Joy Powers: This is Swing State of the Union — a podcast all about Wisconsin and why it’s so important to U.S. politics. I'm Joy Powers.
Sam Woods: And I'm Sam Woods. Thank you so much for joining us. We are weeks away from the Nov. 3 election, and early voting in Wisconsin begins Oct. 20.
As voters head to the polls, healthcare may be on their minds. The Big Beautiful Bill cut nearly $1 trillion dollars from Medicaid, leaving many without health insurance. And as healthcare companies focus on profit, some communities are losing access.
Powers: So in this episode, we’re looking at the business of healthcare, the politics of Medicaid and how the care we receive defines our communities.
To start, we head to Waupaca, a city of about 6,000 people.
One Waupaca mother’s story
Woods: It’s early fall in Central Wisconsin. The summer heat is breaking, and dozens of lakes reflect a bright blue sky.
At the library in downtown Waupaca, Cindya Gullickson and her son are picking out books.
Cindya’s son is a little over a year old — and well-traveled. His parents work at renaissance fairs across the country, from Minnesota to Kentucky. And he’s already training to take over the family craft.
Gullickson: He hammers onto his dad's anvil. He's been hearing that anvil noise since he was in the womb. So he sleeps right through it and everything, because he's so used to that “tink-tink” sound of the anvil.
Powers: But Waupaca is their home base. Cindya grew up in the area, and the community has grown up with her.
Gullickson: Waupaca is really great. It's such a strong community, and there's so many community events that go on. I mean, the library that we're in right now is like a hub for a lot of the community events. Like, I do “Baby and Me” with him here. And there's baby garden here that, like, one of my friends growing up runs now.
Powers: After trying for awhile to have a baby, Cindya and her partner were getting discouraged, doubting it would ever happen.
Gullickson: When I got the pregnancy “positive” at home, I was like, “There's no way.” And so I immediately called, and I was like, “I need to go into Waupaca and get a test from them, so they can tell me that this is actually a real thing. And she was like, “You're pregnant.” And the way that I looked, just like white in the face, she was, like, “Is this something that you want?” And I was like, “It really is, but like, I was not expecting this right now.”
Powers: This was Cindya’s first baby. But luckily, the staff at Waupaca’s medical center were there for her every step of the way. She says she was treated like royalty.
Gullickson: My doctor, who was kind of with me trying to get pregnant for years, as soon he found out and all the other doctors that I went to found out that I was pregnant, they're like, “Oh yeah, another baby that we can have here.” And so, a mom, pregnant, I was like top priority in Waupaca.
Powers: At that time, the hospital had a labor and delivery unit, which provides medical care for people during labor, childbirth and immediate recovery. For expectant mothers like Cindya, the hospital was a one-stop shop.
Gullickson: You're supposed to do kick counts. And so I was doing kick counts, and he wasn't moving. And of course, as soon as I got to the labor and delivery unit, he was wiggling all around, and I was fine.
But Callie was there and she told me, “If anything like this happens, don't be afraid to come in. Just because this was a false alarm, we're here for you. And if you feel like something's wrong, don't hesitate to come back. Even if you think that you're crazy, and you don't have anything actually wrong with you, if you feel like there's something wrong, just come in and get checked out because that's what it's there for.
Waupaca labor and delivery unit closes after healthcare merger
Woods: But a shift was underway. Earlier that year, ThedaCare, the nonprofit organization which owned the hospital in Waupaca, merged with a larger nonprofit, Froedtert and the Medical College of Wisconsin. This put the place Cindya expected to have her baby in jeopardy.
Powers: About seven months into her pregnancy, ThedaCare told Waupaca doctors that it planned to close the labor and delivery unit Cindya had come to rely on.
In a statement to WUWM, ThedaCare said the decision was made to “ensure safe, high-quality care for mothers and babies,” and that the decision was not made for financial reasons.
Cindya got the news the next day.
Gullickson: It was my birthday. Yeah. I found out on my birthday.
Waupaca rallies to save labor and delivery unit
Powers: The Waupaca community rallied to try to save the labor and delivery unit .
Woods: The first step? Get over 3,000 signatures on a petition.
