Monday, September 26, 2011

State starts making public Medicaid cut proposals

State starts making public Medicaid cut proposals Associated Press | Posted: Monday, September 26, 2011 2:02 pm
Gov. Scott Walker's administration unveiled a website Monday that includes a handful of Medicaid cost-savings proposals intended to help it reach required cuts of about $444 million over the next two years.
But there's a long way to go.
Most of what was released was either already known about or would make little progress toward what needs to be cut.
Only three of the six areas of savings detailed Monday had not been previously announced. Those three total $6 million in savings in state money, just 3 percent of the $181.8 million that must be found under the two-year budget that took effect in July. The total amount of unspecified cuts that must be found, including federal funding and other sources, is $444 million.
The largest single item on the website was $106 million in savings achieved through freezing enrollment in the popular Family Care program, which is designed to keep people out of nursing homes, a step that the Legislature approved in June.
That is counted separately from the $181.8 million in cuts in state funding that the agency must come up with in order to balance the budget.
Other than the savings from freezing Family Care, there was $6 million in new savings and $7 million and previously announced changes including modifying payments to those providing end-stage renal disease services and changing the formula for determining pharmacy reimbursements.
More proposals will be placed on the website in the coming days, said agency spokeswoman Stephanie Smiley.
Advocates who have been calling on the agency to be more forthcoming about its plans were not impressed.
"We've been waiting for almost seven months since legislators gave the department sweeping authority to make Medicaid cuts and we still don't know what their plans are," said Jon Peacock with the Wisconsin Center on Children and Families. "I'm glad they've acknowledged that they're interested in public comments, but it's not a very meaningful gesture until we see the meat of their plans."
Robert Kraig, director of the consumer advocacy group Citizen Action of Wisconsin, called Monday's proposals "more or less window dressing for drastic cuts in Medicaid."
Efficiencies being proposed may be needed, but they will do little to get toward the cuts called for under Walker's budget, he said.
Kraig said it's always a good idea to solicit the public's input through the website, "but they haven't offered the option of having the wealthy and corporations pay their fair share and not cut Medicaid."
The cuts were ordered given growth in Medicaid and a decrease in federal funding to pay for the programs which include BadgerCare Plus, Family Care, and SeniorCare. About one out of every five Wisconsin residents, or 1.2 million people, participates in at least one of its programs.
Smiley said all of the items listed Monday can be achieved unilaterally by the department. Other items to come may require the OK of the Legislature's budget committee or the federal government.
Smith has publically discussed calling for higher copayments or premiums for beneficiaries and stopping payment to people who can afford private insurance.
Online: DHS Medicaid reform site:

Read more:

Thursday, September 22, 2011

Featured News

Super Committee: Everything You Need to Protect Medicaid, Medicare, and the Affordable Care Act
Now that the super committee process is in full swing, the attacks on Medicaid, Medicare, and the Affordable Care Act are sure to escalate. The next meeting of the super committee is this week, but thankfully Families USA has made getting involved easy. Visit our new super committee action center to stay up-to-date on the September 22 meeting, learn more about each committee member, and find easy and meaningful ways you can engage to protect your health care rights. Visit our action center today to learn more!
Take a Bow / Hang Your Head
The Census Bureau released its annual Current Population Survey, and it revealed that the rate of uninsured Americans is deeply troubling. Especially in Texas – which should hang its head for having the highest rate of uninsured citizens. Massachusetts can take a bow for having the lowest rate. But regardless of where your state ranks on the list, there are 49.9 million uninsured Americans nationwide. Without vital programs like Medicaid and the Affordable Care Act, that number would be even higher. That's why it's so important to protect these programs from reckless cuts proposed by the Republican leadership.

Myth of the Moment

A Sales Tax on Home Sales? Not So Much.
Earlier this year, we saw a disturbing – and misleading – chain email claiming that under the Affordable Care Act people will pay a new 3.8% sales tax if they sell their home. This "fact" is flat out wrong. We debunked it in our blog, and debunked it with a "pants on fire" rating. But, we learned this rumor is kicking around again so we wanted to once more shed truth on this lie. The reality: The only people subject to such a tax are individuals with incomes of more than $200,000 ($250,000 for a couple) who sell their home for a PROFIT of more than $250,000 ($500,000 for a couple). Another health care myth – debunked.

Our first-of-its-kind Twitter tool is taking off. So far 904 people have told their elected officials to protect Medicare, Medicaid, and the Affordable Care Act from damaging cuts. Help keep the momentum going – and if you're the 1,000th tweeter, you'll win a free t-shirt! Tweet your elected officials TODAY!

Trivia Question

The Affordable Care Act doesn't take full effect until 2014, but already many Americans are being helped by the law. Thanks to early implementation, what group of Americans already gained insurance over the past year? Make Your Guess on Facebook!

