People
in Wisconsin and Minnesota living just barely above the poverty line
are about to see their health care fortunes change — in opposite
directions.
In
Wisconsin, about 77,000 people are expected to lose Medicaid and will
have to purchase coverage through private exchanges. These include
38,067 people between 101 percent and 133 percent of the federal poverty
level, and 35,781 people between 134 percent and 200 percent, according
to figures provided by the state.
In
Minnesota, an estimated 35,000 childless adults whose incomes fall
between 75 and 133 percent of poverty are expected to be newly eligible
for Medical Assistance, the state’s Medicaid program. In addition,
85,000 children and parents will move to the full Medicaid program from
MinnesotaCare. MinnesotaCare is another health care program funded by
federal Medicaid, state funds and premiums paid by its low-income
subscribers.
The
federal poverty level is $11,490 a year for an individual, $15,510 for a
family of two and $23,550 a year for a family of four.
The
Wisconsin changes mean some residents here will soon be required to pay
for their coverage while Minnesotans in the same income brackets will
be moving onto Medicaid. Medicaid plans are often free to recipients,
with the costs split between states and the federal government. The
enrollment transition in Wisconsin, originally planned for Jan. 1, has
been pushed back to April 1.
Currently,
Wisconsin offers Medicaid coverage to a broader swath of the population
than does Minnesota. Wisconsin’s Medicaid program, known as BadgerCare,
covered adults up to 200 percent of the federal poverty level. But long
waiting lists meant that many eligible childless adults were not
getting coverage at all.
Wisconsin’s
changes mean that an estimated 83,000 childless adults will be newly
able to get coverage through BadgerCare. This change, too, will be
pushed back to April 1.
Minnesota,
meanwhile, had much lower coverage levels but was providing Medicaid to
most of those who qualified. Minnesota has also been covering
individuals above 200 percent of the poverty level on MinnesotaCare,
which charges some premiums. That level will drop to 200 percent of the
federal poverty level next year.
Under
the Affordable Care Act, both states are adopting new rules regarding
Medicaid coverage. Both decisions, steeped in politics, will have
profound consequences for tens of thousands of people.
Minnesota
and Wisconsin, while similar demographically, have taken different
paths in line with each state’s ruling political party.
Wisconsin
policies veer to the right, under Republican Gov. Scott Walker and GOP
majorities in the state Senate and Assembly. Minnesota, under Gov. Mark
Dayton, of the Democratic-Farmer-Labor Party, and Democratic majorities
in both houses of the legislature, has veered to the left.
Minnesota
chose to establish its own health exchange, MNsure, to serve as a
one-stop marketplace for consumers to shop for and compare health
insurance options. Wisconsin opted to use the federal exchange.
The two states also took different approaches in providing health insurance for those just above the poverty line.
Walker,
much to the dismay of state Democrats, decided to forgo $119 million in
federal funds to expand Medicaid. Instead, he wants to move some of
those who had been receiving BadgerCare to the federal health care
exchanges, and use the savings to provide coverage to childless adults
up to 100 percent of the poverty level.
“It
would have been fiscally unsustainable and would have added tens of
thousands of people to the Medicaid rolls when my goal was to have fewer
people dependent on the government, not more,” Walker wrote in his new
book, “Unintimidated: A Governor’s Story and a Nation’s Challenge.”
In
an interview with the Wisconsin Center for Investigative Journalism,
Walker said he tried to avoid the two routes taken by most states:
accepting the federal expansion at the risk of a future expense to the
state or rejecting the federal funds and leaving many residents
uninsured.
“I disagreed with Obamacare. I have consistently been against it,” he said. “I tried to provide a viable alternative.”
The
number of Wisconsin parents, children and childless adults who receive
Medicaid coverage under BadgerCare will go up slightly next year, to
about 800,000 people. This figure does not include the Medicaid coverage
for the blind, elderly and disabled, which will not change.
