U.S. Rep. Tom Tiffany speaks to voters on Jan. 27 at a listening session on the campus of UW-Eau Claire Barron County. (Henry Redman | Wisconsin Examiner)

U.S. Rep. Tom Tiffany painted a rosy picture of how the budget reconciliation law recently signed by President Donald Trump will affect Wisconsinites and pushed for state and federal policies that encourage the growth of extractive industries in the state during a telephone town hall hosted by the right-wing organization Americans for Prosperity on Tuesday evening. 

Tuesday’s event struck a far different tone from the in-person town hall hosted by U.S. Rep. Bryan Steil last week and the tour of in-person listening sessions Tiffany made across his northern Wisconsin district in the early weeks of the second Trump administration in January. 

At Steil’s event, in the much more politically mixed 1st Congressional District in southern Wisconsin, he faced a hostile crowd. And at one of Tiffany’s events in January, the crowd was made up of a mix of supporters and opponents worried about what the first weeks of Trump’s term meant for the country’s direction. 

But on Tuesday, all six questions Tiffany took came from people who expressed broad support for the Trump administration and the policies in the “One Big Beautiful Bill” passed by congressional Republicans and signed by Trump. 

Tiffany has been flirting with running for governor next year. He recently told the Milwaukee Journal-Sentinel he’d make a decision about entering the Republican primary by the end of September. 

During the phone call, the moderator, Americans for Prosperity-Wisconsin’s Megan Novak, noted that she was “seeing a lot of questions” in the queue about Medicaid but instead of letting a constituent ask the question, Novak asked if Tiffany could “clear up some of the information about what the bill actually does related to Medicaid to help protect it for the most vulnerable members of our society.” 

The Medicaid provisions in the law are among the most controversial. In an effort to cut federal spending and partially fund the cost of expanding the tax cuts passed by Republicans in 2017 during Trump’s first term, the law imposes strict work requirements on people seeking to qualify for Medicaid coverage. The nonpartisan Congressional Budget Office has estimated that the law will cause 10 million people to lose health care coverage. 

Tiffany said he doesn’t believe the estimates and added that only people without legal documentation to be in the U.S. and lazy people will lose coverage. 

“Let’s say there’s a 30-year-old young man sitting on his couch each day collecting $50,000 in benefits from you, the taxpayer,” Tiffany said. “Should you pay for their health care? I say no, and I think most people agree with that, that we should not, as taxpayers, be paying for someone’s health care when they’re able bodied and they can work.” 

There is no evidence that a large subset of 30-year-old Americans who are not working are enrolled in Medicaid. Research has shown that many Medicaid enrolled adults work for low wages at small companies and in industries with low rates of employer-provided insurance coverage. 

In his opening remarks, Tiffany said that the provisions of the Republican reconciliation package that will most benefit Wisconsinites are those that  increase spending on air traffic controllers, codify a number of Trump’s executive orders and increase mineral drilling and logging in Wisconsin and across the country. 

Throughout his career as a state legislator and member of Congress, Tiffany has been a major supporter of extractive industries. Several times during the town hall, he said the country and Wisconsin had to do more to use natural resources while deriding energy from sources such as solar and wind. 

In an answer about passing policies to bring energy costs down, Tiffany said Wisconsin had to stop “sidelining baseload power” from sources such as coal and oil. He said that the country has devoted too much effort trying to move to intermittent power sources like solar and wind and complained that China is selling wind turbines to Americans while continuing to build coal plants. 

China has continued to build coal-burning power plants and remains the world’s largest emitter of greenhouse gases, however it is also the biggest installer of green energy technology. Last month, the country installed 100 solar panels every second, the Guardian reported. 

“I believe you have to be able to utilize your natural resources to be prosperous,” he said. “You know, whether it’s forestry, mining, oil, gas, and, of course, agriculture. And I would say to you, tourism, also … and if we get rid of that red tape, we are going to be able to see more businesses created, especially in these regions where we get to utilize our natural resources.”

With the largely friendly lines of questioning, tight controls that prevented constituents from speaking and the relatively short 40-minute duration, Tiffany was under far less pressure than other Republicans at recent town halls, giving him room to promise that “we’re going to do more stuff around these lines” as the budget reconciliation package and to compare its  provisions to those passed under President Ronald Reagan in the 1980s. 

