Where Are Their Souls?

I refuse to watch the Republican debates, I opt to read the summaries the next day. What caught my attention was the cheering from the crowd over the death penalty and the hypothetical illness of someone that is uninsured. You can't help but wonder.... where are their souls? What makes this group of people so heartless? Let's review what they have done to this country since their big win last year.

They campaigned on jobs, jobs, jobs, less government and spending cuts. The first thing they did was attack union workers and slash funding to schools and health care, while giving tax breaks to corporations. Took away local government in Michigan, attacked planned parenthood and other vital health care services, rewrote districts to their advantage, made it near impossible to sue business for negligence, made it more difficult to vote, attacked the EPA and DNR, and anybody that does not agree with them. Threatening Social Security, Medicare and Medicaid. Making their constituents pay to meet with them. Forcing recalls and playing every dirty game in the book to win. They continue to hold the U.S hostage from the near government shut down to the debt ceiling and the continuation of not moving a jobs bill through congress. Am I forgetting anything? If I am you get the message anyway, this is beyond disgusting.

Time and again the people have spoken and they have said enough is enough, the people want have said what action they want taken and yet they refuse to listen and act on it. The President was right when he said we don't have 14 months to wait to correct this problem at the ballot box. It makes me wonder if the Republicans know how far they can obstruct the President and the country before the damage is beyond repair. Is their plan to win the presidency by hook or by crook? It would seem that way.

These Tea Party Republicans rack up more wins, they would create a world that would be unrecognizable, and not in a good way. What is their manefesto? What is their ultimate goal, maybe I'll do some connecting of the dots and let you know what I find. I can tell you this, I don't like what I see, it's become good .vs. evil.

Wisconsin Council on Children and Families

555 W. Washington Ave., Suite 200

Madison, WI  53703

Phone (608) 284-0580

Health Care Coverage

Wisconsin Budget Project – WCCF

Jon Peacock and Sara Eskrich

Sept. 1, 2011

Please feel free to forward messages to any other interested parties, and encourage others to sign up for this and/or other WCCF mailing lists at http://capwiz.com/wccf/mlm/signup/.

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In this issue:  

  1. Expert Analysis Concludes Health Care Reform Would Significantly Improve Insurance Coverage in WI

  2. Sept. 15 Hearing on AB 210 – Relating to ACA Implementation

  3. “BadgerCare Plus: Who’s Eligible, for What, and at What Price?”

  4. GOP Governors Renew Push for More Authority to Restrict Medicaid

  5. Proposed Treasury Dept. Rules Define Affordability of Family Coverage

  6. HHS Regulations Will Help People Choose Insurance through Exchanges

  7. Health Watch Posts Public Testimony on Impact of Medicaid and BadgerCare Cuts

  8. Deficit Reduction, Accountable Care Organizations, & Marshfield Clinic’s Success

  9. Other Health Care Issues in the News

 10. Please Support WCCF!  

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1. EXPERT ANALYSIS CONCLUDES HEALTH CARE REFORM WOULD SIGNIFICANTLY IMPROVE INSURANCE COVERAGE IN WISCONSIN

A long-awaited study of the likely impact of the federal health care reform law on the insurance market place in Wisconsin concluded that it will reduce the number of uninsured state residents by 65% -- from about 520,000 now to an estimated 180,000 in 2016. However, if you had just listened to Walker Administration officials summarize the report you probably would have missed that piece of very good news and other positive findings.

At a briefing for the press (and closed to the general public) and in an op-ed column, DHS Secretary Dennis Smith focused on the ways that the report will change private coverage for some Wisconsinites, and will increase premiums for people who are young and healthy.

The study was authored by economist Jonathan Gruber, under a $400,000 contract initiated by the Doyle Administration, using a federal planning grant. Gruber, who works at Gorman Actuarial, LLC, and Massachusetts Institute of Technology, is an expert on Health Insurance Exchanges and was actively involved in their development in Massachusetts.  