In
Minnesota, Dayton accepted federal funding to expand Medicaid to raise
the state’s coverage threshold to 133 percent. The Minnesota Department
of Human Services estimates 880,000 people will be in the program in
2015, as well as 145,000 MinnesotaCare enrollees.
“We’re
really looking at the tale of two states here,” said Bobby Peterson of
ABC for Health, a Wisconsin-based nonprofit advocacy group. “We’re
struggling a little bit now, compared to the state of Minnesota.”
Minnesota,
he said, embraced health care reform under Democratic President Barack
Obama, set up its own marketplace and worked from early on to expand
Medicaid. “I think we can look at some of those decisions as part of the
reason why (Wisconsin is) behind the curve right now.”
In
Wisconsin, Walker declined the Medicaid expansion along with more than
20 other Republican governors in states such as Indiana, Alabama and
Maine.
Of
those states, Wisconsin is the only one “that will not have a gap in
health care coverage after April 1, 2014,” wrote Claire Smith,
spokeswoman for the Wisconsin Department of Health Services, in an
email.
Walker
delayed implementation of the changes from Jan. 1 to April 1 because of
the mess he said the Obama administration had made of its health care
rollout.
“I’m
not going to let the failure of the federal government let people fall
through the cracks,” Walker said in announcing the delay.
But
the delay comes at a cost for others: The estimated 83,000 childless
adults at or below the poverty line who are expected to be newly
eligible for Medicaid coverage in Wisconsin must also wait until April
1.
The delay has caused howls of protests from state Democrats.
"This is shameful!" shouted Assembly Minority Leader Peter Barca,
D-Kenosha, as the delays were passed. But Republicans blamed the delay
on the federal government for not having the health care exchanges ready
in time.
According to a
Legislative Fiscal Bureau report,
Wisconsin will save $23 million by keeping most childless adults off
the rolls for three more months while continuing to cover people above
100 percent of poverty.
At
a University of Wisconsin multi-campus webinar on the Affordable Care
Act in November, Wisconsin Medicaid Director Brett Davis was asked about
the people who are facing difficult transitions because of the state’s
health care choices.
His reply: “We wish it was a perfect world and we could do everything for everyone.”
In Minnesota, Dayton moved quickly after taking office in January 2011.
In his first act in office, he expanded Medicaid eligibility, adding
childless adults with incomes of up to 75 percent of the poverty level.
“That was a huge deal,” said Jeremy Drucker, a spokesman for the Minnesota Department of Human Services.
Dayton
made Minnesota one of the first states to move forward with the early
Medicaid opt-in. The Department of Human Services said the early opt-in
will have attracted $1.2 billion in federal aid through early 2014.
Those funds represent the typical 50 percent federal Medicaid funding
match. The funding, however, will bump up to 100 percent next year for
newly eligible childless adults.
The
full expansion of Medicaid, known as Medical Assistance in Minnesota,
is expected to save the state about $117 million over the next two
years.
“Minnesota’s
doing the right thing and saying, ‘Look, the feds are paying us to give
Medicaid coverage to guys below 133 (percent of poverty) – let’s do
it,’ ” said Jonathan Gruber, an MIT economist who assisted planning for
MNsure and helped design the Affordable Care Act.
Gruber
said the Medicaid expansion also helps consumers who purchase private
coverage through the exchanges. Typically, he said, those on Medicaid
tend to be sicker, so forcing them to purchase private coverage will
drive up premiums by 10 percent or more on the marketplaces because of
the way insurers calculate costs. (See sidebar, “States differ widely on
costs.”)
Gruber
said he had fewer concerns about the population between 133 percent and
200 percent of the federal poverty level, which is losing coverage in
Wisconsin but will be covered in Minnesota under MinnesotaCare/Basic
Health Program.
“I
can sort of see Wisconsin’s argument” for removing that group of
people, Gruber said. “They were very generous. The federal government is
now offering an alternative through the exchanges, and they are saving
the state money if the guys go on the exchanges rather than on Medicaid.
For Medicaid, the state pays half. For the exchanges, the state pays
nothing.”
