Urban Institute Report on Medicaid Expansion

http://www.rwjf.org/files/research/6019.400316.optinginto.2012.aug.pdf 

The Urban Institute estimates that 181,000 Wisconsinites would gain eligibility for BadgerCare if the state takes advantage of the opportunity provided by the Affordable Care Act (ACA). The report, issued with the Robert Wood Johnson Foundation (RWJF) early this month, examines the make-up of the population that could gain coverage if Wisconsin uses the federal funding that would cover almost all of the cost of the adults who would be newly eligible for BadgerCare coverage, beginning in 2014.

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Wisconsin Alliance for Women's Health

PO Box 1726 Madison, WI 53701

[p] 608.251.0139 | 866.399.WAWH | [f] 608.256.3004

www.supportwomenshealth.org

Top 10 Reasons to Use the Affordable Care Act to Fill the Gap

in BadgerCare

The Affordable Care Act (ACA) gives Wisconsin an exciting opportunity to improve access to health care for a large segment of uninsured Wisconsinites – i.e., adults who aren’t custodial parents of a dependent child – using the proven and successful Medicaid program.   Here are ten of the many reasons why Wisconsin should use this option to close the current gap in BadgerCare coverage. 

1)      It’s the right thing to do.  Everyone is worthy of health care coverage, and using the Medicaid opportunity in the ACA would close the largest gap in Wisconsin’s health care system.

2)      It will save lives.  States that have extended Medicaid coverage to “childless adults” have seen fewer deaths - especially those caused by disease, accidents, injuries, and drug abuse.[i]

3)      It also saves money.  Covering more adults will reduce emergency room visits and uncompensated care costs that are incurred by hospitals and then shifted onto other health care consumers. 

4)      It’s a very good deal for Wisconsin. The federal government will pick up the full cost of coverage for newly eligible adults for three years and at least 90% of those costs in subsequent years.[ii]

5)      It will help protect Wisconsin workers against preventable illnesses, result in a healthier and more productive workforce for Wisconsin employers, and improve our economic competitiveness.[iii]

6)      Four-fifths of the adults who gain BadgerCare eligibility are too low-income to be eligible for subsidized coverage in the new health insurance exchanges (because those subsidies are for people between 100% and 400% of the federal poverty level).[iv]

7)      More of our federal tax dollars will be used in Wisconsin by taking advantage of this opportunity to close the BadgerCare gap, which is especially important in our state because we currently get much less federal support than most other states.[v]  

8)      The new federal dollars for this insurance coverage will be spent locally, benefiting Wisconsin economically and generating new state tax revenues that will help yield a net positive gain for Wisconsin’s budget from implementation of this coverage opportunity.[vi]

9)      Filling the gap in BadgerCare coverage is likely to yield savings by pushing down state and local mental health costs for the uninsured.[vii]

10)  Wisconsin can once again be a leader in providing access to cost-effective preventive care by closing the gap in BadgerCare and providing insurance to low-income adults without dependent children, many of whom are now on the waiting list for the BadgerCare Core Plan.[viii]

(See footnotes on next page.)

Wisconsin Budget Project

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[i]   See the recently published study in the New England J. of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMsa1202099

[ii]   Because Wisconsin already covers a modest number of adults without dependent children, but with a benefit that falls short of Medicaid coverage, it isn’t clear yet whether our state will initially get 100% federal funding for all “childless adults” below 138% of the poverty level. 

[iii] The most recent Family Health Survey (for 2010) found that 60% of uninsured, low-income “childless adults” in Wisconsin have not had a checkup during the past two years. 

[iv] A recent analysis by the Urban Institute estimated that there are about 181,000 Wisconsinites who would be newly eligible for BadgerCare coverage, and 145,000 (80%) are below the poverty level.  For a discussion of the number of people who would benefit, see the recent WI Budget Project paper:  Using the ACA to Fill the Gap in BadgerCare; Who Would Be Served and What Is It Likely to Cost?

[v]  Based on the most current Census Bureau data, which is from 2010, federal spending in Wisconsin was more than $800 per person below the national average.

[vi]  An analysis by the state of Arkansas concluded that implementing the Medicaid option would generate about $35 million per year in higher state tax revenue, because of the influx of federal dollars and increased economic activity.

