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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.
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