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ACA in Wisconsin, ACA: Medicare & Medicaid

ACA and Medicaid Expansion for Wisconsin’s Low-Income Uninsured

On June 28th the Supreme Court upheld nearly all provisions of the Affordable Care Act (ACA). The benefits for Wisconsin women have shown time and time again that reforms in the law are working for women and their families. From covering preventive services at no additional cost, to allowing adult children to stay on parents’ plans until their 26th birthday – the ACA ruling was a victory for Wisconsin.

Under the ACA, individuals below 138% of the federal poverty line would be eligible for Medicaid, and individuals between 100% and 400% FPL would be eligible for tax subsidies to help pay premiums for plans purchased within the Exchange. Women are more likely to be low income, uninsured and depend on a spouse for health care insurance. Consequently, health care reforms – including more options for low-income women – are necessary and moving forward with ACA implementation is crucial.


Wisconsin Alliance for Women’s Health staff with Rep. Brett Hulsey – Day of the SCOTUS decision release.

You might remember, however, one portion of the law was not upheld in full, that is, the penalties for states that do not expand their Medicaid program. This was the part of the law that said states who chose not to participate in the expanded Medicaid program, with the support of federal funds, would be at risk of losing all current Medicaid funds as a penalty. The Supreme Court ruled that the federal government was unable to take away all Medicaid funds – effectively making the Medicaid expansion a choice for states, without penalties for not participating.

This small change in the law affects a large number of Wisconsinites – and therefore vital Wisconsin to take advantage of the expansion. There are 235,000 uninsured individuals in Wisconsin that would become eligible for Medicaid with the expansion, and a significant portion of these individuals are below 100% FPL.  According to one editorial, this makes the issue of Medicaid expansion a little trickier than probably intended. The drafters’ of the health care reform law anticipated individuals under 100% FPL would have access to health care coverage through the Medicaid programs in their state, however, the Supreme Court ruling makes it possible for these individuals to fall through the cracks.

As previously stated, tax subsidies toward premiums were only created for individuals between 100% and 400% FPL; leaving some people under 100% FPL at risk of remaining uninsured, should Wisconsin opt out of the expansion. This is because they wouldn’t be eligible for Medicaid or for assistance to pay for premiums within the Exchange. It is important that Wisconsin leaders take into considerations all scenarios when determining ACA implementation in our state and ensure we honor the ACA’s commitment to coverage as it was intended – affordable, accessible and quality health coverage for all Wisconsin women and families. That said, it is imperative Wisconsin take full advantage of ACA implementation – including federal funds to cover low-income individuals through Medicaid.




  1. Pingback: Important Implementation Deadlines Looming « - October 3, 2012

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