Robert Kraig, executive director of Citizen Action of Wisconsin, wrote an op-ed column that provides some background on the study and takes issue with the way the state officials “cherry pick” the findings they highlighted. He also took issue with the exclusion of the public from the press briefing and the departure from the usual practice of having the author on hand when it is released to the media. 

 An article in the Capital Times by Shawn Doherty describes the report and the way in which it was unveiled and summarized by Walker Administration officials. She interviewed the report’s author for his perspective. See “Economist Jonathan Gruber says state officials spun the results of his health care reform study.”

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2. SEPTEMBER 15 HEARING ON AB 210 – RELATING TO ACA IMPLEMENTATION 

As mentioned in last month’s Health Care Coverage newsletter, Rep. Petersen (R-Waupaca) introduced AB210, relating to the “implementation of health insurance reform, providing an exemption from emergency rule procedures, and granting rule-making authority.” Though this bill is being described as implementing the Affordable Care Act (ACA), it includes numerous provisions not required by health reform and contrary to consumer protections, including:

·         granting emergency rule-making authority to the Insurance Commissioner without finding of emergency,

·         repealing the WI statutes related to internal and external appeals (which are more generous than those required by the ACA),

·         allowing the Insurance Commissioner to refuse to disclose rate filing information if it’s determined to be proprietary,

·         and a repeal of all changes if the ACA is found unconstitutional.

For a more detailed analysis of this bill, see ABC for Health’s HealthWatch Wisconsin newsletter here,

and the full bill text with a Legislative Reference Bureau summary here.

There will be a public hearing on September 15^th at 10:45 AM in room 328 Northwest of the Capital. We encourage advocates to attend and help shed light on the extraneous elements of this bill.

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3. “BADGERCARE PLUS: WHO’S ELIGIBLE, FOR WHAT, AND AT WHAT PRICE?”

Shortly after BadgerCare Plus began in 2008, we wrote a summary document about the income eligibility criteria, what people are eligible for, and how to calculate the premiums for families of different sizes and incomes.   We recently got a couple of requests for an updated version of that report, and this seemed like a good time to make it current – before the state begins debating how or whether to change the premiums and various other aspects of BadgerCare Plus.

A new version of “BadgerCare Plus: Who’s Eligible, for What, and at What Price?” has been completed, and can be found on the WCCF website. Appendix 1 provides a table comparing the benefits available in the Standard Plan and the Benchmark Plan. Appendix 2 provides a number of examples of how to apply the tables for determining the premiums, and how those hypothetical families might be affected if the state raises the premiums to 4% of family income.

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4. GOP GOVERNORS RENEW PUSH FOR MORE AUTHORITY TO RESTRICT MEDICAID

The Republican Governors Association (RGA) released a report Tuesday (Aug. 30) detailing 31 recommendations for loosening federal Medicaid standards, in order to give states far more autonomy in determining who is eligible and what they are eligible for. The report, titled A New Medicaid: A Flexible, Innovative and Accountable Future, has been endorsed by 30 GOP governors, including Governor Walker.

GOP leaders in the House have been trying all year to get Congressional approval of these sorts of recommendations – including repeal of the health care reform law's “maintenance of effort” requirement, which places restrictions on the ability of states to cut their Medicaid rolls. Since the Senate has blocked those efforts, the Republicans’ attention will now turn to getting these recommendations into whatever deficit reduction plan is developed by the so-called super committee (charged with trying to cut $1.2 trillion from the federal deficit).

Advocates are concerned that giving states broad authority to change Medicaid will be very detrimental for the low-income families, seniors and people with disabilities that the program serves, and ultimately will significantly increase the number of uninsured Americans -- thereby also increasing uncompensated care and cost shifting.

Read more in WCCF’s September 1 blog post about the report and the concerns of advocates.

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5. PROPOSED TREASURY DEPT. RULES DEFINE “AFFORDABLITY” OF EMPLOYER COVERAGE

On August 12^th, the Department of Health and Human Services (HHS) and the Department of the Treasury released three proposed rules regarding Health Insurance Exchange, premium tax credit, and Medicaid eligibility. These rules are meant to interact and create a simple, seamless, and affordable system of coverage in the Exchanges. (See item #6 below for an overview of the rules proposed by HHS.)

