Walker's Gaffe Within A Gaffe

Today the Milwaukee Journal Sentinel's Patrick Marley was all a-titter that Scott Walker made a Freudian slip regarding something that is old news - that Walker wants to be president:

Speaking to reporters at the National Governors Association in Milwaukee, Walker was asked
about the idea of Republicans trying to block the federal budget to halt the Affordable Care Act, also known as Obamacare.

“Right now I’ve got my hands full being governor. I’m not real involved yet at the – strike that last word – at the federal level,” Walker said to laughter.

Wisconsin’s Republican governor is named frequently as a potential 2016 candidate for governor, though Walker has largely downplayed such talk. Walker’s own response to his use of the word “yet” shows he’s aware of how his comments can be read when speaking on national issues.

This gaffe prompted a press release from Mike Tate, head of the Democratic Party of Wisconsin, including a pretty good zinger:

Even as he denies it, everyone knows Scott Walker is running for president -- he’s never here to govern Wisconsin because he's too busy raising campaign cash at Tea Party gatherings all around the country. So it’s pretty ironic that Walker's Freudian slip came on a day he was visiting Wisconsin.”

But Marley's article contained a more subtle, but more significant gaffe.

Per the article, Walker went on to talk about Obamacare and Walker, predictably, took the insane, inane and wrong-headed approach:

“I’ll let them work that out for right now,” he said. “Obviously I have concerns on principle about he Affordable Care Act, not only in terms of the implementation, but I don’t think it’s good pubic policy to have the federal nor the state government dictate to me and my family what we do or what any other family in this state or this country does on health care. But I’d have to look at all the different options are going forward.”

It's odd that Walker would take that stance, since dictating what poor people did regarding health care was exactly what Walker was doing for the vast majority of his time as Milwaukee County Executive, when he administered the GAMP program:

The program was called the General Assistance Medical Program orGAMP for short. The best description I've found of GAMP, and the benefits it gave to its consumers and to the taxpayers, comes fromThe Commonwealth Fund (emphasis mine):

Wisconsin's General Assistance Medical Program (GAMP) provides health care coverage to indigent Milwaukee County residents who are not eligible for other forms of public coverage (such as Medicaid and the State Children's Health Insurance Program) and are not enrolled in private coverage. The county redesigned the GAMP program into a community-based primary care model in the late 1990s to achieve two interrelatedgoals: to provide increased primary care services, and to do so via community-based clinics. The new design was intended to improve effectiveness and efficiency of care. Prior to this, indigent patients relied on the emergency room of the county hospital, which created access barriers for enrollees and cost inefficiencies for the county. Under the redesigned model,GAMP enrollees select a participating clinic as their primary care provider, which is then responsible for providing andcoordinating services. The clinic coordinates specialty care for the enrollee by working with specialists and hospitals that participate in the GAMP network. The program covered a total of 24,000 individuals in calendar year 2003, with some 10,000 to 12,000 individuals enrolled at any given time. All in all, GAMP estimated that it saved $4.2 million in 2000 (in comparison to the projected costs had the previous system remained in place). Administratorsbelieve that inpatient and outpatient costs have been controlled largely through a Utilization Management program that ensures delivery of care in the appropriate settings and using appropriate resources.

In other words, the County designed and ran a health care system that limited people's choices by having to go through a community clinic first, and only if it was covered in the network. Yet, instead of leaving people without insurance and forcing them to go to hospital ERs, it saved $4.2 million. That's a big chunk of change for a relatively small amount of people.

Other descriptions of the program include the one from Milwaukee County itself and a report(pdf) from the state after the program just started. The County page calls the program as "nationally recognized." The state's report summarized the program with this sentence:

Inpatient hospital and specialty services constitute the majority of the GAMP budget
although, the program has successfully used primary care services provided in community based clinics and selective utilization management techniques to control and reduce inpatient and outpatient hospital costs over the last two years.

The only reason GAMP ended was because Governor Jim Doyle was able to expand BadgerCare to cover these individuals, taking the load of the county.

Given that he has experience running a government-controlled health care program and knows that it saves taxpayers money and provided affordable health care, there is no valid reason for Walker to reject it on a higher level.

In fact, the only reasons that Walker would have for turning rejecting Obamacare is that he is using the poor as political pawns (something he has done before) , pure malfeasance or both.

