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The Senate Chambers at the State Capitol in Madison, on Tuesday, December 4, 2018. PHOTO BY MICHELLE STOCKER

Wisconsin Republicans voted in a lame-duck session late Tuesday and early Wednesday to enact a work requirement for some Medicaid participants as part of a series of changes to the program. 

The state Assembly approved the legislation shortly after midnight, with all Democrats and Rep. Todd Novak, R-Dodgeville, voting against it. The Senate passed the bill on a party-line vote just before 11 p.m.

The bill codifies into state law a work requirement for able-bodied, childless adults under age 50 who are insured through the state's BadgerCare Plus program. BadgerCare Plus is available to adults whose incomes fall below the poverty threshold. President Donald Trump's administration approved the work requirement in October, but Democratic Gov.-elect Tony Evers said last month he is considering ending the policy.

Also under the changes approved by the Legislature, some childless adults insured under BadgerCare would be required to pay monthly premiums depending on their income level, and would be charged co-payments for nonemergency visits to the emergency room.

The bill also codifies a plan authorized by Gov. Scott Walker to create a reinsurance pool — a tool available under the Affordable Care Act to compensate insurers for covering high-risk individuals who, under the Obama-era federal law, cannot be charged higher premiums based on their status. The effort was designed to bring premiums down and encourage insurers to participate in the individual marketplace.

But more than 30 health care providers and insurers warned the changes included in the bill were "too complex for the expedited timetable the bills are on." 

The lame-duck bills were first introduced Friday afternoon and were advanced early Tuesday morning by the Legislature's Joint Finance Committee.

"There is simply too much in these bills to be able to accurately understand how the many different provisions will impact the State of Wisconsin and the communities we serve," the organizations wrote in a letter.

The groups were concerned the legislation might go further than codifying existing waivers and "could have unintended consequences that will impact health care delivery in Wisconsin."

The bill gives the Legislature more authority over health care waiver requests made by the governor. Senate Minority Leader Jennifer Shilling, D-La Crosse, argued the measure would handcuff the incoming Democratic administration while transferring more power to the Joint Finance Committee. 

But state Rep. Mark Born, R-Beaver Dam, argued lawmakers should have more oversight over the state's public benefit programs.

"We have worked hard … to bring accountability to the system and true help to the people in these programs," Born said. "One person could stop all that work."

Both chambers of the Legislature broke to allow lawmakers to meet privately in partisan caucuses after voting on the Medicaid measures, which now await Walker's signature. By 1 a.m., lawmakers had not yet taken up additional measures in the lame-duck package that would narrow the state's window for early voting and curb the authorities of the incoming governor and attorney general. 

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