Six years after the Affordable Care Act was signed into federal law, its impact is still being debated at the state level.

Wisconsin is the only state in the nation to refuse additional federal funding while still using the Affordable Care Act to expand Medicaid. Gov. Scott Walker uses provisions of Obamacare to ensure more people are covered under Medicaid, but continues to reject additional federal funding available under law. 

Republicans say elements of the Affordable Care Act, also known as Obamacare, costs the state millions, while Democrats say the act could save the state millions.

If Wisconsin were to accept the federal funding, they would save $200 million, Rep. Katrina Shankland, D-Stevens Point, said.

David Canon, a University of Wisconsin political science professor, said Walker doesn’t want to accept the federal money because he is worried it will cause Medicaid to get bigger and increase the overall cost to the state.

Walker has continued to oppose the Affordable Care Act. In February, he announced his support of a lawsuit against the Health Insurance Providers Fee, a part of Obamacare.

“Once again, we are taking action to protect Wisconsin taxpayers from the adverse effects the Obama administration’s Affordable Care Act has on our citizens,” Walker said in a statement. “If left unchallenged, the Health Insurance Providers Fee will force states to pay between $13 to $15 billion in payments over the next decade.”

Report says Wisconsin would save $42 million by switching insurance models

Wisconsin is currently involved in three lawsuits against the Affordable Care Act.

Though costs to the state will go up, Canon said the Affordable Care Act is an overall good deal in terms of the benefits for the amount of money spent.

Canon said nationally 20 million people have access to health insurance that would not have it without assistance from the Affordable Care Act. Enrollment numbers for the Affordable Care Act have been on pace or exceeding expectations even after a rough start, he said.

“[Not accepting Obamacare funding] will clearly cost the state money in the long haul,” Canon said.

Rep. Joe Sanfelippo, R-New Berlin, said the major problem with Obamacare is the cost to the state. The federal government has said Obamacare will cover 90 to 95 percent of the state cost of health care, but the federal government has not covered what they said they would cover, Sanfelippo said.

“The problem is states are asking the federal government for money [for Obamacare], but in some cases, getting only 10 cents on the dollar for what their request is,” he said.

Obama calls out Wisconsin Republicans over Affordable Care Act

In the first year of Obamacare, states that took federal money, like Ohio, saw expenses double what they estimated, Sanfelippo said. States have also seen more people enroll into the program than expected, he said. Ohio has already seen more than 600,000 people enroll, which was the expected enrollment four years from now, Sanfelippo said. This results in higher costs than anticipated.

But Rep. Daniel Riemer, D-Milwaukee, said federal funding should be used because it will help people who were previously uninsured get care and help Wisconsin’s budget.

“People all over the state have just paid taxes and we are not getting any of that money back [by not accepting federal funds],” Riemer said.

Riemer said people have generally changed their mind to support Obamacare, since it is helping more people get access to health insurance.

Linda Reivitz, UW nursing faculty associate and expert on health care policy, said many more people have the ability to afford insurance and get care. She said Wisconsin has the lowest uninsured rate that has ever been recorded in this country, about 90 percent.

With this influx of new people with health insurance, Reivitz said hospitals and other health care providers have been challenged to improve the value of care.

“We have a lot more information and data,” Reivitz said. “People are using that data to say how can we best spend the money that is available to get the best health.”

The health care system has changed to focus on preventative services in addition to treatments because of the Affordable Care Act, Reivitz said.

Riemer said the Affordable Care Act has problems, but getting more people health care is beneficial for Wisconsin and the country.

“Let’s be honest, there are still parts of [the Affordable Care Act] that need to be figured out and changed,” he said. “For the most part, the individual features of the Affordable Care Act have had a positive effect on the economy and the health care system as a whole.”