Walker The Wishdoctor

Yet another nonpartisan, nonprofit group has come to the same conclusion - Walkercare won't work (emphasis mine):

A new national study from the RAND Corporation says states choosing
not to expand Medicaid under federal health care reform will leave millions of residents without health insurance and increase spending, at least in the short term, on the costs of treating uninsured residents.

Wisconsin is among the 14 states studied in the analysis, which examined the impacts of Medicaid expansion on insurance coverage, federal payments into the states and state spending on care for the uninsured.

“Our analysis shows it’s in the best economic interests of states to expand Medicaid under the terms of the federal Affordable Care Act,” said Carter Price, the study’s lead author and a mathematician at RAND, a nonprofit research organization.

The study says that if the 14 states decide not to expand Medicaid under the Affordable Care Act, as intended by their governors, those state governments collectively will spend $1 billion more on uncompensated care in 2016 than they would if Medicaid is expanded.

The study also says that failing to expand Medicaid could have more than financial consequences. The study estimates that an additional 19,000 deaths could occur annually if the 14 states studied do not expand Medicaid.

The article goes on to show just how badly Scott Walker and the Republicans have screwed this one up:

Citizen Action of Wisconsin has voiced opposition to this potential deal.

“By conceding that hospitals will be damaged by an increase in uncompensated care, such a deal would be an admission that Walker’s plan will cause tens of thousands people throughout Wisconsin to lose health coverage. This has been denied by the governor and his allies in the Legislature up to now,” said Robert Kraig, executive director of Citizen Action of Wisconsin. “It would be a stunningly callous and immoral act to compensate hospitals for impact of forcing people of health coverage, when it would be easy to prevent this tragic result in the first place by taking the federal health care dollars that are on the table.”

Women’s health advocacy groups have also voiced opposition to Walker’s decision on Medicaid. On Tuesday, the Wisconsin Alliance for Women’s Health (WAWH) will mark a Wisconsin Women’s Day of Action for Health Care Coverage supported by American Association of University Women–Wisconsin (AAUW), League of Women Voters of Wisconsin Education Network, Mid-Day Women’s Alliance, NARAL Pro-Choice Wisconsin, Planned Parenthood Advocates of Wisconsin, Reproductive Justice Collective, The Demeter Foundation, Wisconsin Women’s Network, the Women’s Fund of Greater Milwaukee and the Wisconsin Alliance for Women's Health.

“Women are the primary recipients of Medicaid services because they make up a larger portion of low-income and elderly populations, and are likely to be custodial parents,” said WAWH executive director Sara Finger. “For those committed to advancing Wisconsin women’s health and economic security, they must protect current BadgerCare coverage and improve Gov. Walker’s initial proposal.”

The Wisconsin Nurses Association also released a statement opposing Walker’s proposal, as executive director Gina Dennik-Champion said, “Nurses are deeply concerned about the approximately 88,500 patients that could lose access to Medicaid coverage. These patients would be put into a health insurance exchange that has yet to form and they would face expensive premiums, copays, and deductibles that would limit their access to quality, preventive health care services. This unnecessary barrier to health care will come with a significant cost to our hospitals, providers, and ultimately, Wisconsin taxpayers.”

But here is the real kicker of this. Walker already has first hand knowledge that not only would this work, but how it could work.

During his time as Milwaukee County Executive, up until the creation of Badger Care, Walker was responsible for seeing to the administration of a program called General Assistance Medical Program or GAMP for short. As I pointed out four years ago:

Wisconsin's General Assistance Medical Program (GAMP) provides health care coverage to indigent Milwaukee County residents who are not eligible for other forms of public coverage (such as Medicaid and the State Children's Health Insurance Program) and are not enrolled in private coverage. The county redesigned the GAMP program into a community-based primary care model in the late 1990s to achieve two interrelated goals: to provide increased primary care services, and to do so via community-based clinics. The new design was intended to improve effectiveness and efficiency of care. Prior to this, indigent patients relied on the emergency room of the county hospital, which created access barriers for enrollees and cost inefficiencies for the county. Under the redesigned model, GAMP enrollees select a participating clinic as their primary care provider, which is then responsible for providing and coordinating services. The clinic coordinates specialty care for the enrollee by working with specialists and hospitals that participate in the GAMP network. The program covered a total of 24,000 individuals in calendar year 2003, with some 10,000 to 12,000 individuals enrolled at any given time. All in all, GAMP estimated that it saved $4.2 million in 2000 (in comparison to the projected costs had the previous system remained in place). Administrators believe that inpatient and outpatient costs have been controlled largely through a Utilization Management program that ensures delivery of care in the appropriate settings and using appropriate resources.