“I think much like the 1980s when we saw the seminal changes that President Reagan led with the Reagan Revolution, I think you’re going to see the same thing as a result of the ‘One Big, Beautiful bill,'” Tiffany said. “This is going to kick off a decade, a decade of prosperity if we continue to move in the direction of free markets and free people.”

Emma Widmar, shown with her dog Zander, has relied on Medicaid while managing complex health problems that she has had since she was 12. (Photo courtesy of Emma Widmar)

At the age of 26, Emma Widmar has been chronically ill for more than half her lifetime.

Widmar was 12 when her symptoms first showed up — severe allergies to food, hormones and her environment. At the age of 18 she qualified for Social Security disability payments as well as for Medicaid. The combined federal-state health insurance program pays for her ongoing medical care, frequent emergency room visits and necessary home care.

“I equate Medicaid to a lifeline,” Widmar says. “Some people might think that’s an exaggeration, but it isn’t. It ensures all my needs are met.”

With the enactment on July 4 of the mega-bill extending the tax cuts passed during President Donald Trump’s first term along with deep cuts in Medicaid and other safety net programs, Widmar is uncertain how her life might change.

After she graduated from Gateway Technical College, Widmar worked for four years for the Racine County Eye, an online journalism outlet. A case of respiratory syncytial virus — RSV — in January 2024 brought on severe neuropathy and hampered her breathing, forcing her to give up a job she had loved.

“I lost my ability to walk,” Widmar says. “It really wreaked havoc on my body and I couldn’t keep up.”

As complex as her health problems are, they’ve also become deeply familiar to her. 

 “It has been my life, and I simply can’t ignore it,” Widmar says. “It’s just the way that it is.”

While she and her family along with many others hope that science will one day unlock treatments for intractable illnesses such as hers, “these are chronic, lifelong conditions that right now there’s no cure for,” she says. For now, “it’s about finding the best quality of life for myself.”

Widmar lives with her parents in Mount Pleasant. Her mother is a primary caregiver.

Wisconsin’s home- and community-based care Medicaid waiver covers the cost of medications “that allow me to function,” she says.

 It also makes it possible for her to have additional home and personal caregivers. With Medicaid “those caretakers can be compensated,” Widmar says. “It ensures that I always have eyes on me and that I’m getting what I need.”

Her chronic food allergies require a special diet, with food that is more expensive than the typical grocery store purchase. Widmar’s disability has qualified her for benefits under the Supplemental Nutrition Assistance Program — SNAP, known as FoodShare in Wisconsin.

“Health care and food assistance are not just line items in a budget — they are a matter of life and death for American families,” said Sondra Goldschein, executive director of Family Friendly Economy, which campaigned against the mega-bill and shared the stories of people affected by it, including Widmar.

The bill passed despite widespread popular opposition. Widmar says she wants to encourage people “to continue voicing their opinions to policymakers, lawmakers and politicians,” not give up in resignation. “We are the ones that employ the government,” she says. “They work for us and we have to remind them of that.”

Widmar suspects most people wouldn’t consider her a typical Medicaid recipient — younger, coming from a middle-class upbringing and with a family that is able to support her. But that’s really the point: Medicaid, she observes, has helped people from all different backgrounds, regardless of class, race, ethnicity or education.

She also expects the spending cuts will ripple far beyond the Medicaid population.

“We’re altering health care as a whole, which will have an impact on everyone,” Widmar says.

For several years, the Affordable Care Act has helped drive down the number of people without health insurance. The mega-bill’s changes not just to Medicaid but also the ACA have been forecast to reverse that trend, increasing the uninsured population by 17 million over the next decade.

One Medicaid change, scheduled to take effect in 2027, will be the imposition of work requirements for some recipients. Nationally, two-thirds of Medicaid recipients already work full- or part-time, according to KFF, a nonprofit health policy research, polling and news organization, and researchers have found that some people who qualify are excluded due to paperwork problems.

Widmar has already experienced a work requirement as part of her SNAP enrollment. When her illness made work impossible, the requirement was waived.

With the extent of her current disabilities, she hopes that she would qualify for an exemption from the coming Medicaid work requirement.