[vii] See the July 2011 Urban Institute report, “ACA and State Governments: Consider Savings as Well as Costs.”

[viii] As of August 2012, there were about 136,000 people on that waiting list, but some have income above the income ceiling for the ACA Medicaid option, which is 138% of the federal poverty level. 

The Affordable Care Act: Improving Health Care for Older Women & Strengthening Medicare
Greetings!
Wisconsin women are winning with the Affordable Care Act (ACA)!  The health care law is making it easier for women to get services we need to stay healthy at all stages of life.  By making the Medicare program stronger and better, the ACA is helping older women deal with the barriers to quality, affordable care that they are more likely to face just because we are women. Older women often need more health care than older men do because they live longer and are more likely to suffer from chronic conditions like arthritis and osteoporosis.  Older women also have lower Social Security and pension benefits than men do, on average, so we have been spending more of their income on out-of-pocket health care expenses.  The health care law is helping to change that with its emphasis on making primary and preventive care more affordable.  In 2011, nearly 24.7 million women with Medicare got preventive health care without financial barriers. Thanks to the ACA, Medicare is already covering preventive services without co-pays:       An annual wellness exam for you and your doctor can create a personalized prevention plan to help you stay healthy       mammograms           colorectal cancer screenings       vaccinations       blood pressure, diabetes and cholesterol testing       counseling about quitting smoking, losing weight, choosing healthy foods, treating depression       flu shot, pneumonia shot and hepatitis B shot For women 65 and older - Important Ways That the ACA is Making Medicare Stronger & Better: Making prescription drugs more affordable with 50% discounts on brand name drugs if your expenses are so high that you fall into the non-reimbursed "donut hole." Improving access to primary care for older women, thanks to new bonus payments that give primary care providers a greater financial incentive to see Medicare patients. Streaming Medicare enrollment, making it easier to get the full range of benefits you are entitled to and giving you the time you need to consider your choices. Reducing bureaucratic hurdles that make it hard for low-income seniors who are enrolled in both Medicare and Medicaid to get the benefits they're to which they are entitled.  Rewarding Medicare providers who meet measurable goals for improving the quality of care so older women will be less likely to experience preventable health problems.  Making more affordable prescription plans available for senior women living on low, fixed incomes including $0 premiums for women with the most limited financial resources. Improving access to affordable home- and community-based services so women on Medicare are not forced into nursing homes or other institutions if they can safely stay in their homes with support from qualified home health programs. Making sure the Medicare program is financially sound so that it will be there for the women who rely on it. The Affordable Care Act is helping all Wisconsin women get AFFORDABLE PREVENTIVE health care! Download a copy of our fact sheet here.                     For more information, use AARP's online tool at: www.aarp.org/healthlawguide.   And if you need to sort out Medicare Fact or Fiction, visit the Center for Medicare Advocacy's chart at www.medicareadvocacy.org/medicare-facts-fiction-quick-lessons-to-combat-medicare-spin/.  To learn more about what's at stake for Wisconsin women and girls with the Supreme Court decision, visit our Raising Wisconsin Women's Voices site at www.raisingwiwomensvoices.org or our blog atrwwv.wordpress.com.   Thank you for continuing to support Wisconisn Women's Health, Greetings!

Headlines

Medicaid Health Care Denied to Needy Due to Red Tape, Cost

The Huffington Post, Aug. 15, 2012
She jumped through hoops, wrangled with bureaucrats and overcame obstacles, but Gracie Fowler finally figured out how to make sure her kids weren't among the more than 500,000 Florida children without health insurance.

Paul Ryan's Biggest Budget Cuts are to Medicaid, not Medicare

The Washington Post, Aug. 13, 2012
Paul Ryan’s Medicare overhaul may be the most controversial part of his budget.But the proposed cuts to the program are not the biggest cuts in the plan.

Wisconsin's Medicaid Coverage Better than Many Other States'

 
Wisconsin Public Radio, Aug 9, 2012
More Medicaid patients will seek care under the new federal health law. A national study on access to doctors shows where these patients may have trouble doing that.