Similar findings have been found with Obamacare.  Because having affordable assurance makes it easier for people to take care of themselves, it has drastically cut down on the much more expensive hospital stays.

The gentle reader is probably wondering why Walker would then go ahead and make such a bungle of the health care reforms if he already knew better.

The answer is really rather simple.

Walker is stupid.

Walker, despite his protestations to the contrary, is doing everything based on how it would affect his presidential campaign.

He's not about to do anything remotely resembling accepting Obamacare.  He's seen the way that the red meat Teapublicans tore up New Jersey Governor Chris Christie for doing what was in his state's best interest after last year's Frankenstorm.  He is trying to out-conservative all of his potential candidates.  Apparently, Walker napped for the three years of the 2009-12 GOP primary.

So instead of giving the slightest impression of cooperating with that Black Man in the White House, Walker somehow thinks it will help his aspirations by allowing people to deny needlessly and to raise the taxes on the living for that privilege.

Less services, more deaths, higher taxes.

That's not exactly a winning slogan, especially for a POTUS wannabe.

In fact, that's sounds pretty damn stupid.

With Walker's mishandling of health care reform for purely political reasons, he has shown himself to be a wish (he was gonna be president) doctor who should face charges for malfeasance as well as malpractice.

Walker's Handling Of Healthcare Reform Is Just Sickening

As the gentle reader already knows, Scott Walker is a bit of a schmuck.

Action photo of
Walker crafting his version
of health care exchanges

So it should come as no surprise at the irresponsible and ignorant way he has approached health care reform and Obamacare.

Instead of embracing the Affordable Health Care act as a sane person would, Walker decides to use the health and lives of the poor and working classes as political pawns.

First he refuses to start making the necessary preparations. Instead, he authorized Attorney General J.B. Van Hollen to join in a multi-state fiasco of challenging the law all the way to the Supreme Court.

But the law is upheld.

Walker again refuses to do the right thing, saying he is going to hold off until Mitt Romney is elected and can kill Obamacare.

We all know how well that worked out for them. (By the way, you'd best take care when near any Republicans. Judging from the foam and spittle around their mouths, they are still having lots of problems coping with reality.)

And during Walker's showboating of his obstinance, he throws away $38 million meant to help the state create its health care exchanges.

In other words, he's gambled twice with our money and our health and has thrown away $38 million in his bad bets. I bet you can guess who's going to end up paying for his political myopia.

But it doesn't end there!

Walker is now again showboating, saying there's no big rush, even though a plan is due to the federal government by this coming Wednesday:

Walker told reporters Wednesday in Milwaukee that he will be meeting with state officials this week to discuss the next steps. He downplayed the urgency of the situation, saying no matter what the state does, the federal government won't review it for months. Walker has said he doesn't think it would be a problem for the state to get an extension.

"Even after notifying them, we have until next fall to make modifications as we see fit," Walker said. "We haven't made a decision yet."

Walker said the choice for his administration was whether to accept an exchange run by the federal government, set up its own or pursue a combination.

"The question, from our standpoint, is what option is best for the taxpayers of Wisconsin," Walker said.

Ah, but guess what! As is always the case with all things Walker, there's more. There's always more.

The group Citizens Action of Wisconsin has been keeping their eye on the ball and has some distressing news. It appears that Walker has been working behind closed doors to come up with a secret plan for implementing the new health care exchanges, without any input from anyone. Well, anyone but ALEC, I suppose.

Here is what Citizens Action found and their accurate summary of what it means:

However, records obtained by Citizen Action of Wisconsin under the state’s open records law shed light on the direction Walker will take. In June of 2011 Walker’s Office of Free Market Health Care produced a PowerPoint for a briefing of legislators entitled: “Preliminary Plan for Building the Wisconsin Health Insurance Portal and Interchange.” This document is the closest thing we have to a blueprint for the Walker’s Administration’s position on exchanges. From it two key conclusions can be drawn.

