Monday, December 30, 2013

* * H A P P Y  N E W  Y E A R ! ! * *
HealthWatch WatchDog Season 6, Episode 9: “A Year in Review
The health coverage landscape changed dramatically in 2013. In a year of reform, Wisconsin took a different path than most states. Bobby and Brynne look back at the tumultuous 2013 and make predictions for 2014.
Click here  to watch the episode!
Miss an episode? Visit our WATCHDOG LIBRARY to catch up on topics from previous seasons!

Monday, December 23, 2013

Wisconsin and Minnesota — a tale of two states and Medicaid

Wisconsin family braces for a Medicaid transition

In Lisa Nerenhausen’s house, the consequences of the state of Wisconsin’s approach to the Affordable Care Act are mixed. Read more
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.”

Read more:

Wednesday, December 11, 2013

A Four Year Review

At this time four years ago I was literally dying. I had signed up for Wisconsin's Badgercare in October of 2009 and had to wait until January first 2010 for the HMO to kick in, I was in surgery January third. I can only say that God held me up until the time came for  the insurance to be in full force. God also lead the right doctors me in order to be properly diagnosed, fixed and then make a full recovery.

On a financial level, I was able, to once again, pull my house out of foreclosure. I was able to get a modification and almost forty thousand was dropped off of my balance, all due to HAMP. I am still dependent on SSI/SSDI and foodshare, which I am thankful for every day for it. I have been watching the news on these issues and know there are others in a similar situation as mine and are suffering due to decisions being made by those in Washington. I am truly grateful for this assistance, without it we would have lost everything. I still make and sell things at a local farmers/artisan market during the Summer. Although this year I wanted to enjoy time with my family, they have been a huge source of comfort and support, I wanted to reciprocate the time and attention they have given to me. Whenever we spend time together, the world melts away and everything that's going on out there is left behind, at least for a little while.

Health wise, I have had a few scares but overall am doing very well. I have been stable now for three and a half years! If I had followed the course most have, that have this disease, I would be on my third surgery. I developed new growth shortly after the surgery in 2010 but for some reason it has stopped growing. I would like to know why, because I would like to keep doing whatever it is that has stopped the growth! I do have moments when I don't feel so great, but if I stay quiet for a little while it passes. The hernia causes more discomfort than the mucinous tumors do. Despite that, I am able to get up every morning and control my day, I don't dwell on my condition, there is to much to be done to give it much thought. I truly understand and appreciate the gift I was given, the gift of life. Life really does take on a whole new meaning when you realize you almost lost it. You appreciate the good things in life, learn from the bad and work what is good toward others. I read a quote from Erma Bombeck that sums it up perfectly...'when I stand before God at the end of my life, I would hope that I do not have a single bit of talent left, and I could say, I used everything you gave me.'
When I stand before God at the end of my life, I would hope that I would not have a single bit of talent left, and could say, 'I used everything you gave me'.

I will continue to post information as I receive it from advocacy groups here in Wisconsin. They work hard to make sure we have the facts on what's happening and the decisions being made by elected officials. Thank you for following along all these years!
When I stand before God at the end of my life, I would hope that I would not have a single bit of talent left, and could say, 'I used everything you gave me'.

When I stand before God at the end of my life, I would hope that I would not have a single bit of talent left, and could say, 'I used everything you gave me'.
When I stand before God at the end of my life, I would hope that I would not have a single bit of talent left, and could say, 'I used everything you gave me'.
Read more at then I have seen some interesting things. Shortly after returning home from the hospital, I watched the President sign into law the ACA, I watched as lawsuits quickly followed. I watched as the Supreme Court upheld the law. I watched politicians use it to campaign on, to replace and repeal, to repeal and used it to shutdown the government. I watched the roll out for the website go horribly wrong, but knowing it would be fixed. I watched others use it as a means to trash the President. All the while wondering if those that are so determined to bring down the ACA and by extension the President, do they truly understood the fear of having a serious health issue? Do they understand the fear you experience while desperately trying to keep it all together? First, the fear of not knowing what's wrong, the fear of losing everything, what little you have left? Listening to them, you would think that everyone that is sick or has health problems did it to themselves. In my case, a rare disease was not brought about by anything I did, or by a life of debauchery, why is it so hard for them to understand that 'time and unforeseen occurrences befall us all'? They should know the scripture just sited, since they claim to  be people of faith, they should know 'that calamitous times can fall suddenly'.

