While news coverage has focused on how Governor Scott Walker [3]'s budget repair bill attacks the state's 300,000 public sector workers (and by extension, the entire middle class), the law is increasingly recognized as an attack on the poor. It curtails (and perhaps eliminates) access to the Medicaid programs relied upon by 1.2 million Wisconsinites, limits access to public transportation, and hinders rural community access to broadband internet. The bill keeps the poor unhealthy, immobile, and uninformed.

Governor Walker and the GOP [4] have said they will not balance the state's alleged "budget deficit" by raising taxes and increasing revenue. Instead, they will focus on decreasing expenditures in a way that disproportionately impacts the poor and middle class. At an event at Wisconsin Law School on February 24, former U.S. Solicitor of Labor and professor emeritus of law Carin Clauss said, "We have to acknowledge that we are imposing what amounts to a de facto tax hike" on the poor. She noted that "this bill will kick people off medicare, require increased payments into health and pension funds," and "could hamstring mass public transport," all of which decrease take-home pay and increase costs for poor- and middle- class Wisconsinites.

Keep 'Em Unhealthy: The Governor's Attack on Medicaid

Buried in Governor Walker's bill are big changes to the state's Medicaid and BadgerCare health care programs for low-income individuals. The bill not only restricts eligibility, but gives the Secretary of the Department of Health Services (DHS) unprecedented authority to drastically limit or even eliminate Medicaid.

According to Jon Peacock of the Wisconsin Council of Children and Families, the bill suggests the state will limit eligibility for Medicaid programs by reducing the income ceiling from 200% of the federal poverty line to 133%, which would disqualify a single person working a full time job at minimum wage. It would also end coverage in a family of three or four that has two people working full time at the minimum wage. Peacock says a reduction in eligibility to the 133% level would kick about 70,000 Wisconsin residents off state health insurance. "This means no preventative care, that people will seek more expensive treatment in emergency rooms, and that those costs will be passed on to us in the form of increased healthcare premiums."

Over 1.1 million Wisconsin residents benefit from the state's Medicaid programs, and though many advocates had expected Walker to introduce modifications, most anticipated the chance for public input and legislative debate. Instead, Walker introduced the bill on a Friday afternoon and scheduled a vote for Tuesday. "It was appalling," said Representative Sandy Pasch (D-22), for Walker to impose a decision that "affects over one million people without input from health providers and advocates ... I don't want to be melodramatic, but we offer health care to keep people from dying," and this bill has life or death consequences. "This bill may result in the death of many people and it was just rushed through the legislature."

While the budget repair bill itself imposes major changes without outside input, it also grants the head of DHS nearly unilateral authority to modify or limit the state's healthcare programs. The provision caught the attention [5] of the state's non-partisan Legislative Fiscal Bureau, who wrote in a February 14 memo that the provision "would remove the entire Legislature from determining substantial elements of the medical assistance program."

"This is an unprecedented way of setting policy," says Peacock. "It is unheard of in any state to give an unelected agency head carte blanche to override legislative authority" to limit Medicaid eligibility, reduce benefit levels, "increase premiums and co-pays to the point that it is unaffordable, and prevent persons from enrolling if they have access to private coverage, even if there is no way they could afford that coverage."

Specifically, the bill would give DHS expanded authority to pass "emergency rules" that, according to the bill, the Secretary deems necessary "to increas[e] the cost effectiveness and efficiency of care." David Riemer, director of the Community Advocates' Public Policy Institute, tells the Capitol Times "it sets up a situation where the DHS could promulgate rules that violate state Medicaid statutes that are still on the books."

"It has been demonstrated that input from healthcare providers and advocates can lead to the most effective services at the lowest price," says Pasch, "but this provision would do away with the chance for input and oversight."

While emergency rules do not have the notice, hearing, and publication requirements applicable to other rules, under current law they require a showing that the rule is immediately necessary to preserve "public peace, health, safety, or welfare," require legislative approval, and expire after 150 days. The budget repair bill does away with all of this. Under Walker's law, DHS can pass an emergency rule without any showing of immediate necessity, would be subject to only passive review by the Joint Committee on Finance (who are not required to hold a public hearing), and eliminates time limits, meaning the "emergency" can last indefinitely.