She might not know for sure until late 2026, however. Wisconsin won’t be able to draw up the details of how it implements the work requirement until the publication of the federal rules, which aren’t due until next June.

In her previous experience with SNAP, Widmar said work requirements didn’t always match the realities for people with disabilities.

“Unfortunately we don’t make it easier for people who are disabled to have a job and contribute,” she says. “It’s not a system that says, ‘We have a work requirement — do what you’re able to do…’”

When she was able to work, “I loved my job,” Widmar says. Her employer was understanding and accommodated her disabilities.

That was no small matter. Because of her condition, Widmar says, she can’t be alone: Her low blood pressure can cause her to faint unpredictably. Her hours also had to be flexible to match her erratic energy levels.

“It’s difficult to work and have a disability and be on these programs,” Widmar says. “It’s like an agility course you have to go through.”

While Widmar is concerned about what lies ahead for her when the changes to Medicaid take effect, her foremost worry is for people whose lives are more difficult.

“I have a support system to help me get through it. But there’s people that don’t know where to turn for help. And it’s really unfortunate for them,” she says.

For people living at or near poverty, she sees life on the verge of becoming more harsh.

“We’re already at bare bones,” Widmar says, “and now we’re taking away more from the most vulnerable populations.”

Nichole Robarge, right, describes the challenges faced by people with disabilities she assists when enrolling in Medicaid. With her is Kathleen Cummings, who provides similar assistance to people 60 and older. Both said impending changes to the program are likely to increase those challenges. (Photo by Erik Gunn/Wisconsin Examiner)

With the Congressional mega-bill that cuts $1 trillion from Medicaid now law, people who have relied for their health care on the state-federal insurance plan and their advocates are scrambling to figure out  how and when it will hit home.

The timing of many of the law’s changes is still uncertain.

“This bill was written very hastily,” said Tami Jackson, policy analyst for the Wisconsin Board for People with Development Disabilities (BPDD), at a discussion of the law Thursday morning in the Wisconsin Capitol.

“There are implementation dates for various pieces of Medicaid that are not all in alignment,” Jackson said. “So, you’re going to get this in waves.”

Janet Zander of the Greater Wisconsin Agency on Aging Resources paraphrased promises from members of Congress who publicly defended the bill.

“It’s really easy to listen to what we’re hearing about — ‘This isn’t going to harm us here in Wisconsin. We’re not doing anything that’s going to hurt older adults, people with disabilities, low-income families,’” Zander said. “Those of us who are working in these programs know that’s not the case at all.”

The new law imposes requirements for Medicaid participants to work or be preparing for work — although a majority already are working — or else be approved as exempt from having to meet the requirement.

That provision’s implementation date of Jan. 1, 2027 is less than 18 months away, Jackson said. And it could be up to a year before the federal Department of Health and Human Services (HHS) produces an administrative rule to direct states on how they manage the requirement.

That doesn’t allow for much time to work out “20 or 30 unanswered questions” about how to require people to demonstrate they’re working, qualify for an exemption or prove that they’re exempt, Jackson said.

The added requirements will also impose new demands on agencies in charge of implementing the Medicaid changes in each state, as well as county agencies that help people navigate the program.

“If you are ramping up the workload and how much people have to do, and ramping up the staffing it takes to do that, that’s a lot more that counties are going to be doing locally, or will have to do,” Jackson said. “That’s going to exacerbate how many people lose coverage.”

Other items have no implementation date — which is usually interpreted as taking effect with the bill’s signing, said William Parke-Sutherland, government affairs director at Kids Forward.

“This bill, which is being kind of talked about as a tax and spending bill, is really a health care redesign bill, and it makes the most substantive changes to the health care system that we’ve seen since the Affordable Care Act,” Parke-Sutherland said.

That national health care law had four years to be implemented. With the new Medicaid changes, “we have no time in comparison.”

But the probable long-term impact remains dire, advocates said — making it harder for people to get coverage and keep coverage.

Taking together the projected loss of Medicaid coverage as well as the projected loss of Affordable Care Act coverage for low-income people who lose subsidies for their premiums that expire at the end of this year, as many as 17 million people in the U.S. could lose health care and long-term care coverage, Zander said.