Spotlight On

The Affordable Care Act means at least 32 million new people will become eligible for quality, affordable health care. We're really excited about the launch of a great new organization – Enroll America – that's working hard to make getting coverage easy to do. Learn more about the Affordable Care Act and how to get enrolled at

1201 New York Avenue NW, Suite 1100 | Washington, DC 20005 | P: 202-628-3030 | E:

Wednesday, September 21, 2011

Thursday, September 15, 2011

State & National News

Analysis and Comment
Standing Up for Income Maintenance
In a Joint Finance Committee meeting this week, Sen. Bob Jauch (D-Poplar) laid out his concerns about serious funding disparities that exist in how the state funds county services. According to the press release issued by Sen. Jauch's office on September 14, the Senator brought the issue to the committee’s attention after local county staff expressed concern to him about the significant disparity state aid cuts would dramatically hurt counties in northeastern Wisconsin. “During the state budget, we decided to allow counties to create regional consortiums to help reduce the impact of a 15% cut in state aid for local income maintenance programs,” said Jauch. “What we created was an inequitable, unfair system that allows wealthier counties to avoid deeper cuts while forcing rural, lower spending counties to take deeper cuts.” On a party line vote, the committee rejected Jauch’s proposal to make $400,000 available to the Department of Health Services to address inequalities of the proposed consortium. On an 11-5 vote the committee did adopt a second motion by Jauch directing the Department of Health Services to provide a full report on the consortia funding plan that explains state efforts to ensure adequate and equitable provision of income maintenance services throughout the state.
New Uniform Insurance Plan Summary Form is Unveiled
A new national uniform standard in health insurance coverage plans-a new format to consistently lay out the details of each policy-was unveiled this week. The new summary form reminds most people of the popular "food-nutrition label" required to disclose relevant information to a consumer. In the context of private health insurance, the label here lists an overall insurance deductible, or the amount a consumer must pay before coverage kicks in, and deductibles for specific categories, such as drug coverage. A list of medical events and associated services, such as home health care and emergency transportation, would likely be shown along with the consumer’s cost for each. The summary would also explain the consumer’s possible expenses for three common situations: having a baby, treating breast cancer, and managing diabetes. This form would likely be given to people shopping for plans, before they are locked into a selection, by means including insurance agents, email, or websites where policies are sold. Under the health reform law, it is also supposed to be supplied to workers with employer coverage when they sign up for plans as new hires or during open enrollment. Federal regulators unveiled the proposed summary form, part of the health-care overhaul law, on Wednesday. The requirement is supposed to take effect next March.
Federal COBRA insurance subsidies end for laid-off workers
Phil Galewitz, Kaiser Health News, 31 August
"One of the key consumer benefits of the fede
ral stimulus package--subsidies to help laid-off workers continue their health care coverage--draws to a close Wednesday, raising concerns about how the unemployed will cover those expenses."

Act 32 modifies “adult child” insurance requirements
Andrew J. Bezouska, Inside Track, Sept 7 2011
Starting in January, insurers and self-insured governmental plans that provide dependent coverage will be required to cover adult children until age 26, regardless of marital status or the cost of health insurance premiums.

Rep. Richards, Sen. Erpenbach: Unveil Wisconsin Patients’ Bill of Rights, Sept 7, 2011
The Wisconsin Patients’ Bill of Rights secures key health care consumer and patient protections provided under the federal Affordable Care Act into state law.

Advocates wait for details on $500 million in Medicaid cuts
David Wahlberg, Wisconsin State Journal, Sept 12, 2011
Some decisions, such as whether to drop more than 50,000 people from BadgerCare Plus, depend on federal approval of the state’s plans by Dec. 31, a process that can take months, advocates say.

Small businesses can get new federal tax credit for offering health insurance
Donna Gehrke-White, Sun Sentinel, Sept 12 2011
The Internal Revenue Service wants to make sure that small businesses know they may qualify for a new federal tax credit if they pay at least half their employees' health insurance premiums.

Health and Human Services Department rejects Delaware healthcare waiver
Sam Baker, Healthwatch, Sept 12 2011
Delaware asked HHS to phase in the 80 percent premium expense standard over the next three years.
State Funding for County Income Maintenance Includes Huge Disparities
Sen. Bob Jauch, Sept 14 2011
Funding disparities in how the state funds county services, including medical assistance and Food share, would dramatically hurt counties in northeastern Wisconsin.