Patient Transportation Switch A Worry

 
Milwaukee Journal Sentinel, Aug 9, 2012
The Department of Health Services expects some glitches next month when a new company begins providing transportation to doctors and other health care providers for people covered by state health programs, such as BadgerCare Plus, in southeastern Wisconsin.

Governor Walker Must Move Wisconsin Forward on Health Coverage

Press Release, ABC for Health, Aug. 3, 2012
While Wisconsin’s Administration calls a Medicaid expansion envisioned in health reform “unhealthy,” thousands in Wisconsin lack access to coverage and care.

Medicaid Expansion May Lower Death Rates, Study Says

Into the maelstrom of debate over whether Medicaid should cover more people comes a new study by Harvard researchers who found that when states expanded their Medicaid programs and gave more poor people health insurance, fewer people died.

• The study, published online Wednesday in The New England Journal of Medicine, comes as states are deciding whether to expand Medicaid by 2014 under the Affordable Care Act, the Obama administration’s health care law. The Supreme Court ruling on the law last month effectively gave states the option of accepting or rejecting an expansion of Medicaid that had been expected to add 17 million people to the program’s rolls.

Medicaid expansions are controversial, not just because they cost states money, but also because some critics, primarily conservatives, contend the program does not improve the health of recipients and may even be associated with worse health. Attempts to research that issue have encountered the vexing problem of how to compare people who sign up for Medicaid with those who are eligible but remain uninsured. People who choose to enroll may be sicker, or they may be healthier and simply be more motivated to see doctors.

The New England Journal study reflects a recent effort by researchers to get around that problem and allow policy makers to make “evidence-based decisions,” said Katherine Baicker, an investigator on the study who served on former President George W. Bush’s Council of Economic Advisers.

“I think it’s a very significant study in part because of the paucity of studies that have really looked at health outcomes of insurance coverage,” said Karen Davis, the president of the Commonwealth Fund, a nonpartisan research foundation. “Actual mortality studies are few and far between. This is a well-done study: timely, adds to the evidence base, and certainly should raise concern about the failure to expand Medicaid coverage to people most at risk of not getting the care that they need.”

The study, conducted by researchers from Harvard’s School of Public Health, analyzed data from three states that had expanded their programs in the last decade to cover a population not normally eligible for Medicaid: low-income adults without children or disabilities. The new law also expands coverage to a similar population nationally.

Researchers looked at mortality rates in those states — New York, Maine and Arizona — five years before and after the Medicaid expansions, and compared them with those in four neighboring states — Pennsylvania, Nevada, New Mexico and New Hampshire — that did not put such expansions in place.

The number of deaths for people age 20 to 64 — adults too young to be considered elderly by the researchers — decreased in the three states with expanded coverage by about 1,500 combined per year, after adjusting for population growth in those states, said Dr. Benjamin D. Sommers, a physician and an assistant professor of health policy and economics who was an author of the study.

In the five years before the expansion, there were about 46,400 deaths per year, while in the five years after the expansion, there were about 44,900 deaths per year. During the same period, death rates in the four comparison states increased, said Dr. Sommers, who began a yearlong stint as an adviser to the federal Department of Health and Human Services after research for the study was completed, but before its publication.

When researchers adjusted the data for economic factors like income and unemployment rates and population characteristics like age, sex and race, and then compared those numbers with neighboring states, they estimated that the Medicaid expansions were associated with a decline of 6.1 percent in deaths, or about 2,840 per year for every 500,000 adults added.

While the data included all deaths, not just deaths of Medicaid recipients, the decline in mortality was greatest among nonwhites and people living in poorer counties, groups most affected by expanded Medicaid coverage.

“I can’t tell you for sure that this is a cause-and-effect relationship,” that the Medicaid expansion caused fewer non-elderly adults to die, Dr. Sommers said. “I can tell you we did everything we could to rule out alternative explanations.”

Several experts with varying views on the Affordable Care Act said the study, which was completed long before the Supreme Court hearings on the law, was conducted by highly qualified researchers who carefully analyzed the available data. Still, they and the study’s authors pointed to limitations in the data, noting that the mortality figures represent county-level statistics, not individual deaths.