The draft rule developed by the Treasury Department sets the standards for how individuals and families will receive premium tax credits. An important aspect of this proposed regulation relates to the “affordability” of coverage, and warrants comment and revision by the Department.

Individuals and families who are offered employer sponsored insurance (ESI) are generally ineligible for the premium tax credit. However, if the ESI is deemed unaffordable (costing more than 9.5% of family income) or does not provide minimum value (covers less than 60% of total allowed costs of benefits) they may be eligible. The problem is that the proposed rule considers ESI affordable for the entire family as long as coverage just for the employee costs no more than 9.5% of the family’s income. For more on this element of the rule see CBPP’s blog post.

More on the entire rule, and links to the full regulations and overviews can be found in this WCCF blog post. See also, The Commonwealth Fund post for a more overarching description of the Treasury proposed rule.

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6. HHS REGS WILL HELP PEOPLE CHOOSE INSURANCE THROUGH EXCHANGES

Many of us have frustratingly tried to decide which insurance plan to choose – and it’s like comparing apples to bananas to oranges, all in a foreign language. Thankfully, a preliminary federal rule announced on August 17 by the Department of Health and Human Services – implementing part of the health care reform law – will ensure that all consumers of private insurance are provided clear, consistent, and comparable information about their health plan benefits and coverage.

The proposed regulations clarify the implementation of the ACA provision ensuring that consumers have access to two forms to help them understand and evaluate health care choices, specifically:

• An easy to understand summary of benefits and coverage, which will enhance comparison shopping; and
• A uniform glossary of terms commonly used in health insurance coverage such as “deductible” and “co-pay.”

Read more in our Aug. 17 blog post, or in the Aug. 18 article in USA Today. There’s also a great blog post by the Center for Children and Families.

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7. HEALTH WATCH POSTS TESTIMONY ON IMPACT OF MEDICAID & BC+ CUTS

HealthWatch Wisconsin has posted the complete video footage of public testimony on the impact of proposed BadgerCare+ and Medicaid cuts that will affect 1.2 million Wisconsinites covered by these programs. In March, HealthWatch Wisconsin sponsored two days of public hearings during the HealthWatch Wisconsin Annual Conference, drawing hundreds of people to listen, learn, and for some, to share their stories and the stories of loved ones. HealthWatch Wisconsin staff was on hand to record participants' testimony.

View the public testimony footage on the HealthWatch website.

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8. DEFICIT REDUCTION, ACCOUNTABLE CARE ORGANIZATIONS, AND MARSHFIELD CLINIC’S SUCCESS

The new “super committee” will likely be looking at health spending as a part of deficit reduction. However, real deficit reduction will take real, systemic health care reform. On this note, recent news of success in the Medicare shared savings demonstration project at Marshfield Clinic shows a glimmer of hope. The goal of the project was to improve quality of care and reduce costs in order to achieve shared savings. Already, Marshfield has earned $56.2 million in shared savings payments from the project.

This particular demonstration project has laid the groundwork for Accountable Care Organizations (ACOs), creating incentive for working across care settings to achieve savings, to be determined by the quality of care. For more information about Marshfield’s success and how it relates to deficit reduction and health care reform, see our August 15^th blog post.

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9. OTHER HEALTH CARE ISSUES IN THE NEWS

-- United Way drive to target infant mortality in Milwaukee - Aug. 31, Journal Sentinel – “The United Way of Greater Milwaukee will look to bolster the fight against infant mortality in the city with a $48 million fundraising campaign this fall.”

--  Good news on controlling health care costs‎ - Aug. 30, WI State Journal editorial – “Most health care professionals are paid by the visit and procedure. So the more care they provide, the more money they make. The Marshfield Clinic in central Wisconsin just provided some hard and welcome evidence that changing this skewed payment incentive can help improve patient outcomes while controlling soaring cost.”

