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Health Care Coverage – 2011 # 5
Wisconsin Budget Project – WCCF
Jon Peacock and Sara Eskrich
Sept. 14, 2011
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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
1. NEW CENSUS STATISTICS SHOW BADGERCARE HAS MITIGATED INCREASE IN THE UNINSURED
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.
2. WHAT’S AT STAKE IN THE STATE’S MEDICAID WAIVERS?
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.
3. ADVOCATES URGE DHS TO UNVEIL ITS COST-CUTTING PLAN & PROVIDE TIME FOR ROBUST PUBLIC DEBATE
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.
4. LAWMAKERS PROPOSE “WI PATIENTS’ BILL OF RIGHTS”
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.
5. AB 222 WOULD STIFFEN CITIZENSHIP DOCUMENTATION REQUIREMENTS FOR BENEFITS
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."
6. WISCONSIN RANKS 5TH IN ANALYSIS OF SUPPORTICE SERVICES FOR LONG-TERM CARE
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.
7. ADVOCATES CALL FOR MORE BALANCE ON HEALTH EXCHANGE WORKING GROUPS
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.
8. WI OFFICIALS MUST REVIEW HEALTH INSURANCE RATE HIKES OF AT LEAST 10%
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.
9. OTHER HEALTH CARE ISSUES IN THE NEWS
-- “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.
-- National Medicaid Expert Jim Jones Joins Sellers Dorsey – Sept. 8, Business Wire