“They are trying really hard with the data that they have available, but at the end of the day it doesn’t really compensate for the fact that you don’t have the data you want, which is individual mortality rates and what happens to people with change in coverage over time,” said Gail Wilensky, a health economist who headed Medicareand Medicaid during the administration of the elder President George Bush. In addition, when the researchers looked individually at each of the three states, the only state with a statistically significant decline was in the largest state, New York, and she questioned whether every state would have the same experience.

Douglas Holtz-Eakin, president of the American Action Forum, a Republican-oriented group, said the study was “well done” and “brings more evidence in about the benefit side” of Medicaid, but he wondered if the results could be generalized. The three states studied voluntarily expanded their Medicaid programs, presumably confident they could pay for the expansion, and had enough doctors accepting Medicaid to treat additional beneficiaries. Other states may be less able to afford it, he said, and it is possible that “having a piece of paper that says you’re on Medicaid doesn’t do any good because they can’t see anybody.”

Nonetheless, experts said, the results support those of another Medicaid study being conducted by some of the same researchers in Oregon. Oregon expanded its Medicaid program in 2008, but, without money to cover everyone at first, chose 10,000 people by lottery. Dr. Baicker and her colleagues, comparing those who got Medicaid with those who did not, have so far found that Medicaid recipients see doctors more often, and report better health and better financial stability.

The New England Journal study, published online several weeks before the print edition because of its relevance to the current debate, also found that people added to Medicaid in the three states reported better health and were less likely to delay getting care.

While the data did not describe specific causes of death, researchers found declines in two broad categories of deaths — those caused by disease and those caused by accidents, injuries and drug abuse, possibly suggesting that even accident victims may get or seek more extensive care if they are insured.

“So often you hear, ‘Oh well, poor people just shoot each other, and that’s why they have higher mortality rates,’ ” said Diane Rowland, executive vice president of the Kaiser Family Foundation, a nonprofit group. “In the midst of many claims about what Medicaid does and doesn’t do, it actually shows that it cannot only be beneficial for health, but in preventing some of the premature deaths of the uninsured.”

Janet M. Currie, director of the Center for Health and Well-Being at Princeton, said the new study, combined with the Oregon research, should help transform the Medicaid debate into one about dollars, rather than over whether covering poor people improves health.

“This says, well there is benefit to giving people insurance,” Dr. Currie said. “Maybe you don’t want to pay the cost, but you can’t say there’s no benefit.”

Walker should accept, and implement, new health law

By Sara Finger

July 28, 2012 4:00 p.m.

http://www.jsonline.com/news/opinion/walker-should-accept-and-implement-new-health-law-3o68iqc-164080046.html

Recently, the Washington Post published an op-ed by Gov. Scott Walker on the implementation of the Affordable Care Act (ACA). Governor Walker's column selectively uses data and ignores the many ways the ACA will benefit our state. Implementation of the ACA is far too critical to the lives, health and economic well-being of all Wisconsinites to be prisoner to partisan politics.
Walker was right about one thing. Wisconsin has been a national leader in extending health care coverage. BadgerCare and Medicaid in our state were developed on a bipartisan basis with BadgerCare started by Gov. Tommy Thompson. The programs provide nearly 1.2 million individuals and working families in our state paths to cost-effective health care. The ACA gives us the opportunity to continue that tradition and to stabilize and improve BadgerCare through the use of enhanced federal Medicaid reimbursements, all while lowering the state's percentage of the program's cost.
With the ACA, Wisconsin has the option of offering BadgerCare to adults below 133% of the federal poverty line ($25,390/year for a family of three) who do not currently qualify. This expansion would offer affordable coverage to over 200,000 of our fellow residents.
While strengthening BadgerCare through the ACA is the right thing to do, it will also improve the state's bottom line. Under the health care law, the federal government will pay between 100% to 90% of the costs for newly eligible participants in BadgerCare. And, there is good reason to believe Wisconsin will not face even this very small share of the cost. Outside analysts estimate that, nationally, states' share of Medicaid spending will fall by $39 billion over the first five years of the Medicaid expansion and that states and local governments will save more than $100 billion over that period in other state pro grams that serve the uninsured.
Wisconsin has a myriad moral and economic reasons to move forward with extended Medicaid coverage. First, strengthening BadgerCare reduces the annual shift of nearly $1 billion from uncompensated care costs such as uncovered emergency room visits in Wisconsin hospitals. Currently, we all pay for uncompensated care in the form of higher health care costs and premiums. If Wisconsin fails to address the problem of uncompensated care, the burden of higher health care costs will continue to grow for everyone in our state.
Second, the ACA's federal funding promotes prevention and wellness and can offset other state programs that pay to prevent the consequences of untreated illness. Consider the millions of dollars that counties and the state spend on treatments like mental health. For low-income adults, most of these treatment costs would be paid by the federal government through the ACA, and the state would be spared the costs that arise when mental illness is left untreated - such as those incurred by our corrections system or for substance abuse.
Refusing the ACA's Medicaid expansion funds for BadgerCare would also depress the private sector. Wisconsin is home to a world-class health care industry, which makes up a significant portion of our economy and touches every county in the state. Eleven of the top 25 employers in the state are in the health care business. Over the last 18 months, Wisconsin has been near the very bottom of the nation in job growth. We simply cannot afford to turn away significant resources to grow jobs in a key sector. If Wisconsin does not expand BadgerCare, our leaders will have chosen to ship our federal tax dollars to Illinois, Minnesota and other states to invest in health care and jobs there, all while our state's health and economy deteriorates.
We call on the governor and our legislative leaders to do what is right for our communities and state and move forward to ensure all Wisconsinites have access to health care through a program that saves lives, money and strengthens our economy.

