At least 11 Wisconsin counties may add an advisory referendum to the November ballot on the question of whether Wisconsin should expand BadgerCare and take the federal funding that would cover the full cost of newly eligible childless adults. The proposed ballot measure has generated a healthy debate about whether the Medicaid expansion topic is an appropriate matter for an advisory referendum.

There are many strong arguments in favor of taking the federal funding (see WCCF’s “Top Ten” list); however, some people who argue against including the BadgerCare question on the November ballot contend that it’s not a concern of county government. But even if we assume for the moment that an interest in county residents’ access to affordable health care isn’t reason enough for counties to allow voters to weigh in on the issue, counties also have their own reasons to be very interested in whether the state expands BadgerCare and accepts the federal funds:

• One very important consideration for counties is they bear the financial responsibility (rather than the state) for some community-based Medicaid services. By getting 100% federal funding for coverage of childless adults below 138% of the federal poverty level, counties would enjoy substantial savings for mental health services. They could use those savings either to improve those services or for other local purposes, including property tax relief.
• Another important consideration for counties is that the state recently projected a $93 million GPR deficit in the Medicaid budget – primarily as a result of the much higher than anticipated BadgerCare enrollment of childless adults with incomes below the federal poverty level. That deficit could be eliminated by expanding BadgerCare eligibility and accepting the full federal funding for coverage of childless adults. If policymakers don’t choose that option, significant budget cuts will be needed, and state aid for counties could be one of the budget items at risk.

The risk of significant cuts to Medicaid or elsewhere is also pertinent with respect to another argument that has been made against the proposed referendum – that there is no chance of convincing the Governor and legislators to reconsider their decision to turn down the federal funding. I think that assumption is mistaken because a number of different factors give new life to the issue – not the least of which is that we are electing new lawmakers this fall, and the candidates will probably have to debate the question of how to close the Medicaid deficit. Putting the Medicaid expansion issue on the ballot in November raises the visibility of that debate during the fall campaigns, and it gives voters who may plan to support GOP candidates for other reasons an opportunity to send those candidates a message that they should rethink their position on BadgerCare.

Some people have argued that advisory referenda are simply a waste of time and money because policymakers won’t pay attention to them. I can relate to that cynicism, but how far do we want to take that line of reasoning? If all lawmakers’ minds are closed on this and other policy issues, should we put an end to public hearings? Should the state save money by taking steps to shut down other forms of public input, such as closing down legislators email accounts?

In the current world of almost unlimited campaign contributions, it’s easy to give in to cynicism and think that public referenda, letters to legislators, and public hearings are all futile exercises. However, I would argue just the opposite. With the rapidly growing influence of money in politics, it is more important than ever to find ways to involve the public and shine more light on the policy choices facing state and local lawmakers.

The question of whether to take federal funding to expand BadgerCare is an important issue for Wisconsin voters and for counties. It makes a lot of sense for counties to put the question on the November ballot – to raise the visibility of the issue and to give voters a chance to weigh in on a very important matter of public policy.

By Jon Peacock

Photo by Brendan C released under a Creative Commons license.