Gullickson: I couldn't believe how many people signed the petition. I mean, I was sending that to everybody.
Woods: Second step: rally local political support from the city council.
Waupaca City Council Member: Now, healthcare economics, I'm sure, has changed in 20 years. And it's probably a real tough decision the local board made. However, the commitment is slipping.
Woods: Third step: reach out to Governor Tony Evers and state legislators.
Gullickson: We were going on both sides. Like, this is not a political-sided issue. It was like, “Moms deserve care.” Maternal mortality is high for a reason, and we could do something to stop that. And that shouldn't be like a “I'm on this side of things,” or “I'm on that side of things.” It's like, “Everyone should come together and support moms and babies, because that's our future.”
Woods: Cyndia, her doctor and a group of about 10 residents and medical staff met with ThedaCare to plead their case. They protested outside ThedaCare headquarters in Neenah and got statewide media coverage.
Public outcry fails to save Waupaca labor and delivery unit
Powers: But it didn’t work. ThedaCare announced it would close Feb. 15.
Gullickson: My due date at the time was March 8. I was like, “That's not gonna work. Unless I have a really early baby, that's not gonna work.” And I kind of held out hope for awhile longer, and we were really fighting it.
Powers: Despite their efforts, the unit closed. Cindya was left to figure out what to do next.
She opted for a homebirth, in part because she could hire the medical staff she was familiar with throughout her pregnancy to be there for the birth. Her Medicaid insurance covered some of it, but she says it still cost her a few thousand dollars.
Gullickson: You're the one responsible for buying all the supplies, which is also really scary. When that gets shipped to your house, you're like, “This is all the stuff that will sop up my blood if I hemorrhage.” But you basically get a kit, that you're responsible for paying for, that has all of the medical supplies that you might need. So yeah, all said and done, it was like $3000 with everything.
Home birth complications after Waupaca labor and delivery closure
Powers: In fighting the closure of the labor and delivery unit, Cindya learned a lot about what could go wrong during birth. Then, she lived it.
Woods: After she gave birth, she started hemorrhaging.
Gullickson: As soon as I saw Laura, one of the other midwives, come at me with a giant syringe of pitocin, she put that into my leg. And then that wasn't enough, so they put another one into my other leg. I asked her, and I said, “I'm hemorrhaging, aren't I?” And she said, “Yeah, but it's gonna be okay.” And I was like, “Okay.”
But I knew exactly what was going on before they told me, because I had every scenario in my head that could possibly happen when you're giving birth. That is a lot easier to deal with when you're in a hospital than when you’re in your child's nursery.
Woods: ThedaCare’s namesake, Theda Clark Peters, was a woman who died in childbirth in 1903 in Neenah, Wisconsin. Luckily, Cindya did not share Peters’ fate. But had she needed to be transferred to a hospital, the closest one would’ve been in Neenah, about 40 miles away.
Gullickson: All I could think about is: “I hope that they can fix this now, because if they can't, I'm gonna be ambulanced or helicoptered to somewhere separated from my child, which I had heard stories from from other moms. And that was the worst-case scenario for me was being separated from him right after I gave birth.
Woods: Cindya’s team of doctors, doulas and midwives were able to apply pressure to her uterus and stop the bleeding before she needed to be airlifted to a hospital.
Critical access hospitals, explained
Woods: While Waupaca’s labor and delivery unit is no longer in operation, the hospital there remains. It’s known as a “critical access hospital.” That’s an official designation for a small rural hospital that provides 24-hour emergency care and often treats people with low incomes, or who are uninsured.
Powers: Hoping for the best is an increasingly common childbirth story. Critical access hospitals and safety net hospitals — the urban designation for a similar type of facility — are struggling to stay afloat. Labor and delivery units are often the first to go. One in three counties in the country are classified as a “maternity care desert,” according to the March of Dimes.
In Wisconsin, both rural and urban communities are affected. Milwaukee’s South Side was left without a labor and delivery unit, when Ascension St. Francis Hospital closed its services a few years ago.
But how do hospitals make money, and why are services like labor and delivery being cut?
Why does healthcare cost so much?
Woods: Can anyone tell us why healthcare costs so freaking much?