Wisconsin Council on Children and Families
555 W. Washington Ave., Suite 200
Madison, WI  53703
Health Care Coverage – 2011 # 5
Wisconsin Budget Project – WCCF
Jon Peacock and Sara Eskrich
Sept. 14, 2011
Please feel free to forward messages to any other interested parties, and encourage others to sign up for this and/or other WCCF mailing lists at
PLEASE SUPPORT WCCF – WCCF relies on the generosity of its members to support the work we do. By making a contribution, you can help us sustain our efforts to protect and improve cost-effective programs like BadgerCare that provide Wisconsinites with access to quality, affordable health care. You can contribute on the following portion of our website:  
In this issue:
1. New Census Statistics Show BadgerCare Has Mitigated Increase in the Uninsured
2. What’s at Stake in the State’s Medicaid Waivers?
3. Advocates Urge DHS to Unveil Its Cost-cutting Plan & Provide Time for Robust Public Debate
4. Lawmakers Propose WI Patients’ Bill of Rights
5. AB 222 Would Stiffen Citizenship Documentation Requirements for Public Benefits
6. Wisconsin Ranks 5th in Analysis of Supportive Services for Long-term Care
7. Advocates Call for More Balance on Health Exchange Working Groups
8. Wisconsin Officials Must Review Health Insurance Rate Hikes of At Least 10%
9. Other Health Care Issues in the News
The U.S. Census Bureau released data Tuesday (9/13) from the annual Current Population Survey (CPS), relating to poverty, income and insurance status of Americans is 2010. Nationally, the number of uninsured increased by nearly 1 million from 2009 to 2010. The recession and its aftermath have also affected coverage in Wisconsin. An estimated 504,000 non-elderly Wisconsinites lacked health insurance in 2009-10, an increase of almost 31,000 since 2007-08. Approximately 162,000 Wisconsinites under the age of 65 lost their employer-sponsored coverage from 2007-08 to 2009-10, but 102,000 gained Medicaid or BadgerCare Plus coverage, largely offsetting the loss of job-based coverage. Therefore, the CPS data underscores the importance of public coverage programs like BadgerCare in tough economic times.
Read more in our Sept. 13th blog post.
A short WCCF paper examines some of the potential consequences if Wisconsin seeks and obtains a federal waiver allowing the state to make changes to Medicaid and BadgerCare that conflict with current federal law. The biennial budget bill directs DHS to submit a waiver exempting the state from “maintenance of effort” (MOE) standards in the Affordable Care Act, which require states to maintain current eligibility levels. Those standards prevent states from reducing current income eligibility for children (regardless of the state’s current income cap), and require maintaining coverage of adults up to 133% of the poverty level. The MOE requirements also preclude other sorts of changes that influence program participation, such as cost-sharing, frequency of reviews of eligibility, and restrictions on the eligibility of people who have offers of employer coverage.
If the state does not receive a federal waiver by Dec. 31, 2011, the budget directs DHS to reduce eligibility for adults to 133% of the poverty level, beginning July 1, 2012, which would end coverage for about 60,000 adults. Unfortunately, the alternatives that could stem from getting a waiver would end or narrow coverage of many even lower income families and individuals.
Our new 2-page paper examines the likely consequences of increasing BadgerCare premiums, ending express lane enrollment, adopting more restrictive eligibility standards for people with offers of employer coverage, and increasing the frequency of reviews of eligibility. It explains why those changes would significantly increase the number of uninsured Wisconsinites, thereby increasing reliance on emergency rooms for basic care and increasing cost-shifting.
When the Walker Administration rushed the budget repair bill through the Legislature in February, DHS officials argued that they needed lawmakers to act immediately to grant the department extraordinary authority to make changes to Medicaid and BadgerCare -- in order to implement budget savings as quickly as possible. Now, six months after the Legislature gave DHS unprecedented power to make changes that conflict with state statutes, we still haven’t seen the DHS plans to achieve the budget savings.
WCCF and a diverse array of 11 other organizations sent a letter to Secretary Smith last Thursday, urging him to unveil the department’s budget cutting plans and to give Medicaid and BadgerCare recipients a meaningful opportunity to review and comment on those plans. Advocates are concerned that delays in making the plan public, coupled with the Dec. 31 deadline set by the budget bill for federal approval (see item # 2), are creating a time crunch that doesn’t leave adequate time for public input and thorough deliberation by federal officials.
Read more about the letter and the initial DHS comments in David Wahlberg’s Sept. 12 article in the WI State Journal.
Rep. Jon Richards and Sen. Jon Erpenbach announced on Sept. 7 that they plan to introduce a WI Patients’ Bill of Rights. The bill secures key health care consumer and patient protections provided under the Affordable Care Act (ACA) into state law. A summary of the bill and a list of groups endorsing it can be found in the press release issued by the co-authors.
In contrast to AB 210, which revokes the ACA consumer protections if the law is found unconstitutional, the Patients’ Bill of Rights ensures these rights for Wisconsin families now and into the future. One of the key ACA consumer protections the new bill would solidify in state law is the prohibition against denials of coverage because of pre-existing conditions. In addition, the new bill would reinforce the ACA provisions that prohibit lifetime and annual limits on coverage, and it requires insurers to provide an accessible summary of benefits and coverage information in plain English.
WCCF’s executive director, Ken Taylor, noted in a press release that there should be broad support for codifying these popular parts of the ACA in the state statutes: “There has been a lot of talk since the recall elections, on both sides of the aisle, about a more bipartisan spirit in the Legislature. The Wisconsin Patients’ Bill of Rights is a great place to start putting that talk into practice.”
Read more in our Sept. 7 blog post.
AB 222, which was introduced in mid-August by Rep. Mursau and Senator Grothman, would require the documentation of citizenship or immigration status to receive public benefits in Wisconsin. If enacted, the bill would apply to virtually all public benefit programs in our state. However, my understanding is that there would be little or no effect on people applying for Medicaid or BadgerCare, because those programs already require citizenship documentation. The effects will be much more significant for programs like Food Share and child care subsidies.
The bill doesn’t narrow eligibility ‎for any major public benefit programs; instead, it adds to the red tape related to proving eligibility. Since these programs aren’t serving ineligible non-citizens, the additional red tape will have little or no effect on immigrants – other than scapegoating them. The adverse effects will be felt by citizens like the homeless and some of the elderly who don’t have photo IDs. As I noted in an August 24th Capital Times article about AB 222: "The bill is a paperwork burden in search of a problem to solve."

