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Governor Scott Walker is looking to improve his state’s Medicaid program.

The debate has been raging for years; should more restrictions, including drug testing, be placed on citizens receiving state or federal aid? While conservatives pushed the issue, the Obama administration never would have agreed and had the ability to block all attempts.

The Trump era has brought in many more opportunities for these types of measures. His dedication to less federal intervention means a chance for states to step up and implement new legislation. Wisconsin is leading the charge with a proposed measure this week that would add work requirements and drug mandates to their Medicaid program.

Governor Scott Walker has indicated he believes the president will support the changes. “Now with a new president and a new Congress. We can actually go forward with our plan to ensure that everyone seeking welfare can actually pass a drug test.”

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Wisconsin is one of 19 states that have chosen not to expand their Medicaid program. Obamacare broadened the scope of the program to include low-income people in all states. A Supreme Court ruling in 2012 altered it to be an optional extension. For political and financial reasons, some states opted out.

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With Medicaid costs rising consistently, something must be done to ensure the budget is well spent.

As the drug epidemic has gotten worse instead of better, despite nationwide efforts, lawmakers are looking for other solutions. Las Vegas, NV is installing vending machines that will dispense clean needles to drug users in an attempt to combat spreading of disease. Some cities in California have been considering safe spaces for drug users to try and reduce overdoses and dirty needle sharing. Critics will say that drug testing of Medicaid recipients is not altruistic but cynical. That is not necessarily the case.

It is true that our government spends billions on health care. The Centers for Medicare and Medicaid Services reports that America’s Medicaid spending rose to $545.1 billion, an increase of 9.7%. That accounts for 17% of the total National Health Expenditure (NHE).

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State costs vary. A report released in 2011 projected that Wisconsin would spend approximately $14 billion over the following two years; about $2,500 per year from every taxpayer in the state. The report also stated that the program was currently spending “about $19 million in state and federal funding per day.”

Those kinds of numbers indicate an incredible burden on each state. Local and federal governments want to help their impoverished citizens but every dollar needs to be well spent. That is where some of these modifications begin to really matter.

First and foremost, Wisconsin is seeking to reward those on Medicaid that help take care of themselves. If participants engage in healthy behavior they could see premiums that are cut in half. They would also be rewarded with emergency room co-pays of only $8 in the first year and $25 after that. Lawmakers say that they hope to “promote appropriate use of healthcare services and behavior that is mindful of health care value.”

New work requirements are aimed at non-disabled adults under the age of 49 who are not students. Typically, this is the demographic most likely to engage in fraud, using benefits they do not truly need and taking away from those that do. Under the proposal, participants in this group must either participate in a training program or find part-time employment of at least 80 hours a month. Failure to do this within generous time limits, four years on Medicaid, would result in loss of eligibility for six months.

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Deaths from overdose are rising indicating a rise in use as well.

The drug testing component is easily the most controversial. Wisconsin would require an assessment of each participant to gauge substance abuse. If abuse is indicated then a drug test would be administered. At the point, a person has three options. One, refuse the testing and become ineligible for Medicaid. Two, take the test, fail, and lose eligibility for six months. Three, remain eligible and enter a treatment program.

The state is further trying to combat the drug epidemic by paying for more residential addiction treatments. In order to do this, some participants of Medicaid would be charged a premium of $1 to $10 a month based on income. In addition, Governor Walker has proposed similar drug testing for certain residents who receive unemployment and food assistance. Again, younger, non-disabled participants that may well be capable of holding a job.

The Wisconsin plan is well thought out, reasonable, aims to help the most people possible, and focuses on the biggest problems. It is likely that liberals will tear it apart. They view Medicaid as a right, not a privilege but are unwilling to contribute ideas for how that would be logically funded.

A detailed proposal will be released on Wednesday. The state plans to hold public hearings to receive feedback and then submit a final version to the president by May 26.

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Representative Robert Aderholt (R-AL) has already initiated changes in Medicaid at the federal level.

The federal government has begun steps in a similar direction already. Republicans introduced legislation to the House earlier this month that would repeal laws barring states from developing their own requirements for aid recipients.

However, Congress does not have plans to hand full power over to the states quite yet. They have included stipulations that “Only welfare applicants who either have lost their job due to drug use or are seeking a job that regularly requires employees to pass a drug test would be candidates for screening.”

With Democrats so outspoken on this issue, the fight in D.C. could get messy. President Trump has stood strong so far, pulling back many government overreaches that Obama put in place; there is no reason to think this won’t proceed in a similar fashion.