  

-- In pain, mom-to-be found only dentist wait list -- This Aug. 30 Journal Sentinel article highlights the severe problem of dental care access for Wisconsinites in Medicaid or BadgerCare.

-- Health Insurance Premiums for State Workers Decline – Aug. 23, Journal Sentinel – The WI Department of Employee Trust Funds said that health insurance premiums for the majority of state workers will decline by 3.3% next year, a first ever drop. [But see the next story.]

-- Health Insurer to Drop State Employees – Aug. 26, Eau Claire Leader-Telegram – “Beginning in January, Group Health Cooperative will stop providing health insurance to state employees in several west-central WI counties, citing costs as the barrier to providing coverage.”

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9. PLEASE SUPPORT WCCF

WCCF relies on the generosity of its members to support much of the work we do. By becoming a WCCF member or making an additional contribution, you can help us sustain our efforts on to ensure that Wisconsin has the revenue necessary for strong state and local programs serving children and families.

You can contribute on the following portion of our website:
https://payments.auctionpay.com/ver3/?id=w043832 

What A Sad Commentary Of Our Times

http://www.huffingtonpost.com/2011/09/12/income-inequality_n_958472.html

How The American Jobs Act Works

Good afternoon,

Last night President Obama walked Congress and the nation through the American Jobs Act, his plan to create jobs in America now. It's up to Congress to act on this set of bipartisan ideas that put people back to work and put more money into the pockets of working Americans.

You can watch a special enhanced version of the speech, featuring charts and other relevant information here:

Here are a few important points about how the American Jobs Act works, and why Congress should act quickly:

• First, it provides a tax cut for small businesses, not big corporations, to help them hire and expand now and provides an additional tax cut to any business that increases wages.
• Second, it puts people back to work, including teachers, first responders and veterans coming back from Iraq and Afghanistan, and construction workers repairing crumbling bridges, roads and more than 35,000 public schools, with projects chosen by need and impact, not earmarks and politics.
• Third, it helps out-of-work Americans by extending unemployment benefits to help them support their families while looking for work and reforming the system with training programs that build real skills, connect to real jobs and help the long-term unemployed.
• Fourth, it puts more money in the pockets of working and middle class Americans by cutting in half the payroll tax that comes out of every worker's paycheck, saving families an average of $1,500 a year. And it removes the barriers that exist in the current federal refinancing program (HARP) to help more Americans refinance their mortgages at historically low rates, save money and stay in their homes.

The American Jobs Act is based on ideas supported by both Democrats and Republicans, and is fully paid for by closing corporate tax loopholes and by asking the wealthiest Americans to pay their fair share. It would have an immediate impact on job and economic growth, but Congress has to act now.
You can learn more about the American Jobs Act on Whitehouse.gov.
Over the next few days there are a number of ways for you to ask questions and engage with Administration officials about the American Jobs Act including Open for Questions live panels and Twitter Office Hours.
In fact, next week, I’ll be participating in my very first White House Office Hours on Twitter, so be sure to tune in and send me your questions using the hashtag #WHChat.
Here’s a list of the full lineup of events so far:

• Today at 4:30 p.m. EDT: Brian Deese, Deputy Director of the National Economic Council will be answering your questions on Twitter during White House Office Hours using the hashtag #WHChat.
• Monday September 12 at 4:30 p.m. EDT: White House Office Hours on Twitter with Stephanie Cutter, Assistant to the President and Deputy Senior Advisor.
• Tuesday, September 13 at 5:30 p.m. EDT: I’ll be answering your questions on Twitter during White House Office Hours using the hashtag #WHChat.
• Wednesday, September 14th at 4:00 p.m. EDT: White House Office Hours with Brian Deese, Deputy Director of the National Economic council.

Sincerely,
David Plouffe
Senior Advisor to the President
P.S. After last night’s address, a few White House policy experts answered questions about the speech. Check out the video of the event: WhiteHouse.gov/JobsSpeechOFQ
 

Walkers Priorities, Not WI's Priorities

http://host.madison.com/ct/news/local/govt-and-politics/city-hall/article_46c9a6f2-daee-11e0-821e-001cc4c002e0.html

This is disgusting, Walker along with his wife, set a bad example of prioritizing, at a time when Walker has decimated vital programs, his wife is fund raising to renovate the governors mansion? They should have to live in it as is, how about this.... the mansion gets fixed up after the schools do, or funding is restored to vital health programs. What a disgrace!

