Playing Hardball with Your Friends

The hearing room was quiet. Legislators were milling around waiting for the meeting to begin. The Joint Legislative Audit committee was to vote on approval of an audit of Medicaid – the state’s health program for low income people.

But something was not quite right. The chair convened the meeting and explained he was trying to reach consensus and had not yet been successful. Ten minutes after it began, the meeting ended. No vote had been taken.

After more than a week of intense negotiation, I found myself joining four Republicans on the committee calling for a vote to audit the fast growing Medicaid program.  Not a single Democrat agreed to join me and we needed one more vote to move forward with an audit of this important program.

Medicaid is the largest single program in the state budget. One in five people in Wisconsin receive health care through Medicaid. There has been dramatic increase in participants and costs – a growth of nearly a billion dollars in just one year. Cost overruns, excessive HMO administrative fees and shifting state costs on to counties all added up, in my mind, to the need for a program audit.

But my Democratic colleagues did not agree. One colleague argued we didn’t need the audit as all the answers were available from other Legislative service agencies.

This argument was rebuked by the service agencies themselves. No other agency is charged with making sure the numbers add up and with answering the question of how well the program is running and how we can improve things.

Another colleague argued that Medicaid as a whole is too big to audit; that we should audit a smaller portion of the program.  As if the Audit Bureau should stick to scrutinizing how we spend the nickels and dimes and not how we spend the hundred dollar bills.

Some Democrats feared an audit would arm those who wish to dismantle the program.

Those crafting a plan to destroy Medicaid don’t need a blueprint. But those who wish to preserve – or even expand the program – must acknowledge that finding efficiencies can improve services to people. Streamlining a program doesn’t have to mean people who benefit from the program will lose out.

My Democratic colleagues came back to me with changes in the proposed audit, crossing out words like ‘financial solvency’, ‘administrative costs’ and efforts to follow the dollars in the program.

In one closed door meeting I was warned about the Legislative Audit Bureau; “We can’t control what they say and we can’t control how they say it.”

That’s exactly why the Audit Bureau exists!

Our nationally recognized, non partisan Audit Bureau needs to delve into the details of how our state Medicaid program is run. We need to know what is working and what is not. As stewards of the people’s money, we need to understand how we spend every one of the six billion dollars invested in the program.

Regardless of who is in power next January, we will all be wrestling with a shrinking budget, greater need for services and fewer federal dollars. The audit can provide us with a blueprint for fixing a program upon which so many in Wisconsin depend.

Eventually the Audit committee will be taking a vote. Hopefully at least one other Democrat will join me to authorize a meaningful look at our Medicaid program.