Dan Weissman: I'm Dan Weissman. I'm a reporter. I make a podcast called “An Arm and a Leg,” about why healthcare costs so freaking much.
Woods: Weissmann’s podcast has been covering healthcare and health economics since 2018. He’s here to give us a glimpse into how hospitals and healthcare organizations make money.
To start, it's important to note that not every hospital system is playing the same financial game.
Higher-end vs. lower-end hospitals
Weissman: There is a spectrum, right? And on the one end, we've got urban safety-net hospitals and rural critical access hospitals, which exist to serve people. They don't make a ton of money. They are often in very tough financial situations.
And on other end, these hospitals will also complain about their financial situations, but you've got the Mayo clinic and the Cleveland Clinic and the like.
And sharing that tier, perhaps not quite as high as them, are tons of big academic medical centers. In Chicago, where I live, that would be like Northwestern Medicine and University of Chicago hospitals and Rush. And these are the kinds of places that you wanna go if you can. And there's a spectrum in between, and they have very different economics.
Woods: Those high-end hospitals try to attract patients with private insurance. This can mean investing in expensive technology, like a cutting edge MRI machine that may not be used often, but projects a sense of status.
Weissman: So that leads those big fancy hospitals to spend a lot of money on things that may not be necessary to meet community needs. They're necessary to attract the people that you think have really great insurance, that you wanna make sure are demanding to be able to come to your hospital.
How nonprofit hospitals play 'financial games'
Powers: Many of the largest hospital systems, like Kaiser Permanente or Advocate Health, are technically nonprofit organizations. But this doesn’t always mean they’re struggling financially.
Weissman: Many of the hospitals on the kind of richer end of the spectrum may technically be nonprofit, but that's a kind of tax designation. Not turning a profit doesn't mean that they can't run surpluses or sock away large reserves of money. So there are nonprofit hospitals that run investment funds out of the money that they've socked away.
Powers: And nonprofit hospitals running investment funds is just the beginning of the financial game of healthcare. While individual hospitals aren’t typically seen as big money-makers by themselves, there are often financial motives behind the kind of care they provide and what they invest in.
So if you want to make money in healthcare, how do you do it?
How health insurance companies put profits over patients
Woods: Let’s start with health insurance companies. Their strategy is fairly straightforward: pay out less than you take in.
Weissman: An insurance company is basically a finance company. The version of insurance that we all think of is like, “I collect premiums from you. I'm gonna put them over here. I've hired actuaries” — basically bookmakers, to make sure I'm on the right side of the odds, to say like, “We're making a bet that the amount that we take in this year is gonna be more than we're gonna pay out in claims. And we're also taking more dollars in today that we won't have to pay out until tomorrow. And so, I've got money that I can go and invest in financial markets.” And so, insurance companies do that.
Woods: In some cases, the same business owns the insurance company, and the provider who bills the insurance. So, they get to pay themselves.
One example is United Healthcare. It is one of the largest health insurance companies in the world. But it’s only one part of the umbrella company, UnitedHealth Group. Also under that umbrella is OPTUM.
OPTUM operates range of services in healthcare, including urgent care clinics and specialty care centers for things like physical therapy.
Weissman: And among other things, Optum is now by far the biggest employer of doctors and healthcare workers in the country. Like, bigger than the VA, bigger than Hospital Corporation of America, bigger Kaiser Permanente. By a lot.
Powers: The Affordable Care Act tried to reign in how much insurance companies could charge for premiums, by limiting their profits to about 15-20%.
But since UnitedHealth Group owns both an insurance company and employs many doctors, it can set rates that it knows will turn a profit for everyone under the umbrella.
Weissman: I'm almost getting dizzy. But like, I, United Healthcare, the insurance company, I'm paying this doctor their inflated rate. And I get to keep a 15% profit on top of that. And I'm making a big profit as UnitedHealth Group, Optum, on the doctor's labor.
Powers: Another way UnitedHealth Group makes money is by not paying doctors in a timely manner. Then, they can issue loans to the same doctors and collect interest.
Weissman: OPTUM runs a bank, like an FDIC-insured bank, which has been known to offer what amount to payday loans to doctors who are like, “Gosh, I can't get my claims paid fast enough by the insurance company, United Healthcare, and so I'm short of cash.” And an Optum bank is like, “We got you. We'll loan you some money to tide you over. And we'll just take it out of what you get when you get paid on a claim.”
