By Shawn Doherty
The Capital Times
March 10, 2011

Health reporter Shawn Doherty previously worked for Newsweek and the Los Angeles Times. Vital Signs explores medical news, health-care tips, policies, and politics, and reader comments.

Once again, Medicaid seems forgotten as another wave of protests and media stories rocks the Capitol. Last night's surprise vote by GOP lawmakers pushing a pared down version of the so-called budget repair bill through a hastily convened conference meeting and a rapid approval by the Senate to what now seems to be almost definite passage as early as this morning impacts not just collective bargaining rights in the state, but the health care and benefits of nearly 1.2 million Wisconsin residents in the public health programs.

But you'd never know it.

Once again, virtually all of the news coverage and outrage has focused on how the measure acted on last night would strip away decades of collective bargaining rights from tens of thousands of state workers. That is huge, of course, but advocates for the one out of every five state residents on Medicaid say that the impact of them is huge as well.

This omission rubs salt in the wounds of advocates for the elderly, the disabled, and the poor and middle class recipients of Medicaid benefits, thousands of whom have been organizing over the past several weeks to make known their opposition to the measure, which would hand unprecedented powers to the state health department to revamp and even gut programs without following normal legislative processes and without public input. We have been posting regularly about these provisions and about the efforts of advocates to fight them, which have included protests, press conferences, e-mail and phone campaigns and even a wheelchair occupation of the GOP headquarters.

Advocates were as caught by surprise as the rest of the state late yesterday afternoon as news spread that the Republicans would be splicing parts of the original bill, which Walker had insisted was a fiscal matter necessary to balance the budget, into a separate measure as a way to get around what had been holding the bill up for weeks---the need with any fiscal legislation to get a quorum of 20 senators, which in this case would have required one Democrat to be present along with the 19 Republicans.

To do this, Republicans hacked off not just the controversial collective bargaining pieces of the original legislation. They peeled off all the Medicaid provisions, too, which are equally Draconian and unprecedented.

I spoke to several advocates and analysts about what got passed last night, and they said that the language of the measure---which many of them had only received after the vote--- was so complex and confusing that aspects of it baffled them. Still, it appeared that the parts of the original legislation that had most concerned them were indeed part of the package approved last night.

These include provisions handing what would amount to unilateral authority to revamp and even gut the Medicaid programs, including changes in eligibility standards and benefits, to the state health department. For years, such changes have needed to go through a legislative process involving hearings and public input.

Making advocates especially nervous about this change is that the state's new secretary of health is Dennis W. Smith, a Washington bureaucrat well-known for his staunchly conservative views, including opposition to federal health care reform. As I have reported before, Smith as a senior fellow at the conservative think tank The Heritage Foundation authored a series of memos advocating that states walk away entirely from Medicaid programs.

One minor tweak over the original proposal does seem to have been made.

It appears that the administration has revamped bits of the language around the emergency rule-making authority granted to the health department, but that's not necessarily good news, advocates say, since it may make it harder for them to fight the legislation on legal grounds, using the argument raised by the bill's own drafting attorney that it violates the separation of powers doctrine.

But again, I should note that as of midnight last night even folks much more steeped in all this remained confused by the language of the bill. I will post additional information and their thoughts as soon as I can.

What is obvious is that advocates are stunned, furious, and devastated. A flurry of press releases containing such reactions went out shortly after the vote was taken at around 6:30 p.m. last night. "We have just witnessed a stunning lack of leadership; a callous disregard for the workers and medically needy of our state," said Public Interest Attorney Bobby Peterson of ABC for Health in one of those statements. "The Wisconsin Senate disparaged the law and ramrodded profound policy changes in a process that is both corrupting and corrosive to democracy. This action shall not stand and will not stand. The Walker Administration, Senator Scott Fitzgerald and the remaining Senate Republicans supporting this vote will get their comeuppance from the people of Wisconsin."

Also within hours members of the Medicaid community were swarming into the Capitol, determined to make their voices heard along with those of thousands of other protesters, many chanting, others in tears. "One fifth of Wisconsin residents are affected by Medicaid, the most vulnerable people in our state," said Dane County Board Supervisor Barbara Vedder, who was paralyzed in a car crash years ago and gets around in a wheelchair.. "How this was done is disgusting and reprehensible."

Jon Peacock, the research director for the Wisconsin Council on Children and Families, sat pouring through the measure until nearly midnight trying to make sense out of it. The "small improvement" he found that now requires the health department to use the existing rule-making process, as opposed to emergency rules, "does not cure the fundamental problem of giving an unelected state official a blank check to supersede nearly all of the Medicaid statutes that have been carefully crafted over the last two decades," he said. "Enactment of this legislation will strip everyone in this state of our fundamental right to engage with our elected legislators on Medicaid policymaking and to hold our legislators accountable for the decisions that are made."