Jon Peacock: Keeping Them Honest For Our Sake!

FYI – today’s Wisconsin Health News has an interview w. Sec. Smith.  I highlighted in yellow the portion about the waiver request: 

 

On the Record with Department of Health Services Secretary Dennis Smith

Governor Scott Walker's administration is "working hard" to lift the cap on Family Care enrollment, Department of Health Services Secretary Dennis Smith told Wisconsin Health News in a recent, exclusive interview.

"The governor is deeply committed to Family Care," he said. "We are working really hard on what reforms we can bring to the program to be able to lift caps, as we all want to do."

In a wide-ranging interview, Smith also defended the rollout of a recent state report on the federal health reform law, discussed when the administration plans to submit a waiver from maintenance of effort requirements, and talked about why states deserve more flexibility in their Medicaid programs.

Excerpts are below.

WHN: Last month, the Office of Free Market Health Care released a report examining the impact the federal health reform law will have on Wisconsin. Advocates, Democratic lawmakers, and even one of the economists who worked on the report, criticized Governor Scott Walker's administration for only highlighting its negative aspects. How do you respond to that?

DS: Originally, people were quite excited when we were told that reform meant the cost of health care was going to go down. That is what people were sold on in terms of why we were going to pursue what became the Patient Protection and Affordable Care Act. Obviously, people are frustrated with the report we released that said that won't be the case. Now people are trying to move the goal posts on us, that it was supposed to be these other things. Why didn't we emphasize the reduction in the uninsured, for example? Why didn't we emphasize other things? To a large extent, (with the report), we went back to the original promise that got everyone so excited. Showing people a picture of that is what we should really concentrate on. We now know that premiums for young people will go up significantly. We know that there will be disruption in the market. We should focus on what we should be doing between now and 2014 to mitigate those negative aspects in the market?

WHN: So you disagree with the claims that the Office spun the report's findings?

DS: If I was really putting a spin on it, I would have done much more to highlight those areas where I disagree with the authors. They have a relatively modest erosion in employer-sponsored health insurance. I believe, and many other people believe, that it will be much more significant than that. The reason I believe that is from prior history. If you go back to look at what happened when the State Children's Health Insurance Program was created in 1997, you see a migration out of private insurance into public insurance. Once those new public benefits were offered, that erosion of private coverage was much more substantial than the authors were saying it would be. I didn't highlight my disagreements where I thought the report was wrong. I said these are what the facts are. This is what the report said.

WHN: According to the report, 340,000 more Wisconsin residents will have insurance coverage under the federal health reform law. That seems like a significant finding. Why has that not been highlighted by the Office?

DS: Most of those people who are currently uninsured, most of them will come into Medicaid. The majority of those people are already eligible. People are giving too much credit to PPACA, when you realize where the reduction in uninsured is coming from.

WHN: Last month the Republican Governors Association published a report outlining its recommendations for reforming Medicaid. Among other things, it says that states should have flexibility to make the program work best for their taxpayers. Why is that important?

DS: The federal government has now increasingly limited states' ability to manage their program because the rules coming out of Washington are more and more restrictive. Wisconsin has been a managed care state for many years. It's accepted into the provider culture. It's accepted into our general population culture. And yet, CMS says we have to follow rules that the federal government comes up with that may not reflect our markets, either geographically, or the population that's used to being in managed care. When you go back and look at Medicaid, the majority of Medicaid spending occurs because states are the ones that decided in the first place to expand beyond the minimum federal requirements. States like Wisconsin, that have been very generous, have expanded eligibility far above what the federal mandates are. It's fundamentally wrong for federal officials to say, well, we have to impose these federal requirements, because without them state Medicaid programs won't be of high quality. They won't meet the needs of the population. That is fundamentally offensive to states. States are the ones that expanded the programs. We ought to as well have the latitude to manage the program in a way that is in line with state cultures and markets.

