HealthWatch WatchDog Season 8, Episode 1: “Moving Forward...Finally!”

The US Supreme Court has ruled in favor of subsidies for all Marketplaces. In this Episode of the HealthWatch WatchDog, Bobby and Brynne recap the opinion highlights and talk about moving forward for Wisconsin consumers.

Click here or on the image at the right to watch the episode!

Miss an episode? Visit our WATCHDOG LIBRARY to catch up on topics from previous seasons!

Subsidies or No Subsidies

In HealthWatch Wisconsin’s last update, we gave a quick refresher on the King V. Burwell case. As we await the impending decision, there’s a lot of speculation surrounding the outcomes of the Supreme Court case. If the decision favors Burwell (defendant of the current law) the subsidies will remain intact. However, there are a number of possible outcomes if the court rules in favor of King (who argues that the law says the federal subsidies are only available to consumers in state run exchanges). First and foremost, consumers in states without their own health care exchange, including Wisconsin, will lose their tax subsidies. According to DHS, that means more than 6 million people will lose their subsidies. Kaiser Family Foundation shows that in Wisconsin, over 160,000 individuals currently receive tax subsidies, leading to an average savings of $315 per enrollee. If the court rules against subsidies in federal exchanges, Wisconsinites could see a 252% spike on their premium payment.

Secondly, a ruling against subsidies may severely hinder the ACA’s mission. Without subsidies, current plans will be more than 8.05% of consumers’ incomes, and they’ll be exempt from the tax penalty for not having insurance. This means that a large amount of newly insured Americans, would again go uninsured, shrinking the insurance risk pool, increasing health care costs for all.

Many media outlets are predicting that rule will be in favor of the subsidies, however, it can be difficult to predict.  Technically, if the Supreme Court rules against the Obama administration, changes could take effect as early as August. U.S. Secretary of Health and Human Services, Sylvia Burwell, said that if this is the case, it will be up to state officials and Congress to help consumers find affordable coverage, although the administration will work with states in order to mitigate effects. We are expecting a Supreme Court decision by the end of the month.

Keep your eyes open for a Special Edition HealthWatch Update the moment the opinion is delivered, and we'll share the details, and what it could mean for Wisconsin!

Significant Drop in BadgerCare for Childless Adults in May

The May BadgerCare Plus enrollment numbers are now available, showing what appears to be the continued impact of “renewals” (or lack thereof) for the childless adult population. April was the first month for childless adults to renew their coverage (see Ops Memo 15-02) and enrollment declined by over 2,600. The May data, as predicted, followed suit—but the results were far more drastic than April. In May, almost 6,500 childless adults lost BadgerCare Plus coverage – which means in the last two months, over 9,000 childless adults have lost BadgerCare Plus.

Proposed BadgerCare changes hurt access to coverage

 

Lesley Kieffer 3:14 p.m. CDT June 1, 2015

Columnist says the governor’s budget proposal would make drastic changes to BadgerCare — a successful, cost-effective program in both rural and urban communities.(Photo: File/Getty Images/Creatas RF)

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As a physician, I believe all Wisconsin residents deserve access to affordable, quality health care. Unfortunately, I am fearful that many low-income Wisconsinites to whom I provide care are at risk of losing health coverage as a result of recommendations contained in the governor's proposed budget.

The governor's budget proposes drastic changes to our state's Medicaid program, BadgerCare. BadgerCare has proven to be a successful, cost-effective program in both rural and urban communities over the past decade. It provides more than 800,000 men, women, and children across the state with access to affordable health care coverage.

The governor's proposed budget would require the state to request a waiver from the federal government to make changes to the BadgerCare program for childless adults. A "childless adult" is defined an adult without dependent children. The proposed changes include: requiring enrollees to pay monthly premiums; limiting lifetime eligibility to 48 months; and requiring drug testing.

These troubling changes have not received much attention from the media and seem to have flown under the radar in legislative debates regarding the budget. Unfortunately, if enacted, these changes would mainly serve to deny much-needed health care to thousands of low-income Wisconsinites.

While at first glance some of the changes might seem reasonable, people who work with low-income patients quickly recognize why they are so potentially harmful and have been failures when previously tried.

Kieffer  (Photo: Submitted)

Wisconsin already experimented with requiring low-income people enrolled in the Transitional Medical Assistance program to pay monthly premiums and it was a disaster: 21 percent of the adults affected by the policy lost coverage for failure to pay a premium.
Simply put, the people I see make so little money that they cannot afford to choose between paying health care premiums and other basic life expenses. If forced to choose, people will forgo needed medical care to put food on the table.
Limiting lifetime eligibility to no more than 48 months would be an unprecedented change that fundamentally undermines the purpose of BadgerCare, which is meant to be a reliable safety net that provides low-income people with health care.
Economic hardship doesn't always come with a time limit, especially given the reality of wage stagnation and job insecurity. Many of my BadgerCare patients are older adults waiting for their Medicare eligibility, with no other options for insurance. They cannot be left without options if they are 62 and have used their lifetime cap on BadgerCare eligibility.
Rural Wisconsin has not been immune to struggles with drug abuse. However, the drug testing provision raises serious constitutional questions, as a similar proposal for public benefit recipients was recently declared unconstitutional in Florida.
Just as importantly, similar provisions in other states have not been cost-effective and do little to actually help people with substance abuse disorders. If Wisconsin is truly interested in addressing substance abuse, we should direct our resources towards effective treatment programs.

In addition to these troubling proposed changes, the budget also continues the governor's failed policy of rejecting federal money to expand BadgerCare. As a result, there are thousands of low-income adults who cannot afford private health insurance but have too high of an income to qualify for BadgerCare.

Currently, a childless adult is eligible for BadgerCare if he or she earns an income at or below 100 percent of the Federal Poverty Line (FPL), which is only $11,770 for an adult without dependents, or $980 a month.

Accepting federal Medicaid dollars would save the state at least $345 million and provide at least 81,000 additional Wisconsinites with the health care they need.

The Legislature should make the morally and fiscally sound decision to accept these federal dollars and reject the governor's unnecessary and harmful proposed changes to BadgerCare. Our health depends on it.

Dr. Lesley Kieffer, is a Doctor of Osteopathic Medicine (DO) and a family medicine physician at Bellin Health De Pere West.