Sara Finger is the Save BadgerCare Coalition coordinator and executive director of the Wisconsin Alliance for Women's Health.

WAWH Supporter E-Update August 1st: A Day of Celebration for Women's Health! Wisconsin Women Continue to Win with the Affordable Care Act!
Greetings!
Wisconsin women are winning with the Affordable Care Act! The law is already making health care more affordable for women and our families care by requiring insurance companies to cover women's preventive health services without additional charges, like co-pays and deductibles. In 2008, one in four women reported going without necessary health care because they could not afford it. Expensive co-pays are a major barrier, preventing us from getting the care we need - more than half of women have delayed or avoided preventive care because of its cost! The affordable preventive care guaranteed by the ACA will create a powerful tool for improving the health of all women. As of the Fall of 2010 all new plans had to start covering these important preventive health services for women without copays. As of this summer, 413,000 Wisconsin women have already been receiving these preventive services without financial barriers.       mammograms                 sexual health screenings       anemia & hepatitis B screening for pregnant women       blood pressure, diabetes and cholesterol testing       counseling about quitting smoking, losing weight, choosing healthy foods, treating depression, reducing alcohol use Starting today, August 1, 2012 all new plans will have to start covering these important preventive health services for women without copays:        Comprehensive contraceptive care.The full range of Food and Drug Administration approved contraceptive methods, including birth control pills, IUDs as well as sterilization procedures, patient education and counseling for all women with reproductive capacity.        Screening and counseling for intimate partner violence.Screening and counseling for women and adolescents about current and past violence and abuse so that providers can address health concerns about safety and other health problems that may be associated with interpersonal and domestic violence.        Screening for gestational diabetes. Screening pregnant women for gestational diabetes, a form of the disease which develops during pregnancy and occurs more often among women of color. Gestational diabetes increases a woman's risk of developing other forms of the disease in the future as well as her child's risk of being overweight and insulin resistant.        Breastfeeding counseling and equipment.Making trained breastfeeding counselors available to all women during pregnancy and after they give birth and making breastfeeding equipment available to those who want it.        Screening for sexually transmitted infections (STIs).Counseling all sexually active women on STIs annually; screening all sexually active women for HIV infection annually; and adding a test for high-risk human papillomavirus (HPV) - an infection that can cause cervical cancer -- to conventional cervical cancer screening for women starting at age 30 and continuing every three years. These recommendations for counseling and screening are critical at time when more and more women are becoming infected by risk behaviors of their partners that the women may not know about.        Well-woman preventive care visits.Conducting at least one well-woman preventive care visit for adult women each year so that women can get the recommended preventive services The Affordable Care Act is helping women get AFFORDABLE PREVENTIVE health care!  To learn more, visit www.raisingwiwomensvoices.org or our blog at http://rwwv.wordpress.com.