Healthcare and private equity
Powers: At the same time, pension funds and private equity companies are buying up pieces of the healthcare system that are most profitable.
Weissman: One story we did a few years ago was based on hearing from a listener who had gone in for a colonoscopy and had been very surprised by the bill and everything that came with it. And we did some digging and we're like, “Oh, it turns out that place you went to was backed by a big private equity company that had been buying up gastroenterology practices all over the country.”
And my colleague, Emily Pisacreta, found a blog post by a guy in this kind of investing world who was like, “Yeah, we've entered the 'golden age of older rectums.'” It's like, “the colons of baby boomers; there's a gold mine in there.”
Incentivizing costly specialty procedures
Woods: And there are ways of incentivizing doctors to do more of what’s better for a company’s bottom line.
Weissman: Generally, doctors are paid more for things that involve procedures and that involve kind of specialty care that only certain people can do. And that is why providers like primary care doctors and, in many cases, neurologists, who are not doing surgeries, they're doing diagnosis. They're thinking about things. That is not something that gets billed at very high levels.
And so, there's pressure on providers. There's pressure on the people who employ providers to do more of the things that you get paid better for doing.
High costs for prescription drugs
Woods: One way that patients can fall victim to this push for profit is in drug manufacturing. Drugs that treat rare conditions can come at a high price. Weissmann shares one example where a medication to treat Tourette’s Syndrome cost around a half-million dollars per year.
Weissman: And I was like, “How do you justify, you know, ending up charging half-a-million dollars a year for this drug?” And he was like, “Well, look, here's my story. Like, you know, I needed a certain number of millions of dollars to run those clinical trials. It's expensive. And in order to get those millions of dollars, I needed investors. And if I didn't tell those investors, ‘I'm gonna give you these incredible returns,’ they would not have invested in me and what I was doing, because everybody else who was asking for their investment was telling them they would get these kind of incredible returns. So there's no way that I could bring this drug to market or do anything, unless I was promising investors giant returns.”
Who’s to blame?
Woods: So who’s to blame for why healthcare is so expensive? Well, it may depend on who you ask.
Weissman: Every player in this world, whether it's drug manufacturers, insurance companies, hospitals and all of the myriad of kind of middleman and obscure companies in between, they're all very happy to say, “Oh, well see, the problem is this other guy's a shark. You know, I'm a hospital. I’m a doctor. Like, the problem is this insurance company is a total shark, and they're beating up on me. And I've got to kind of do what I've gotta do just to survive in this thing.”
And the insurance company will say, “You know, the problem is these providers are super greedy, and they're gaming the system, and they’re raising prices on us, and all we can do is to raise premiums to cover the cost of what they're charging us.” And that is all more or less true.
Impacts on patients
Powers: So how does all this affect the care you receive?
For one, you may just be priced out of care.
Weissman: I mean, I just think the strongest evidence are the surveys that come out every year showing shocking numbers of people — and the numbers vary from survey to survey.
But it can be like a quarter of people, a third of people saying like, “I didn't take the medicine that my doctor prescribed,” or “I didn’t get follow-up care,” or “I did not get some other version of care that I was told that I needed, or that I knew that I needed,” or “I do not go to see a doctor at all, because I did think I could afford it.”
Powers: But even if you can afford to pay, the care provided at your nearest hospital is subject to investment decisions. For instance, the economic cost of staffing a labor and delivery unit may not be seen as worth it.
Weissman: Because people go into labor at all hours of the day. And so, you’ve got to have some version of it, I assume, up and running 24 hours a day. There's gotta be someplace to come to have your baby, and you gotta have enough staff on hand for whatever's gonna happen.
Powers: And a lot can go wrong, which is — you guessed it — a financial consideration.
Weissman: Labor and delivery is one of the more unpredictable kinds of healthcare you can provide. Lasik surgery is pretty predictable, by contrast. Like, there's a lot more that can go wrong when you're delivering a baby — especially, perhaps, if you're short-staffed or underfunded.