A first of its kind report by AARP, The Commonwealth Fund, and The Scan Foundation measured state-level performance of long-term services and support (LTSS) systems providing assistance to older people and adults with disabilities.  The report is called “Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers.” 


Across the four dimensions, Wisconsin scored 5th. However, the report emphasizes that all states have room for improvement and that public policies play an important role in those improvements. If Wisconsin were to improve to the level of the top performing state, 9,542 more low- or moderate-income adults with activity of daily living disabilities would be covered by Medicaid and 6,057 more new users of Medicaid LTSS would first receive services in home and community based settings, instead of nursing homes.

Read more in our August 8 blog post.
Two consumer advocacy groups called the membership of the health insurance exchange work groups “unacceptable.” Under the Affordable Care Act, states are required to establish health insurance exchanges as an important tool for consumers of all abilities to get health insurance and certain Medicaid/BadgerCare Plus services, and Wisconsin’s Insurance Commissioner has established a number of working groups to advise state officials on how to structure the new exchanges. However, as the Wisconsin Alliance for Women’s Health noted in a blog post, “90% of those on the working groups represent insurers, agents, businesses, or employers.”
A September 2nd press release from Citizen Action of Wisconsin and ABC for Health called on Insurance Commissioner Ted Nickel “to go back to the drawing board” in setting up the working groups and involving the public.
Read more in our Sept. 2nd blog post.
As WCCF noted in a press release on September 1, under a new Affordable Care Act (ACA) regulation, Wisconsin officials must conduct rate review on health insurance premium increases above 10 percent. This will give independent experts the right to determine when rate increases are excessive, not insurance companies. It also allows consumers to access disclosure information online, explaining increases above 10 percent and giving them a chance to comment. Wisconsin has received a $1 million rate review grant, and the U.S. Department of Health and Human Services (HHS) has made available $200 million to strengthen and improve their processes.
-- “Healthcare costs rose, while insurance coverage fell, studies show - Sept. 8, LA Times – “U.S. workers whose wages stagnated over the last decade also saw their health insurance degrade, even as medical costs gobbled up a growing share of their income, two new studies show. An estimated 29 million adults who had health insurance lacked adequate coverage in 2010, leaving them exposed to medical expenses such as high deductibles that they couldn't afford, according to a survey by the nonprofit Commonwealth Fund.”
-- “Medicaid transparency push riles state officials” – Sept. 5, The Hill - Healthwatch – “A federal push for more transparency in how states run their Medicaid programs is pitting patient advocates and medical providers against state officials who fear being hamstrung.” The article quotes DHS Secretary Dennis Smith, who wants states to be free of federal constraints.
-- “Advocates press administration to fix industry subsidy regulations” – Sept. 6, Healthwatch – “The Obama administration is under increasing pressure from its healthcare reform allies to fix a glitch in the law that could leave millions of families without access to affordable coverage. The law, as The Hill first reported in July, would preclude some workers' families from getting subsidies in new state health insurance exchanges if they turned down employer-sponsored family coverage that might be unaffordable.”
-- “ACO Angst” – This Sept. 8 article in Healthcare IT News reports on some of the optimism and concerns relating to the establishment of Affordable Care Organizations (ACOs) as a cost-cutting strategy. It briefly discusses the success of the demo at Marshfield Clinic and includes quotes from Dr. Tim Bartholow, a physician and senior vice president of the Wisconsin Medical Society.

Wednesday, September 14, 2011

Where Are Their Souls?

I refuse to watch the Republican debates, I opt to read the summaries the next day. What caught my attention was the cheering from the crowd over the death penalty and the hypothetical illness of someone that is uninsured. You can't help but wonder.... where are their souls? What makes this group of people so heartless? Let's review what they have done to this country since their big win last year.

They campaigned on jobs, jobs, jobs, less government and spending cuts. The first thing they did was attack union workers and slash funding to schools and health care, while giving tax breaks to corporations. Took away local government in Michigan, attacked planned parenthood and other vital health care services, rewrote districts to their advantage, made it near impossible to sue business for negligence, made it more difficult to vote, attacked the EPA and DNR, and anybody that does not agree with them. Threatening Social Security, Medicare and Medicaid. Making their constituents pay to meet with them. Forcing recalls and playing every dirty game in the book to win. They continue to hold the U.S hostage from the near government shut down to the debt ceiling and the continuation of not moving a jobs bill through congress. Am I forgetting anything? If I am you get the message anyway, this is beyond disgusting.

Time and again the people have spoken and they have said enough is enough, the people want have said what action they want taken and yet they refuse to listen and act on it. The President was right when he said we don't have 14 months to wait to correct this problem at the ballot box. It makes me wonder if the Republicans know how far they can obstruct the President and the country before the damage is beyond repair. Is their plan to win the presidency by hook or by crook? It would seem that way.

