000, Von Hagel said.

“Whether it’s Bayfield or Douglas County, they tend to be more progressive, more liberal, but also more (interested in) the issues of poverty,” she said. “That may be an indication that these counties will support the measure.”

Kraig said he thinks the referendum will pass overwhelmingly in Douglas and Bayfield counties, but that it also will be approved in more conservative counties such as Lincoln and Clark.

“It’s polling consistently as probably the most consistently unpopular thing Governor Walker’s done,” Kraig said. “It’s roughly 60 to 61 percent for taking the money.”

Novak offered no predictions, but he suggested that the BadgerCare issue and a separate referendum on raising the minimum wage are on the ballot for political purposes.

“While a nonbinding referendum does not actually have any effect on anything … aside from saying how voters feel, it seems like the groups that are organizing everything are trying to turn out votes for specific candidates,” Novak said.

But Von Hagel said such referenda aren’t likely to spur additional voter turnout because the “low-information” voters less likely to show up at the polls probably wouldn’t be aware that the questions are on the ballot.

Douglas County Board Chairman Doug Finn, who favors the referendum, said he likes seeing such issues on the ballot.

“There’s nothing better than getting citizen input,” Finn said. “It gives the voters in Douglas County a voice.”