How Big Beautiful Bill cuts hurt hospitals
Woods: Which brings us back to the other end of the hospital spectrum. While your fancier hospital may be investing in a new MRI machine to attract customers with private insurance, hospitals on the other end of the spectrum exist to serve everyone else.
Rural critical access hospitals and urban safety net hospitals both have a mandate to provide medical care, regardless of the patient’s ability to pay. But because they serve a disproportionate share of people without private insurance, they are reliant on government programs like Medicaid.
But after the Big Beautiful Bill cut Medicaid funding by nearly $1 trillion dollars, there are fewer people enrolled in the program and less money to go around.
Weissman: And so, for those people, like Medicaid's really important — because if someone walks in and they have Medicaid, you're gonna get paid something for seeing them. And if someone walked in, and they don't have any insurance at all, you're probably not gonna get paid anything for seeing them — especially if they’re someone who, for instance, Medicaid is being cut back.
[More] people who were previously thought to be eligible for Medicaid are now no longer thought to be as eligible for Medicare — not because they suddenly have more money and can pay medical bills, but because they didn't meet certain qualifications. Well, that's the same person. They're not gonna be able to pay your bill in cash. And there's nobody who's gonna pay their bill for them.
Powers: It's unclear how these types of hospitals will fare in the near future. There could be more hard decisions in store, like closing more labor and delivery units.
After the break, we explore the politics of Medicaid, and investigate who has power in healthcare.
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One Waupaca doctor weighs in
Woods: Back in Waupaca a year and a half ago, Cindya Gullickson was giving birth in her home. The local labor and delivery unit had closed three weeks earlier, but a familiar face was there, along with a team of doulas and midwives.
Gullickson: My OB was there rubbing my back and coaching me through and telling me that I could do it and to keep going. And that helped me so much in the labor process. So yeah, he's a one-of-a-kind dude.
Woods: That ‘one-of-a-kind dude’ is Dr. Ezra Lyon. For him, helping people like Cindya through pregnancy and childbirth is a calling.
Ezra Lyon: It’s an honor to be a part of someone’s life during monumental changes. It really is.
Woods: Today, Dr. Lyon is practicing family medicine in Wausau, about an hour away from Waupaca.
Similar to when he was working at the Waupaca labor and delivery unit, his current clinic serves patients regardless of their ability to pay.
Lyon: I see patients who are all ages. I take care of a few patients who are pregnant, and I take care of kids. I see a number of patients with substance use disorders, so whether that's problems with alcohol or opioids.
Powers: Like Cindya, many of Lyon’s patients are enrolled in BadgerCare — Wisconsin’s version of Medicaid. But increasingly, Lyon is seeing the effects of federal policy.
Even before the Big Beautiful Bill’s cuts to Medicaid, many of Lyon’s patients required help proving their eligibility for coverage.
Lyon: Forms and the complexity needed to prove financial needs are such that most patients can't get through them on their own. And that's especially true for, say, one of my patients who came as a refugee and whose primary language might be Dari or Rohingya or Spanish.
Powers: And this added bureaucracy has a predictable outcome: fewer people have insurance.
Wisconsin patients lose Medicaid coverage
Over 20,000 Wisconsinites have lost Medicaid since the Big Beautiful Bill was enacted.
Lyon: Patients that I saw today — like, I've got a patient who, she's a refugee. She's been on Medicaid. She will no longer be able to be on Medicaid as of two days from now, because of changes in federal policy. And so for her, the business of healthcare is everything. And so for her, this is going, has gone from she was on Badger Care, and we knew what services were covered and who we could get her seen by, to now, she's in the Wild West of not having insurance at all.
Powers: And without insurance, people often take chances with their health — to help pay other bills.
Lyon: Someone might be walking around with blood pressure that is very high. Might know about that, but doesn't feel like it's a priority. They've got to pay their rent. They've got to buy food. They've got to put gas in their car. And so, putting aside hundreds of dollars to get into a clinic, that might give them a discount, and getting their blood pressure under control isn't top of their priorities. But if they wake up in the morning and they've got crushing pain under their chest, and they're worried they have a heart attack, they're still going to go to the emergency room. Then that's an emergency room bill.