The state Department of Health Services estimated in April that at least 52,000 Wisconsin residents could lose Medicaid coverage. Changes the Senate made in the bill will likely increase those estimates, however, according to advocates.

Safety-net barriers, old and new

As ultimately passed by the U.S. Senate and the House of Representatives and signed into law by President Donald Trump, the legislation has thrown new barriers in front of the nation’s safety-net programs, including Medicaid as well as the federal food aid program, SNAP.

Existing barriers were already very high, advocates said.

Kathleen Cummings works for the Columbia County Aging and Disability Resource Center assisting people who are 60 or older applying for Medicaid and other benefit programs. Based on their annual income and total assets, some people on Medicare also qualify for Medicaid to cover their out-of-pocket Medicare costs.

Cummings recounted the experience of a woman who had qualified for Medicaid but recently contacted her because she was getting bills for her health care. The woman accidentally failed to renew her Medicaid coverage when the renewal form she received got buried in a flurry of other Medicaid-related mail, Cummings said.

Under current law the client can get coverage retroactively for bills incurred in the last three months. But with the new law, “that will be changing to 30 days, so we will not, in the future, be able to request that backdated coverage for bills under the situation that she is in,” Cummings said.

Another client has had extensive treatment for lung cancer, she said. The man “is just barely, barely over the federal poverty level” — about $1,300 a month.

“A lot of my clients are very proud and do what they can with what they have,” Cummings said. “But when something like lung cancer comes along, he’s suddenly faced with all these bills that he only had limited coverage [for].”

She’s helping the man apply for Medicaid coverage backdated three months to cover those bills, she said. “Once he shows proof that he qualified, which he will, [he can] get some of these bills paid.”

Nichole Robarge also works for the Columbia County ARDC, helping people from ages 16 to 59 who qualify for federal Supplemental Security Income (SSI) disability benefits and other programs.

Robarge said that currently the disability application takes 12 to 18 months for a decision. As many as 85% of applications are denied at first, she said, and about 20% get overturned on appeal, which takes another 18 to 24 months. A second appeal, with a hearing before an administrative law judge, can take another two years.

In Wisconsin, approval for SSI automatically qualifies a person for Medicaid coverage. Until the SSI decision is resolved, however, the applicant has to apply for Medicaid separately, Robarge said — something that a disability can make much more difficult.

She pulled out the Medicaid application, which currently must be completed annually — a 41-page document that is a half-inch thick.

“Can you imagine getting one of these in the mail and having a cognitive disability or a physical disability, or maybe you had a stroke?…Or maybe you can’t read at all,” Robarge said.

“I bought a house and had less paperwork. I’ve bought a car and I’ve had less paperwork than what it takes to fill one of these out,” she added. “It’s tedious and it’s treacherous … This first barrier is huge, and this is even without getting the documents that you need to provide the proof that they’re asking for.”

Unintended consequences

The new law is poised to make those delays worse, advocates argue — blocking people from Medicaid coverage even though they meet the program’s qualifications.

“Medicaid is a wildly complicated program,” said Lisa Hassenstab, public policy manager for Disability Rights Wisconsin. “What we’ve seen in this bill is that all of these little changes [and] the unintended consequences, because people don’t understand what the program is. They don’t understand what it is, and so they don’t understand what the impact of these changes is really going to be.”

One thing the law won’t do, advocates said, is protect taxpayers.

“It won’t protect me,” said Tyler Engel, whose Medicaid coverage enables him to live more independently in the community with coverage for his caregivers.

“This bill saves money by making it so that, for somebody who is now currently eligible for health care, the provider who provides that care is not going to get paid,” Parke-Sutherland said. “This saves money by people who are currently eligible for health insurance” with federal help “not getting health insurance or having to pay more for it. That’s the only way that this bill saves money.”

Two-thirds of Medicaid participants are working, and therefore they are taxpayers, too, Jackson said.

“It’s a cost shift to the taxpayers,” said Jackson, because when people aren’t covered by Medicaid, “somebody else picks that up — whether it’s uncompensated care, whether it’s a medical bankruptcy, whether it’s your private insurance or your group premium going up.”

“If you stop paying for care, people’s care needs don’t go away,” Parke-Sutherland said. “You still pay. So this isn’t a boon to the taxpayers.”