WHN: In a press briefing announcing the governors' Medicaid report, you said "We get good sound bites from the top leadership (at HHS), but when we get to the regulations it's quite a different story." Could you explain what you mean by that?

DS: If you go back to January of this past year, right before the National Governors Association's winter meeting, Secretary (Kathleen) Sebelius was saying we are all for flexibility. That was music to our ears. But it is inconsistent with what we have been experiencing in the regulations themselves in what has been coming out of CMS. When you look at the maintenance of effort requirement, for example, if you look at the statute, when it originally came out in the stimulus bill it referred to eligibility levels. Which is fine. We all understand what that means. And then CMS, not through regulation, but through a state Medicaid director letter, went on to say that that also means cost sharing. Cost sharing has never been considered an issue of eligibility. So they went far beyond what the statute says. That takes away state flexibility. We are getting mixed messages out of Washington, and that is very frustrating.

WHN: You mentioned maintenance of effort requirements. Governor Walker's budget bill says that if the state does not receive a waiver from MOE requirements by December 31, 2011, DHS must reduce eligibility to 133 percent of the poverty level starting July 1, 2012. Has DHS requested a waiver yet?

DS: We have not. It is still under development. We have assured everyone that we will release it publicly here first before we send anything to CMS. Frankly, we have been through different versions or different parts because of what we hear CMS talking to different states about, and now the latest notice for proposed rulemaking on eligibility under PPACA. This is sort of the irony and the mixed message you get out of Washington. Washington is not willing to give flexibility on how you determine eligibility, even when the alternative is states can simply drop tens of thousands of people off the program. That's a very confusing message.

WHN: When will the waiver request be presented to the public?

DS: Within the next four to six weeks. You will see it in early fall.

WHN: In an interview with the Milwaukee Journal Sentinel this summer, Governor Walker said the cap on Family Care enrollment could be modified or dropped later this year. Where does that stand now? Will the cap be lifted or modified?

DS: The governor is deeply committed to Family Care. We are working really hard on what reforms we can bring to the program to be able to lift caps, as we all want to do.

WHN: Is there a realistic possibility that the cap will be lifted this year?

DS: We are trying to find ways to bring reform into the program so it is sustainable so we can lift the caps. We are still working through those ideas and suggestions, including those from industry and from advocates. I have been very pleased with the very positive response people have had to making this workable. Everyone knows we have a great deal at stake here, and we all share the same goal, which is to ultimately be able to lift the cap. But everyone understands the challenge. We have to make the program sustainable.

WHN: If the administration does decide to continue the cap - which started June 30 - what type of federal approval is needed?

DS: That's an issue we are in discussion with CMS on. We have provided them with some information. They have followed up, and asked us some additional questions.

 

Many thanks to all of you for signing onto the attached letter.  We hand-delivered it late Thurs. afternoon to the Secretary’s office, and we just sent it to Wheeler,  WisPolitics and some health care reporters.  

I’ll be surprised if it actually gets any press, but that isn’t the primary objective.   I think it’s important for groups to start making noise about the importance of public participation, and to begin to draw attention to the fact that the department’s foot dragging puts CMS in an almost impossible position. 

Incidentally, there was an interesting article in “Healthwatch “ (The HILL’s health care coverage) on Wed. regarding the opposition of GOP officials, including Smith, to federal transparency requirements:

http://thehill.com/blogs/healthwatch/medicaid/179507-medicaid-transparency-push-riles-state-officials 

Jon

 

Jon Peacock, research director

Wisconsin Council on Children and Families

(608) 284-0580 x 307

www.wccf.org

www.wiskids.blogspot.com

Obama Cares!

I was curious about the Presidents view of those with disabilities so I went to the official White House website and found this: http://www.whitehouse.gov/issues/disabilities. Obama really does care!

I also recommend looking into this link: http://www.whitehouse.gov/healthreform#healthcare-menu
Lots of excellent information about the affordable care act.