(1) Governor Walker is unlikely to opt for a federal exchange in Wisconsin or to develop a partnership exchange with the federal government. The Walker Administration is hostile to the creation of a federal health insurance exchange. Citing the original executive order creating the Office of Free Market Health Care, the document refers to “protecting Wisconsin from the establishment of a federal health benefit exchange” and makes it an explicit goal “to minimize federal interference.”

(2) The Walker Administration opposes the minimum consumer standards mandated in the Affordable Care Act for insurance sold on health insurance exchanges. It complains in its preliminary plan of a “one size fits all approach,” that minimum coverage standards “will force” consumers and employers “to purchase richer benefits” or to “buy up,” and proposes to “allow all current plans to be marketed” on the exchange, and to “open [the exchange] to the development of new products.” This would mean allowing plans which do not meet minimum federal standards for coverage, or cost sharing, on to the exchange. The document also makes a selective use of MIT Professor Jonathan Gruber’s actuarial analysis of the impact of the Affordable Care Act in Wisconsin to argue that some individuals and small groups will pay more, strongly suggesting that they will seek to design an exchange that permits the sale of lower quality insurance that does would not meet minimum standards. Citizen Action of Wisconsin has previously critiqued the Walker Administration's use of Dr. Gruber’s analysis.

“The Walker Administration is clearly in a bind because it does not want a federal exchange nor does it want a state exchange which meets minimum consumer protection standards,” said Robert Kraig, Executive Director of Citizen Action of Wisconsin. “Based on the record, our concern is that the Walker Administration will try to square the circle by submitting a plan for a substandard exchange which allows health insurers to sell inferior insurance. This could set up a showdown between Walker and federal authorities that could further delay planning for the implementation of health care reform in Wisconsin.”

Isn't that enough to just make you sick?

Heh. Guess what! Yup, that's right, there's still more.

Here's a little something that the gentle reader might not have known or had forgotten: Walker actually successfully ran a government-run health care system for years and knows that it saved taxpayers money.

As Milwaukee County Executive, Scott Walker was responsible for administrating a system called GAMP, which is short for General Assistance Medical Program. As I pointed out over three years ago, GAMP was a big success:

Wisconsin's General Assistance Medical Program (GAMP) provides health care coverage to indigent Milwaukee County residents who are not eligible for other forms of public coverage (such as Medicaid and the State Children's Health Insurance Program) and are not enrolled in private coverage. The county redesigned the GAMP program into a community-based primary care model in the late 1990s to achieve two interrelated goals: to provide increased primary care services, and to do so via community-based clinics. The new design was intended to improve effectiveness and efficiency of care. Prior to this, indigent patients relied on the emergency room of the county hospital, which created access barriers for enrollees and cost inefficiencies for the county. Under the redesigned model, GAMP enrollees select a participating clinic as their primary care provider, which is then responsible for providing and coordinating services. The clinic coordinates specialty care for the enrollee by working with specialists and hospitals that participate in the GAMP network. The program covered a total of 24,000 individuals in calendar year 2003, with some 10,000 to 12,000 individuals enrolled at any given time. All in all, GAMP estimated that it saved $4.2 million in 2000 (in comparison to the projected costs had the previous system remained in place). Administrators believe that inpatient and outpatient costs have been controlled largely through a Utilization Management program that ensures delivery of care in the appropriate settings and using appropriate resources.

In other words, the County designed and ran a health care system that limited people's choices by having to go through a community clinic first, and only if it was covered in the network. Yet, instead of leaving people without insurance and forcing them to go to hospital ERs, it saved $4.2 million. That's a big chunk of change for a relatively small amount of people.

The program was nationally recognized and was only discontinued when Governor Jim Doyle expanded BadgerCare, which provided the same basic service.

And let us not forget SeniorCare, another successful and widely popular program.

To recap, over the past decade, Walker has successfully operated a government-ran health care program and knows full well that they not only provided medical coverage for our most vulnerable citizens, but saved lots of money as well. Yet when it comes to Obamacare, he panders to the red-meat teahadists by grandstanding his opposition to it. But behind closed doors, he's been secretly plotting his own stratagem on how to implement the health care exchanges, but in some demented way, which will only end up harming those most in need and sticking it to the taxpayers.

It's pretty obvious whose side Walker is on, and it's not the people of Wisconsin's side.

And that's just sick.