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
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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!
1. EXPERT ANALYSIS CONCLUDES HEALTH CARE REFORM WOULD SIGNIFICANTLY IMPROVE INSURANCE COVERAGE IN WISCONSIN
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.”
2. SEPTEMBER 15 HEARING ON AB 210 – RELATING TO ACA IMPLEMENTATION
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.
3. “BADGERCARE PLUS: WHO’S ELIGIBLE, FOR WHAT, AND AT WHAT PRICE?”
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.
4. GOP GOVERNORS RENEW PUSH FOR MORE AUTHORITY TO RESTRICT MEDICAID
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.
5. PROPOSED TREASURY DEPT. RULES DEFINE “AFFORDABLITY” OF EMPLOYER COVERAGE
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.
6. HHS REGS WILL HELP PEOPLE CHOOSE INSURANCE THROUGH EXCHANGES
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.
7. HEALTH WATCH POSTS TESTIMONY ON IMPACT OF MEDICAID & BC+ CUTS
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.
View the public testimony footage on the HealthWatch website.
8. DEFICIT REDUCTION, ACCOUNTABLE CARE ORGANIZATIONS, AND MARSHFIELD CLINIC’S SUCCESS
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.
9. OTHER HEALTH CARE ISSUES IN THE NEWS
-- 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.”
9. PLEASE SUPPORT WCCF
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: