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“But, while this bill could and should have been much stronger, it includes very important provisions for Wisconsin that I worked to include. The bill will bring more Medicare dollars to Wisconsin by improving the unfair reimbursement formula that has siphoned money away from the state for years, and by rewarding the high-quality, low-cost care practiced at places like Gundersen Lutheran and the Marshfield Clinic. Wisconsin taxpayers also win because we will see a boost in Medicaid funding, so our state isn’t harshly penalized for its leadership in expanding coverage. The bill also ends discrimination by insurance companies against people with preexisting conditions, expands coverage to 30 million more Americans and reduces the deficit by an estimated $132 billion. Despite the bill’s flaws, it does meet the test of real reform, and the cost of inaction was much too high.”

With tax revenues down and budgets breaking, the states — including Arizona, California, New Jersey, New York and Wisconsin — say they cannot afford to essentially subsidize other states’ expansion of health care.

Under the Senate bill, the federal government would pay the entire cost of expanding Medicaid to those not already eligible under state coverage for the first two years of the program. The following three years, states that do not now have expanded coverage would be reimbursed at a higher rate than those states that do — in general, the states without expanded coverage would be paid back 95 percent of their costs, while those that have already expanded coverage would be reimbursed between 80 percent and 95 percent. Medicaid reimbursement rates are based on per capita income; wealthier states have smaller shares of their costs paid back.

The biggest hit to states that have already expanded will be in covering the people who are eligible now but have not signed up for coverage under the state’s current program. They are expected to enroll because the new legislation will require almost all Americans to have insurance.

States that have expanded already would not get any new matching funds for those people. The Senate bill provides additional money only for those who are “newly eligible.”

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