These Tea Party Republicans rack up more wins, they would create a world that would be unrecognizable, and not in a good way. What is their manefesto? What is their ultimate goal, maybe I'll do some connecting of the dots and let you know what I find. I can tell you this, I don't like what I see, it's become good .vs. evil.

Tuesday, September 13, 2011

Wisconsin Council on Children and Families
555 W. Washington Ave., Suite 200
Madison, WI  53703
Phone (608) 284-0580
Health Care Coverage
Wisconsin Budget Project – WCCF
Jon Peacock and Sara Eskrich
Sept. 1, 2011
Please feel free to forward messages to any other interested parties, and encourage others to sign up for this and/or other WCCF mailing lists at
In this issue:  
  1. Expert Analysis Concludes Health Care Reform Would Significantly Improve Insurance Coverage in WI
  2. Sept. 15 Hearing on AB 210 – Relating to ACA Implementation
  3. “BadgerCare Plus: Who’s Eligible, for What, and at What Price?”
  4. GOP Governors Renew Push for More Authority to Restrict Medicaid
  5. Proposed Treasury Dept. Rules Define Affordability of Family Coverage
  6. HHS Regulations Will Help People Choose Insurance through Exchanges
  7. Health Watch Posts Public Testimony on Impact of Medicaid and BadgerCare Cuts
  8. Deficit Reduction, Accountable Care Organizations, & Marshfield Clinic’s Success
  9. Other Health Care Issues in the News
 10. Please Support WCCF!  
A long-awaited study of the likely impact of the federal health care reform law on the insurance market place in Wisconsin concluded that it will reduce the number of uninsured state residents by 65% -- from about 520,000 now to an estimated 180,000 in 2016. However, if you had just listened to Walker Administration officials summarize the report you probably would have missed that piece of very good news and other positive findings.
At a briefing for the press (and closed to the general public) and in an op-ed column, DHS Secretary Dennis Smith focused on the ways that the report will change private coverage for some Wisconsinites, and will increase premiums for people who are young and healthy.
The study was authored by economist Jonathan Gruber, under a $400,000 contract initiated by the Doyle Administration, using a federal planning grant. Gruber, who works at Gorman Actuarial, LLC, and Massachusetts Institute of Technology, is an expert on Health Insurance Exchanges and was actively involved in their development in Massachusetts.  
Robert Kraig, executive director of Citizen Action of Wisconsin, wrote an op-ed column that provides some background on the study and takes issue with the way the state officials “cherry pick” the findings they highlighted. He also took issue with the exclusion of the public from the press briefing and the departure from the usual practice of having the author on hand when it is released to the media. 
 An article in the Capital Times by Shawn Doherty describes the report and the way in which it was unveiled and summarized by Walker Administration officials. She interviewed the report’s author for his perspective. See “Economist Jonathan Gruber says state officials spun the results of his health care reform study.”
As mentioned in last month’s Health Care Coverage newsletter, Rep. Petersen (R-Waupaca) introduced AB210, relating to the “implementation of health insurance reform, providing an exemption from emergency rule procedures, and granting rule-making authority.” Though this bill is being described as implementing the Affordable Care Act (ACA), it includes numerous provisions not required by health reform and contrary to consumer protections, including:
·         granting emergency rule-making authority to the Insurance Commissioner without finding of emergency,
·         repealing the WI statutes related to internal and external appeals (which are more generous than those required by the ACA),
·         allowing the Insurance Commissioner to refuse to disclose rate filing information if it’s determined to be proprietary,
·         and a repeal of all changes if the ACA is found unconstitutional.
For a more detailed analysis of this bill, see ABC for Health’s HealthWatch Wisconsin newsletter here,
and the full bill text with a Legislative Reference Bureau summary here.
There will be a public hearing on September 15th at 10:45 AM in room 328 Northwest of the Capital. We encourage advocates to attend and help shed light on the extraneous elements of this bill.
Shortly after BadgerCare Plus began in 2008, we wrote a summary document about the income eligibility criteria, what people are eligible for, and how to calculate the premiums for families of different sizes and incomes.   We recently got a couple of requests for an updated version of that report, and this seemed like a good time to make it current – before the state begins debating how or whether to change the premiums and various other aspects of BadgerCare Plus.
A new version of “BadgerCare Plus: Who’s Eligible, for What, and at What Price?” has been completed, and can be found on the WCCF website. Appendix 1 provides a table comparing the benefits available in the Standard Plan and the Benchmark Plan. Appendix 2 provides a number of examples of how to apply the tables for determining the premiums, and how those hypothetical families might be affected if the state raises the premiums to 4% of family income.
The Republican Governors Association (RGA) released a report Tuesday (Aug. 30) detailing 31 recommendations for loosening federal Medicaid standards, in order to give states far more autonomy in determining who is eligible and what they are eligible for. The report, titled A New Medicaid: A Flexible, Innovative and Accountable Future, has been endorsed by 30 GOP governors, including Governor Walker.
GOP leaders in the House have been trying all year to get Congressional approval of these sorts of recommendations – including repeal of the health care reform law's “maintenance of effort” requirement, which places restrictions on the ability of states to cut their Medicaid rolls. Since the Senate has blocked those efforts, the Republicans’ attention will now turn to getting these recommendations into whatever deficit reduction plan is developed by the so-called super committee (charged with trying to cut $1.2 trillion from the federal deficit).
