Medicaid was established to ensure that those living in poverty could access healthcare. The expansion under the Affordable Care Act included healthy, working-age adults without children, which I believe was a mistake.
During my time as governor of Wisconsin, I opted not to implement this expansion. Instead, we created a state plan that effectively covered everyone in poverty—an approach that proved successful.
My predecessor had increased Medicaid income thresholds but failed to adequately fund the resulting gap, leaving many low-income individuals waiting for assistance.
Once I took office, I reinstated restrictions aimed at supporting those in poverty and eliminated the waiting list. Now, Wisconsin stands out as the only state in the nation without gaps in insurance coverage, even without Medicaid expansion.
Moreover, I didn’t want to increase dependency on government aid. For those who are able, I think public assistance should resemble a trampoline—supportive yet driving people to achieve more. True freedom and success come from individuals being in charge of their own paths, not from excessive government oversight.
When I first began my term, the state labor minister asked about my priorities. It seemed the previous administration aimed to maximize federal aid, but I expressed a desire to minimize our reliance on that support so we could promote higher employment rates.
Throughout my governorship, we implemented work requirements for those capable, along with funding for job training and addiction recovery programs, which were quite effective. Employment rates climbed to historic highs during my administration.
Another concern was the federal government’s ability to uphold its promises. While I consistently balanced Wisconsin’s budget, the federal government continued grappling with considerable deficits and debt, a situation that has only worsened since I raised alarms about it.
Initially, many opposed the Medicaid expansion under the Affordable Care Act, but over time, the allure of easy federal funding enticed numerous state leaders. Fortunately, Wisconsin’s Republicans recognized the validity of my apprehensions. As federal cuts increased, we remained one of the few states that avoided significant budget issues.
A proposed plan by Congressional leaders suggests reducing states’ reimbursement rates for the growing Medicaid population from 90% to below 60%. States reliant on federal funding to stabilize their budgets are now facing severe shortages due to these cuts.
If Wisconsin had accepted expansion funding, the potential reimbursement rate changes could have cost taxpayers around $154 million annually, according to a recent Wisconsin Institute of Law study. These expenses would account for nearly 30% of the state’s budget.
Ultimately, Medicaid should primarily support children, families, and senior citizens in poverty. It shouldn’t serve as an obstacle for healthy working-age adults who are capable of joining the workforce. These reforms can lead to meaningful savings while ensuring that the program fulfills its original purpose from 60 years ago.
Going forward, both federal and state officials would benefit from examining Wisconsin’s approach to Medicaid reform. It demonstrates that conservative reforms can be effective.
