House Changes Make a Terrible Bill Even Worse
The House bill to repeal the Affordable Care Act (ACA) goes far beyond changing that law. Without so much as a single public hearing, the bill being voted on by the House this week also makes radical changes to the structure of the Medicaid program that provides health care coverage for about one-fifth of Americans.
The bill would impose an arbitrary cap on federal Medicaid funding, thereby shifting costs to states, health care providers, communities, and those who can least afford it. It would dismantle Medicaid’s flexible financing structure that has protected children, families, individuals with disabilities and seniors during economic downturns or when our state faced increased health care costs due to natural disasters or public health emergencies.
Rather than providing states with more flexibility, this financial restructuring would give Washington D.C. more control over Wisconsin because federal politicians would be able to lower the amount they send our state to support Medicaid. Read more
Weaker Carrots & Different Sticks = Huge Increase in the Uninsured
The House plan to the repeal and replace the Affordable Care Act (ACA) is having the strange effect of uniting an extremely broad range of federal lawmakers. The plan that was unveiled Monday evening seems to be opposed not only by all the Democrats, but also by the most Conservative Republicans, like the members of the “Freedom Caucus,” and by a number of more moderate Republicans in Medicaid expansion states.
But notwithstanding the broad opposition, it appears that the new 400-page bill will be voted on in two different House committees on Wednesday. What’s particularly alarming is that those committees will vote on the bill without waiting for the Congressional Budget Office’s estimate of the effects on the federal budget and on the number of Americans who have health insurance. Two committees will cast their votes without knowing whether the bill adds up and without adequately assessing the potential damage to health insurance access and affordability. Read more
Federal policy guidelines that were adjusted for inflation last week are worth examining because they help illustrate the challenges faced by low-income working families. They show, for example, that single parents with one child are currently ineligible for BadgerCare if they have a full-time job that pays more than $7.81 per hour!
The federal poverty guidelines are updated early each year, and the 2017 guidelines that were issued on January 31 increase the Federal Poverty Level (FPL) by 1.3%. That raises eligibility for many federal benefit programs, such as Medicaid, food stamps and child care subsidies. An updated table on the Wisconsin Budget Project website shows what the poverty level is for different family sizes and how that affects eligibility for different public benefits. It also translates the annual poverty level figures into monthly and hourly incomes. Read more
New data from the Wisconsin Hospital Association show that the federal health care reform law has had the desired effect of causing a sharp drop in uncompensated care. That’s great news because much of the cost of uncompensated care for people who are uninsured gets shifted to other patients and contributes to higher rates for people with insurance.
The reduced spending for uncompensated care – which is the total of charity care and bad debt – also has the benefit of creating a great opportunity for hospitals to make upstream investments that promote public health and alleviate some of the factors causing severe health disparities.
The new data demonstrate that uncompensated care expenses borne by Wisconsin hospitals have dropped precipitously since 2013, as key parts of the Affordable Care Act (ACA) were being implemented – including the new insurance Marketplace and the expansion of coverage for childless adults. After those provisions had been in place for two years, total uncompensated care fell in Wisconsin by $534 million in fiscal year 2015, a drop of 36.8 percent from the 2013 level. Read more
Uninsured Rate Declines Sharply Nationally and in Wisconsin
New data released today by the U.S. Census Bureau show that the federal health care reform law has been extremely effective in reducing the number of people who are uninsured, both nationally and here in Wisconsin. The new figures also bring very good news on national improvements relating to income and poverty.
The number of Wisconsinites who do not have health insurance fell sharply during the first two years of implementation of the Affordable Care Act (ACA). According to the new data from the American Community Survey (ACS), 195,000 fewer Wisconsin residents were uninsured last year than in 2013, a decline of 37.6%.
The national ACS data show that the number of Americans without health insurance fell by more than a third from 2013 to 2015, and the percentage who are uninsured is now at an all-time low. That reflects a drop in the uninsured population of almost 7 million last year, on top of an improvement of about 8.5 million in 2014, when key parts of the health care reform law took effect. Read more
There’s a rapidly growing body of academic research documenting the benefits of using the Affordable Care Act to expand Medicaid eligibility of adults.
Academic researchers love experiments with control groups, and those kinds of tests of public policy changes can be hard to find. However, the 2013 Supreme Court decision that made Medicaid expansions optional for states has been a boon for researchers. They can now study the changes in 31 states that have extended eligibility for adults to 138% of the poverty level, and can compare those states with the 19 “non-expansion” states. (Wisconsin is in the latter group because it caps BadgerCare eligibility for adults at the poverty level.)
One such study was published this month in the Journal of the American Medical Association Internal Medicine (JAMA). It compares health outcomes for patients in Kentucky and Arkansas – two states that accepted the expansion of Medicaid – with outcomes for patients in Texas, which has rejected it. Read more
Wisconsin’s commitment to affordable child care for working families has waned in recent years, making it more difficult for child care providers to work towards improving the quality of child care, according to a new report from the Wisconsin Council on Children and Families.
Many parents with low incomes wouldn’t be able to afford to work without the child care subsidies provided through the Wisconsin Shares program. In 2015, Wisconsin Shares served 46,000 children each month, on average. But the number of children served by Wisconsin Shares has fallen considerably in the past few years, declining 21% between 2008 and 2015. The decline in rural areas has been the most severe.
There has been an even steeper decline in payments to child care providers over this period, with payments dropping by 36% since 2008. Payment rates have been nearly frozen over this period, meaning that inflation has chipped away at the amounts paid to providers, and the state has implemented policies that result in lower payments to providers. Read more
Governor Walker’s public statements and his instructions to state agencies on how to develop their proposals for Wisconsin’s next state budget give some glimpses into what the state’s 2017-19 budget might bring.
Wisconsin has a two-year budget. The process of deciding what to include in the budget starts in the summer of even numbered years — in other words, now — when the Governor instructs state agencies how to develop budget requests. Agencies submit their requests to the Governor in September, and the Governor takes the requests into consideration when developing his own budget proposal to submit to the Legislature. The Governor is expected to release his budget proposal in the early part of 2017. (For more about the Wisconsin state budget cycle, check the Wisconsin Budget Project’s Budget Toolkit.)
Reduced Participation Provides Opportunity and Reason to Streamline Enrollment Procedures
Members of the legislature’s Joint Finance Committee got some very good news last Friday in the form of a quarterly report on the state Medicaid budget from the Wisconsin Department of Health Services (DHS). The letter from the interim Secretary of DHS indicates that the agency now estimates that Medicaid spending during the 2015-17 biennium will be $418.6 million below the amount lawmakers anticipated when they passed the budget bill a year ago.
The portion of Medicaid spending specifically from state General Purpose Revenue (GPR) is projected to be almost $176 million (3.1%) less than the budget bill set aside. That’s an improvement of $90.6 million GPR since the last projection was made three months ago.
These numbers from DHS are very good news at a time when state revenue projections haven’t been very good. The reduced growth in Medicaid spending improves the prospects for keeping the total state budget in the black – without resorting to additional remedial measures (beyond the delay in debt payments that the Governor already implemented). Read more