Wednesday, December 4, 2013

Joint Finance decision on extending health insurance helps some, hurts others

Described by Wisconsin state Rep. Cory Mason, D-Racine, as the “Ebenezer Scrooge” approach to health care reform, the state’s budget-writing Joint Finance Committee voted 11-2 Monday on a proposal that will switch course and force 83,000 childless adults to wait until April 1 for health insurance, while keeping another roughly 80,000 covered through the same date.
The vote, with Mason and Sen. Robert Wirch, D-Pleasant Prairie, voting against it, is the first step to the Republican-controlled legislature addressing the problematic rollout of the Affordable Care Act since its website launched Oct. 1.
Riddled with bugs, it soon became necessary for the federal government to postpone the due date for people to sign up for health coverage, as required by the new law.
That prompted Wisconsin Gov. Scott Walker, never a fan or supporter of President Barack Obama's approach health care reform, to call a special session of the Legislature to approve measures to delay changing BadgerCare eligibility requirements and other measures that would no longer be needed with the health care insurance exchanges in place.
The bad news from from Monday’s Joint Finance meeting is that 83,000 childless adults earning $11,490 annually will not receive insurance through BadgerCare until April 1, as originally promised by the state. These childless adults could have received coverage, as originally promised, on Jan. 1 if the lawmakers and Walker would have agreed to accept federal money to temporarily expand the Medicaid program.
Had the state taken the federal money to expand Medicaid for the next three months, it would have saved roughly $89 million for the remainder of this budget cycle and covered an additional 83,000 people.
The upside is families earning up to 133 percent of the federal poverty level who qualify for BadgerCare insurance coverage will continue to receive coverage through April 1.
The Assembly meets Wednesday to vote on the bill and the Senate is scheduled to take up the proposal Dec. 19.
Here are some noteworthy statements that stuck out from Monday's Joint Finance debate:
Sen. Alberta Darling, R-River Hills: “It really breaks my heart that we are being forced to make these choices today, but we are."
Rep. Cory Mason, R-Racine: “The governor can’t have it both ways. He can’t say, ‘I don’t want to take the federal money to set up an exchange’ and then say ‘oh that darn federal exchange’. There is no reason we couldn’t have set up a state exchange.”
Sen. Glenn Grothman, R-West Bend: “My only comment is I think we are being a little too negative here. We are going ahead and giving this coverage for another three months. And right now 16 other states aren’t even doing that.”
Rep. John Nygren, R-Marinette: “You folks quoting Citizen Action of Wisconsin (on the lower cost of health insurance in Minnesota verses Wisconsin) would be like us quoting information from Americans for Prosperity. It’s just not reliable information.”
Rep. Dean Knudson, R-Hudson: “The fact is Obamacare is a man-made catastrophe of unprecedented proportions.”
Sen. Robert Wirch, D-Pleasant Prairie: “Let’s talk about glitches. I’m a history major. There were glitches with the Social Security rollout … I even think you guys had glitches with the Wisconsin Economic Development Corp (rollout).”
Rep. Jon Richards, D-Milwaukee: “The glitch isn’t with the federal government. The glitch is in this room. When it comes to federal money with roads or schools, there is never a problem. But when it comes to the federal government and health care (accepting money to expand Medicaid, the federal government suddenly becomes an unreliable partner? Give me a break.”
Sen. Robert Wirch: “You sure got between the doctor and the patient when you passed all that pro-life legislation. You sure got between the doctor and the patient on that one,” in response to Rep. Kooyenga arguing the Affordable Care Act does not allow some people to keep their current doctor.
Rep. John Richards, D-Milwaukee: “What we are doing here is putting a Band-Aid on a mistake we created.”
Sen. Alberta Darling, R-River Hills: “When you talk broken promises, those broken promises are occurring at federal level. Let us not forget who put us in this situation.”
Rep. Pat Strachota, R-West Bend: “ I don’t speak too often in finance committee …. but we have this issue before us because of what happened with the federal website. We are here due to the failure of the federal government to create a website.”
Rep. Dale Kooyenga, R-Brookfield: “President Obama admitted there were glitches. Then our democratic colleagues are annoyed we are pointing to Washington D.C.”
Rep. John Klenke, R-Green Bay: “Why I don’t want to spend a lot of time pointing at the federal government … we all knew this one thing: The Affordable Care Act would be problematic. For 85 percent of the population it (the existing health insurance system) was working. It was changed for the other 15 percent.”

Monday, December 2, 2013

Headlines: Featured LInks in this Week's Update

GOP Defends BadgerCare Change Delays in Contentious Hearing, Milwaukee Journal Sentinel, Dec. 2, 2013

Walker's Coverage Gap, Press Release ABC for Health, Nov. 26, 2013

Wisconsin Legislative Leadership: Santas or Scrooges?


Today, December 2, Wisconsin's Joint Finance Committee voted to approve Special Session bills to continue BadgerCare Plus benefits for parents between 100% and 200% of the Federal Poverty Level until the end of March and extend HIRSP benefits (State HIRSP) as well. Unfortunately, the coverage extension means that Governor Walker breaks a commitment to eliminate coverage gaps and start coverage for over 90,000 low-income, childless adults who expected BadgerCare Plus coverage on January 1, 2014. The Appleton Post Crescent Editorial Board wrote this weekend, "We hope our leaders don't turn into Scrooges this season. Let's make this right and cover everyone through March, even if it costs $23 million to protect the neediest of the needy." Will our legislative leaders be Santas or Scrooges? We discuss this more inside this Newsletter!
Also in this issue, the SHOP Exchange enrollment is pushed back while the Feds say is up and working. In this edition of the Update, we look at the federal Marketplace as people have 21 days left to apply and pay for insurance to have active coverage on January 1, 2014.
Read about these breaking news items, case tips, HealthWatch coalition activities, recent articles and more in this week’s Update newsletter. Thanks to all of the current members, subscribers, and supporters--you make the HealthWatch Update possible!
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