Advocates are concerned that giving states broad authority to change Medicaid will be very detrimental for the low-income families, seniors and people with disabilities that the program serves, and ultimately will significantly increase the number of uninsured Americans -- thereby also increasing uncompensated care and cost shifting.
Read more in WCCF’s September 1 blog post about the report and the concerns of advocates.
On August 12th, the Department of Health and Human Services (HHS) and the Department of the Treasury released three proposed rules regarding Health Insurance Exchange, premium tax credit, and Medicaid eligibility. These rules are meant to interact and create a simple, seamless, and affordable system of coverage in the Exchanges. (See item #6 below for an overview of the rules proposed by HHS.)
The draft rule developed by the Treasury Department sets the standards for how individuals and families will receive premium tax credits. An important aspect of this proposed regulation relates to the “affordability” of coverage, and warrants comment and revision by the Department.
Individuals and families who are offered employer sponsored insurance (ESI) are generally ineligible for the premium tax credit. However, if the ESI is deemed unaffordable (costing more than 9.5% of family income) or does not provide minimum value (covers less than 60% of total allowed costs of benefits) they may be eligible. The problem is that the proposed rule considers ESI affordable for the entire family as long as coverage just for the employee costs no more than 9.5% of the family’s income. For more on this element of the rule see CBPP’s blog post.
More on the entire rule, and links to the full regulations and overviews can be found in this WCCF blog post. See also, The Commonwealth Fund post for a more overarching description of the Treasury proposed rule.
Many of us have frustratingly tried to decide which insurance plan to choose – and it’s like comparing apples to bananas to oranges, all in a foreign language. Thankfully, a preliminary federal rule announced on August 17 by the Department of Health and Human Services – implementing part of the health care reform law – will ensure that all consumers of private insurance are provided clear, consistent, and comparable information about their health plan benefits and coverage.
The proposed regulations clarify the implementation of the ACA provision ensuring that consumers have access to two forms to help them understand and evaluate health care choices, specifically:
  • An easy to understand summary of benefits and coverage, which will enhance comparison shopping; and
  • A uniform glossary of terms commonly used in health insurance coverage such as “deductible” and “co-pay.”
Read more in our Aug. 17 blog post, or in the Aug. 18 article in USA Today. There’s also a great blog post by the Center for Children and Families.
HealthWatch Wisconsin has posted the complete video footage of public testimony on the impact of proposed BadgerCare+ and Medicaid cuts that will affect 1.2 million Wisconsinites covered by these programs. In March, HealthWatch Wisconsin sponsored two days of public hearings during the HealthWatch Wisconsin Annual Conference, drawing hundreds of people to listen, learn, and for some, to share their stories and the stories of loved ones. HealthWatch Wisconsin staff was on hand to record participants' testimony.
The new “super committee” will likely be looking at health spending as a part of deficit reduction. However, real deficit reduction will take real, systemic health care reform. On this note, recent news of success in the Medicare shared savings demonstration project at Marshfield Clinic shows a glimmer of hope. The goal of the project was to improve quality of care and reduce costs in order to achieve shared savings. Already, Marshfield has earned $56.2 million in shared savings payments from the project.
This particular demonstration project has laid the groundwork for Accountable Care Organizations (ACOs), creating incentive for working across care settings to achieve savings, to be determined by the quality of care. For more information about Marshfield’s success and how it relates to deficit reduction and health care reform, see our August 15th blog post.
-- United Way drive to target infant mortality in Milwaukee - Aug. 31, Journal Sentinel – “The United Way of Greater Milwaukee will look to bolster the fight against infant mortality in the city with a $48 million fundraising campaign this fall.
--  Good news on controlling health care costs- Aug. 30, WI State Journal editorial – “Most health care professionals are paid by the visit and procedure. So the more care they provide, the more money they make. The Marshfield Clinic in central Wisconsin just provided some hard and welcome evidence that changing this skewed payment incentive can help improve patient outcomes while controlling soaring cost.”
-- In pain, mom-to-be found only dentist wait list -- This Aug. 30 Journal Sentinel article highlights the severe problem of dental care access for Wisconsinites in Medicaid or BadgerCare.
-- Health Insurance Premiums for State Workers Decline – Aug. 23, Journal Sentinel – The WI Department of Employee Trust Funds said that health insurance premiums for the majority of state workers will decline by 3.3% next year, a first ever drop. [But see the next story.]
-- Health Insurer to Drop State Employees – Aug. 26, Eau Claire Leader-Telegram – “Beginning in January, Group Health Cooperative will stop providing health insurance to state employees in several west-central WI counties, citing costs as the barrier to providing coverage.”
WCCF relies on the generosity of its members to support much of the work we do. By becoming a WCCF member or making an additional contribution, you can help us sustain our efforts on to ensure that Wisconsin has the revenue necessary for strong state and local programs serving children and families.
You can contribute on the following portion of our website: 

