More in state must shop for health care coverage
Gov. Scott Walker's decision means thousands more will enter new health marketplace
By Guy Boulton of the Journal Sentinel
June 15, 2013
Gov. Scott Walker rejected federal money to expand the state's Medicaid program because he would like more people to get coverage through commercial health plans instead of government programs.
But the decision also means that tens of thousands more people will need to shop for a commercial health plan on the new marketplace known as an exchange.
That, in turn, will put additional demands on people at hospitals, community health centers and community groups who are expected to do much of the work in helping people sign up for coverage.
"We unfortunately are going to see a very different marketplace in Wisconsin than we have the opportunity to create," said Sara Eskrich, a health care policy analyst at the Wisconsin Council on Children and Families, an advocacy group. "And we are going to have to work with that."
One advantage of Walker's plan is that health insurance sold on the exchange will pay higher rates to doctors and hospitals and generally provide better access to care.
At the same time, people who get subsidized coverage through the exchange will have to pay a premium of as much as 3% of their income and will have higher deductibles than with BadgerCare Plus, the state's Medicaid program for families with children under 19.
They also are going to have to sign up for coverage, a process that will entail shopping for a health plan and determining the federal subsidies available to make the coverage more affordable.
Karla Ashenhurst, director of system advocacy and public policy for Ministry Health Care and Columbia St. Mary's Health System, said that conceivably fewer people in Wisconsin could have health insurance coverage a year from now, although both health systems plan to help people enroll.
The governor's proposal will cost the state almost $150 million more in the next two years — and potentially more than $450 million through 2021 — than if the state had accepted the federal money available under the Affordable Care Act, according to estimates by the Legislative Fiscal Bureau.
That includes $30 million in state dollars for the $73.5 million added to the proposed state budget by the legislative budget committee to compensate hospitals for an expected increase in people without health insurance under the governor's proposal.
The governor's proposal means that an estimated 80,000 to 90,000 people who would have gotten coverage through Medicaid will need to buy subsidized health insurance through the exchange.
Some now have coverage through BadgerCare Plus. Others previously hadn't been eligible for coverage.
The Legislative Fiscal Bureau as well as critics of the governor's proposal said that many people who would have been eligible for coverage under Medicaid will not shop for private plans.
"We know that not everyone is going to make that transition," Eskrich said.