The First Step Towards Eliminating Medicaid in Wisconsin?

There are indications that the eventual goal for Governor Walker and his newly-appointed Secretary of the Department of Health Services, Dennis Smith, is to eliminate state Medicaid, a program through which Wisconsin receives federal dollars to furnish medical care to the disadvantaged. Smith advocated [6] for just that during his time as a fellow at the conservative Heritage Foundation [7], where he wrote that states should walk away from Medicare dollars to avoid the obligations that accompany them. In a 2009 article titled "Medicaid Meltdown: Dropping Medicaid Could Save States $1 Trillion," he wrote "every state would be better off" if it dropped all Medicaid programs altogether, rather than implement the expanded eligibility requirements under President Obama's health care reform bill. He writes "[t]he savings to state budgets are so enormous that failure to leave Medicaid might be viewed as irresponsible on the part of elected state officials."

The budget relief bill could be the first step towards absolving the state of any "irresponsibility." In addition to granting Smith unilateral power to alter substantive aspects of public health plans, the bill prioritizes the repayment of the state's $153 million in Medicaid liabilities, a necessary precursor to cutting Wisconsin's ties to the program.

"I'm not convinced that is their objective," says Peacock, "but it is interesting to speculate about their larger political purpose. Clearly, all policy in the bill shows that they intend to revise Medicaid significantly."

In any case, Rep. Pasch says that "knowing Smith's philosophy, and knowing he is in charge of benefits relied upon by so many people ... should really give us pause. We need to take a much more measured approach."

"It gives me fear."

Keep 'Em Immobile: Bill Causes Loss of Federal Transit Funds

Walker's attack on public sector collective bargaining rights could have collateral consequences besides just silencing the voice of public workers and driving down wages. The state could lose $47 million in federal dollars for publicly-run municipal bus systems, funds contingent upon preserving collective bargaining rights [8].

In Appleton, for example, bus drivers will lose collective bargaining rights under the law and the municipality will lose $2.5 million of its $8.5 million annual operating budget. The poor will be disproportionately impacted by this law, as statistics show ninety-one percent [9] of riders on Appleton buses earn less than $35,000. (Wisconsin's largest urban area, Milwaukee, has private bus operations so will not be affected.)

Asked for her opinion, Rep. Pasch said "I don't understand, in a bill that is supposed to be balancing the budget, why we would give up $47 million. I don't know how to comment on something so irrational."

Keep 'Em Uninformed: Walker Refuses Rural Internet Funds

Also in the bill is a plan for the state to return $23 million in unused federal stimulus funds [10] to expand broadband access to rural areas.

At the time former Governor Jim Doyle [11] accepted the grant one year ago, the Milwaukee Journal Sentinel wrote "the cable could improve police, fire department and hospital communications in rural areas," and could remedy the fact that "[t]he lack of broadband access has put children in rural schools at a competitive disadvantage. Unable to quickly access podcasts, videos and Webinars, these children are a step behind in a technological society."

Walker claimed that the state could not avoid violating the stimulus package's requirements with its existing public-private network, which runs on infrastructure owned and managed by AT&T [12]. Robert Bocher, an IT consultant for the Department of Public Instruction, told the Journal-Sentinel that AT&T did not want to be a sub-recipient of the grant because "from a corporate perspective, they did not want to get bogged down in federal grant regulations." Instead, Walker said he asked AT&T for its best offer to expand cable internet and will pay them directly from state coffers, without federal grant money. Cable internet, though, is an older technology, and it may be a loss for Wisconsin not to have high-speed fiber-optic infrastructure in place.

Considering AT&T employees and its PAC donated more than $20,000 to Walker's campaign, some suggest this was yet another handout [13] to a major corporate donor. State Representative Mark Pocan (D-Madison) said:

Not only is he turning away construction jobs that would have come with the federal grant to expand broadband fiber to schools and libraries across Wisconsin, but he's closing off potential to business growth that comes with bridging the digital divide... What's worse, the root of his decision wasn't what was in the best interest of Wisconsin, rather the best interest of his big telecommunications campaign donors.

The diversity of issues in the bill and the breadth of Walker's attack on Wisconsin working families is now just being understood.

This post was revised on February 27.