Sunday, September 11, 2011

How The American Jobs Act Works

Good afternoon,
Last night President Obama walked Congress and the nation through the American Jobs Act, his plan to create jobs in America now. It's up to Congress to act on this set of bipartisan ideas that put people back to work and put more money into the pockets of working Americans.
You can watch a special enhanced version of the speech, featuring charts and other relevant information here:

Here are a few important points about how the American Jobs Act works, and why Congress should act quickly:
  • First, it provides a tax cut for small businesses, not big corporations, to help them hire and expand now and provides an additional tax cut to any business that increases wages.
  • Second, it puts people back to work, including teachers, first responders and veterans coming back from Iraq and Afghanistan, and construction workers repairing crumbling bridges, roads and more than 35,000 public schools, with projects chosen by need and impact, not earmarks and politics.
  • Third, it helps out-of-work Americans by extending unemployment benefits to help them support their families while looking for work and reforming the system with training programs that build real skills, connect to real jobs and help the long-term unemployed.
  • Fourth, it puts more money in the pockets of working and middle class Americans by cutting in half the payroll tax that comes out of every worker's paycheck, saving families an average of $1,500 a year. And it removes the barriers that exist in the current federal refinancing program (HARP) to help more Americans refinance their mortgages at historically low rates, save money and stay in their homes.
The American Jobs Act is based on ideas supported by both Democrats and Republicans, and is fully paid for by closing corporate tax loopholes and by asking the wealthiest Americans to pay their fair share. It would have an immediate impact on job and economic growth, but Congress has to act now.
You can learn more about the American Jobs Act on
Over the next few days there are a number of ways for you to ask questions and engage with Administration officials about the American Jobs Act including Open for Questions live panels and Twitter Office Hours.
In fact, next week, I’ll be participating in my very first White House Office Hours on Twitter, so be sure to tune in and send me your questions using the hashtag #WHChat.
Here’s a list of the full lineup of events so far:
  • Today at 4:30 p.m. EDT: Brian Deese, Deputy Director of the National Economic Council will be answering your questions on Twitter during White House Office Hours using the hashtag #WHChat.
  • Monday September 12 at 4:30 p.m. EDT: White House Office Hours on Twitter with Stephanie Cutter, Assistant to the President and Deputy Senior Advisor.
  • Tuesday, September 13 at 5:30 p.m. EDT: I’ll be answering your questions on Twitter during White House Office Hours using the hashtag #WHChat.
  • Wednesday, September 14th at 4:00 p.m. EDT: White House Office Hours with Brian Deese, Deputy Director of the National Economic council.
David Plouffe
Senior Advisor to the President
P.S. After last night’s address, a few White House policy experts answered questions about the speech. Check out the video of the event:

Saturday, September 10, 2011

Walkers Priorities, Not WI's Priorities

This is disgusting, Walker along with his wife, set a bad example of prioritizing, at a time when Walker has decimated vital programs, his wife is fund raising to renovate the governors mansion? They should have to live in it as is, how about this.... the mansion gets fixed up after the schools do, or funding is restored to vital health programs. What a disgrace!

Friday, September 9, 2011

Jon Peacock: Keeping Them Honest For Our Sake!

FYI – today’s Wisconsin Health News has an interview w. Sec. Smith.  I highlighted in yellow the portion about the waiver request: 
On the Record with Department of Health Services Secretary Dennis Smith

Governor Scott Walker's administration is "working hard" to lift the cap on Family Care enrollment, Department of Health Services Secretary Dennis Smith told Wisconsin Health News in a recent, exclusive interview.

"The governor is deeply committed to Family Care," he said. "We are working really hard on what reforms we can bring to the program to be able to lift caps, as we all want to do."

In a wide-ranging interview, Smith also defended the rollout of a recent state report on the federal health reform law, discussed when the administration plans to submit a waiver from maintenance of effort requirements, and talked about why states deserve more flexibility in their Medicaid programs.

Excerpts are below.

WHN: Last month, the Office of Free Market Health Care released a report examining the impact the federal health reform law will have on Wisconsin. Advocates, Democratic lawmakers, and even one of the economists who worked on the report, criticized Governor Scott Walker's administration for only highlighting its negative aspects. How do you respond to that?

DS: Originally, people were quite excited when we were told that reform meant the cost of health care was going to go down. That is what people were sold on in terms of why we were going to pursue what became the Patient Protection and Affordable Care Act. Obviously, people are frustrated with the report we released that said that won't be the case. Now people are trying to move the goal posts on us, that it was supposed to be these other things. Why didn't we emphasize the reduction in the uninsured, for example? Why didn't we emphasize other things? To a large extent, (with the report), we went back to the original promise that got everyone so excited. Showing people a picture of that is what we should really concentrate on. We now know that premiums for young people will go up significantly. We know that there will be disruption in the market. We should focus on what we should be doing between now and 2014 to mitigate those negative aspects in the market?

WHN: So you disagree with the claims that the Office spun the report's findings?