BadgerCare expansion debate, explained
Woods: Established in 1965, Medicaid is a joint federal and state health insurance program covering people with low incomes. About 70 million Americans are enrolled in Medicaid. Medicaid covers around 40% of births nationwide and one-half of births in rural areas.
While Medicaid covers people with low income, another federal program, Medicare, covers people over 65.
In Wisconsin, our Medicaid program is known as BadgerCare.
One of the signature aspects of the Affordable Care Act was to expand Medicaid to more people. The federal government would cover 90% of the cost of expansion. 41 states and the District of Columbia opted in. Wisconsin has not.
Powers: This option for states to expand Medicaid began in 2014. At the time, Wisconsin had a Republican governor and Republican-controlled legislature.
The legislation from Democratic President Barack Obama was a tough sell in Wisconsin. Philip Rocco, chair of the political science department at Marquette University, explains how some other states came to expand Medicaid, despite Republican control.
Philip Rocco: That has tended to happen through voter-driven initiatives at the ballot box, which is a process that Wisconsin does not have. But states like Idaho, Utah, Nebraska, Oklahoma and Missouri have — despite legislative opposition — expanded Medicaid at the ballot box. Because Wisconsin doesn't have that, the kind of conflict between, in recent years, a Democratic governor and a Republican state legislature has really made the political challenge of expanding Medicaid quite intense.
How Wisconsin lost out on $1.7 billion in healthcare funding
Powers: By not expanding Medicaid, it’s estimated Wisconsin lost out on about $1.7 billion dollars during the current budget cycle; money that could have helped hospitals and providers serving low-income patients, and make healthcare accessible to more people.
Woods: But the option to expand Medicaid has gotten trickier with the passage of the Big Beautiful Bill last year. The Trump administration and Republicans lawmakers clawed back temporary benefits enacted during the COVID-19 pandemic, limited the types of taxes states can use to pay for the program and added administrative work for states and Medicaid recipients alike.
Even with these changes, Rocco says Wisconsin is still leaving money on the table.
Rocco: But you can see Republicans at the national level trying to do things around the edges that kind of change the cost-benefit calculus for some states. Now, especially in a state like Wisconsin, it doesn't in any way erase that initial 90 cents-on-the-dollar enhanced matching. But it is an attempt to kind of take the bloom off the rose, so to speak.
Passing the postpartum Medicaid coverage extension
Woods: While Wisconsin has not fully expanded Medicaid, it has recently expanded parts of it. Earlier this year, the state passed Medicaid expansion for postpartum coverage — extending BadgerCare’s coverage of postpartum healthcare from 60 days to a full year.
Powers: After years of partisan gridlock, the bill passed with near unanimous bipartisan support. As
JR Ross, editor of WisPolitics explains, Republican Assembly Speaker Robin Vos blocked the bill for years, before relenting and ultimately voting for it.
JR Ross: Two or three sessions in a row that it passed the Senate, like overwhelming — maybe one or two votes against the Senate, got the assembly and died. And Voss said it was expansion of welfare. “We are not going to do this because it's not available in the private sector to mothers. So why we do it for a government program?” Well, this session, he finally gave in.
Now, it could be because he's retiring. It could be because his members finally convinced him, or because he saw the writing on the wall that the members that he has in vulnerable districts were going to get beat up on this issue, because it's quite popular. And so, this time, it went through overwhelmingly. I think Voss even voted for it, I think, on the floor. It finally passed. So it basically was just the end of Robin Voss saying “no.”
Powers: Though Cindya Gullickson is enrolled in BadgerCare, these changes took place in July 2026. That means she missed the window for extended postpartum coverage by about four months.
Woods: So to recap, Medicaid is a government-run health insurance for people of any age with low incomes, paid for primarily by the federal government — with a little bit of contribution at the state level. In Wisconsin, we know this as BadgerCare.
Starting over a decade ago, states could fully expand Medicaid, with the federal government picking up 90% of the cost. Wisconsin is one of a handful of states that has not done this, due primarily to Republican opposition. After passage of the Big Beautiful Bill, Wisconsin is still leaving money on the table by not expanding Medicaid, and it’s become more difficult for Wisconsinites to access the program at all.
Crowley vs. Tiffany on Medicaid expansion
Woods: So, when it comes to healthcare access and Medicaid expansion, who has power?
Powers: Expanding Medicaid in Wisconsin would require support from both the governor and state legislature.
Democratic gubernatorial candidate David Crowley has campaigned on expanding Medicaid as a public option, which would allow anyone to buy into the program. This is what he told WXOW in La Crosse:
David Crowley: And my plan is to actually expand BadgerCare. This will give us an opportunity to double eligibility, taking care of our most vulnerable populations as well, but give our entrepreneurs, our seniors, our students, our gig workers, our farmers the ability to actually pay into this alternative for for-profit insurance.
Powers: As Milwaukee County Executive, Crowley opposed federal cuts to Medicaid included in the Big Beautiful Bill.
Woods: Republican gubernatorial candidate Tom Tiffany is currently a representative in Congress. He voted in favor of the Big Beautiful Bill. Tiffany says as governor, he would combat Medicaid fraud. Here he is at a campaign event with Vice-President JD Vance:
Tom Tiffany: As the next governor of Wisconsin, we're going to audit all of state government. We're gonna audit those food stamp rolls. We're gonna audit the Medicaid program. We're gonna make sure that you, the taxpayers, are protected and you're not being ripped off.
Republicans center Medicaid fraud this midterm season
Woods: Research from Georgetown University suggests that nearly all cases of Medicaid fraud are on the provider side, not the patients.
But as Phil Rocco notes, Republicans have focused on fraud when it comes to a variety of issues — from healthcare to SNAP benefits to education.
Rocco: But that also introduces a tension in that side of the debate, because it's not exclusively about addressing the problems that people are citing when they access the healthcare system. It introduces, in a way, a narrative that it's other people who are defrauding the system that are the reason that you can't get the health care that you need.
Woods: But while Wisconsin’s state government has some power over healthcare in the state, the federal government also has power. A clear example of that: the Big Beautiful Bill and its cuts to Medicaid.
And of course, the owners of healthcare systems have power too.
Corporations vs. communities: Who has power over healthcare?
Powers: While Waupaca still has a critical access hospital for now, the absence of its labor and delivery unit has left a mark on the community.
Though people like Cindya Gullickson and Dr. Ezra Lyon circulated petitions...
Woods: ...protested at ThedaCare headquarters...
Powers: ...organized dozens of people via social media...
Woods: ...got statewide media coverage of their situation...
Powers: ...lobbied state and local government...
Woods: ...and continually met with representatives from ThedaCare, Waupaca’s labor and delivery unit no longer exists.
Powers: In the end, they only had so much power.
Woods: What did you learn about how power works?
Gullickson: More than I wanted to. Yeah. I definitely learned more than I wanted to about how power works.
Woods: When Cindya took that first pregnancy test, she expected to give birth in Waupaca’s labor and delivery unit. Instead, she nearly bled to death in her home, wondering if she’d be helicoptered to a hospital 40 miles away.
Today, she and her son are alive and well, picking out books in the library on her days off. But the feeling of being unheard and powerless left a scar.
Gullickson: People usually had the power in Waupaca, but not for this one. They didn't have any interest in listening to us about it. There's a lot of things where it's, like, it's who you know in Waupaca that will get you places. But when it came to such a corporate company like ThedaCare, they had no interest in listening to the community at all.
Powers: Hundreds of communities across the country have lost labor and delivery units in the last decade.
Dr. Lyon still treats Cindya’s son, despite working an hour away. And he questions how decisions about care are made in Central Wisconsin, and across the nation.
Lyon: If you have a board that is not accountable to the community that it’s supposed to be representing. Where does power lie? Power just lies with the corporation. Power lies with the large non-profit. And there aren't a lot of checks.
Next time on ‘Swing State of the Union’
Woods: On the next episode of Swing State of the Union, we investigate why the cost of living is rising, and what power voters have to address it.
Making ends meet — next time on Swing State of the Union. I’m Sam Woods.
Powers: And I’m Joy Powers. Swing State of the Union is produced by WUWM, Milwaukee’s NPR — a part of the NPR Network. Please subscribe to the Swing State of the Union podcast on the NPR app, or wherever you like to listen.