DS: If I was really putting a spin on it, I would have done much more to highlight those areas where I disagree with the authors. They have a relatively modest erosion in employer-sponsored health insurance. I believe, and many other people believe, that it will be much more significant than that. The reason I believe that is from prior history. If you go back to look at what happened when the State Children's Health Insurance Program was created in 1997, you see a migration out of private insurance into public insurance. Once those new public benefits were offered, that erosion of private coverage was much more substantial than the authors were saying it would be. I didn't highlight my disagreements where I thought the report was wrong. I said these are what the facts are. This is what the report said.

WHN: According to the report, 340,000 more Wisconsin residents will have insurance coverage under the federal health reform law. That seems like a significant finding. Why has that not been highlighted by the Office?

DS: Most of those people who are currently uninsured, most of them will come into Medicaid. The majority of those people are already eligible. People are giving too much credit to PPACA, when you realize where the reduction in uninsured is coming from.

WHN: Last month the Republican Governors Association published a report outlining its recommendations for reforming Medicaid. Among other things, it says that states should have flexibility to make the program work best for their taxpayers. Why is that important?

DS: The federal government has now increasingly limited states' ability to manage their program because the rules coming out of Washington are more and more restrictive. Wisconsin has been a managed care state for many years. It's accepted into the provider culture. It's accepted into our general population culture. And yet, CMS says we have to follow rules that the federal government comes up with that may not reflect our markets, either geographically, or the population that's used to being in managed care. When you go back and look at Medicaid, the majority of Medicaid spending occurs because states are the ones that decided in the first place to expand beyond the minimum federal requirements. States like Wisconsin, that have been very generous, have expanded eligibility far above what the federal mandates are. It's fundamentally wrong for federal officials to say, well, we have to impose these federal requirements, because without them state Medicaid programs won't be of high quality. They won't meet the needs of the population. That is fundamentally offensive to states. States are the ones that expanded the programs. We ought to as well have the latitude to manage the program in a way that is in line with state cultures and markets.

WHN: In a press briefing announcing the governors' Medicaid report, you said "We get good sound bites from the top leadership (at HHS), but when we get to the regulations it's quite a different story." Could you explain what you mean by that?

DS: If you go back to January of this past year, right before the National Governors Association's winter meeting, Secretary (Kathleen) Sebelius was saying we are all for flexibility. That was music to our ears. But it is inconsistent with what we have been experiencing in the regulations themselves in what has been coming out of CMS. When you look at the maintenance of effort requirement, for example, if you look at the statute, when it originally came out in the stimulus bill it referred to eligibility levels. Which is fine. We all understand what that means. And then CMS, not through regulation, but through a state Medicaid director letter, went on to say that that also means cost sharing. Cost sharing has never been considered an issue of eligibility. So they went far beyond what the statute says. That takes away state flexibility. We are getting mixed messages out of Washington, and that is very frustrating.

WHN: You mentioned maintenance of effort requirements. Governor Walker's budget bill says that if the state does not receive a waiver from MOE requirements by December 31, 2011, DHS must reduce eligibility to 133 percent of the poverty level starting July 1, 2012. Has DHS requested a waiver yet?

DS: We have not. It is still under development. We have assured everyone that we will release it publicly here first before we send anything to CMS. Frankly, we have been through different versions or different parts because of what we hear CMS talking to different states about, and now the latest notice for proposed rulemaking on eligibility under PPACA. This is sort of the irony and the mixed message you get out of Washington. Washington is not willing to give flexibility on how you determine eligibility, even when the alternative is states can simply drop tens of thousands of people off the program. That's a very confusing message.

WHN: When will the waiver request be presented to the public?

DS: Within the next four to six weeks. You will see it in early fall.

WHN: In an interview with the Milwaukee Journal Sentinel this summer, Governor Walker said the cap on Family Care enrollment could be modified or dropped later this year. Where does that stand now? Will the cap be lifted or modified?

DS: The governor is deeply committed to Family Care. We are working really hard on what reforms we can bring to the program to be able to lift caps, as we all want to do.

WHN: Is there a realistic possibility that the cap will be lifted this year?

DS: We are trying to find ways to bring reform into the program so it is sustainable so we can lift the caps. We are still working through those ideas and suggestions, including those from industry and from advocates. I have been very pleased with the very positive response people have had to making this workable. Everyone knows we have a great deal at stake here, and we all share the same goal, which is to ultimately be able to lift the cap. But everyone understands the challenge. We have to make the program sustainable.

WHN: If the administration does decide to continue the cap - which started June 30 - what type of federal approval is needed?

DS: That's an issue we are in discussion with CMS on. We have provided them with some information. They have followed up, and asked us some additional questions.
Many thanks to all of you for signing onto the attached letter.  We hand-delivered it late Thurs. afternoon to the Secretary’s office, and we just sent it to Wheeler,  WisPolitics and some health care reporters.  
I’ll be surprised if it actually gets any press, but that isn’t the primary objective.   I think it’s important for groups to start making noise about the importance of public participation, and to begin to draw attention to the fact that the department’s foot dragging puts CMS in an almost impossible position. 
Incidentally, there was an interesting article in “Healthwatch “ (The HILL’s health care coverage) on Wed. regarding the opposition of GOP officials, including Smith, to federal transparency requirements:
Jon Peacock, research director
Wisconsin Council on Children and Families
(608) 284-0580 x 307