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
If Ryan Plan Passes, Continuation of BadgerCare Changes Would Amount to a “Bait and Switch”
A health care plan introduced last week by Speaker Ryan would roll back many of the improvements in health care that have been achieved over the past several years. It would reverse much of the huge increase in the number of people with insurance, undermine improvements in access to preventive health care services, and raise costs for many people with insurance.
I could go on at length about problems with the plan, but I want to focus now on an important Wisconsin angle – how the Ryan plan would adversely affect many of the 60,000 low-income working parents that state lawmakers removed from BadgerCare two years ago. Many aspects of the Ryan plan would compound the difficulties those parents are already coping with because of the policy choices in Wisconsin, and would take away what they were promised when the state ended their BadgerCare coverage. Read more
National Health Policy Expert Critiques State’s Narrow Evaluation of BadgerCare Changes
Wisconsin received a federal waiver to make significant changes to BadgerCare in 2014, and one of the conditions of that “demonstration waiver” was that the state would evaluate the effects of the policy changes. A national health policy expert, Sara Rosenbaum, reviewed the planned evaluation and in a blog post last week wrote that the analysis designed by state officials fails to address several of the key aspects of the policy changes being implemented in our state. Read more
Wisconsin Is Third Lowest Nationally in Total Spending for Public Health
Concerns about the threats posed by the Zika virus have generated debate in Congress about funding for public health and have drawn attention to the importance of public health systems. That makes this a very appropriate time to also look at the funding for our state and local public health departments.
In Wisconsin, as in other states, we expect a lot from the public health system. However, we generally take that system for granted, and Wisconsin has one of the most poorly funded public health systems in the nation.
A recent report by the Trust for America’s Health (Investing in America’s health: a state-by-state look at public health funding and key health facts) compares the total spending level for public health in each state in 2015, and it also ranks states by the public health funding from a variety of sources. Read more
The Legislative Fiscal Bureau (LFB) has calculated that expanding BadgerCare and thereby qualifying for a higher federal reimbursement rate would yield huge savings for Wisconsin.
The most recent LFB analysis, issued last December, examined the effects of boosting the BadgerCare income limit for adults to 133 percent of the federal poverty level (FPL) from 100 percent of FPL now (which amounts to just $7.70 per hour for single parent with one child). The LFB concluded:
- Initiating that change in January 2016 would have saved state taxpayers $323.5 million during the 2015-17 biennial budget period, while covering an additional 83,000 adults.
- The state would have netted nearly $1 billion in savings over a six-year period!
- A one-year delay in the expansion would reduce the savings by $236 million, but Wisconsin would still save an average of more than $15 million per month once the change took effect.
Opponents of expansion haven’t directly challenged those estimates. Read more
A change in federal Medicaid policy announced in February creates an exciting opportunity to improve health care for Native Americans. It’s an opportunity that Wisconsin tribes and state officials should seize in order to help alleviate the extreme disparities in health between Native Americans and whites in Wisconsin.
The revised interpretation of Medicaid reimbursement policy expands the scope of health care services for Native Americans that are fully paid for by the federal government, without the usual requirement for state matching funds. In the past, the federal government paid 100% of the cost of Medicaid services provided directly by Indian Health Services (IHS), but not for health care provided outside of IHS facilities. Under the new policy, federal funding will also cover the full cost of Medicaid services delivered to American Indians by providers under contract with IHS, if IHS or a tribal practitioner refers the Medicaid patient and continues to oversee their care. Read more
The latest quarterly report from the Department of Health Services (DHS) projects that state spending for Medicaid and related services during the current biennium will be $85.2 million less than the state budgeted. That amounts to $12.6 million less state spending than the state estimated in its last update, three months ago. (I’m focusing just on the state share of spending; the total reduction from all sources is almost $203 million, relative to the amount budgeted for 2015-17.)
Granted, Medicaid spending trends can change rapidly, but the DHS report is welcome news – particularly since other budget indicators aren’t so good. Recently reduced estimates of national economic growth in 2016 suggest the possibility of less state revenue growth than anticipated, and as we noted in a recent blog post, state tax collections dropped by $91 million in February. Against that backdrop, the latest DHS report provides a bit of positive news relating to the prospects for keeping the state budget in the black. Read more
Sizing up the ACA’s Accomplishments on its Sixth Birthday
The federal health care reform law turned six today, and for a relatively young law it has made remarkable progress in reducing the number of uninsured Americans and improving access to quality, affordable health care. A WCCF blog post outlines some of the data illustrating the Affordable Care Act’s accomplishments, and for the law’s sixth birthday I’ve distilled those into the six achievements described below.
Of course, the law has its detractors – including many Republican officeholders and candidates who seek to repeal it. During the election campaigns in the months ahead, I hope there will be robust debate about the laws effects – grounded in solid data. I hope the proponents of repealing the ACA will explain how they would replace it and how they would improve upon, or at least avoid reversing, the following accomplishments: Read more
Wisconsin Lags Far Behind in Reporting on National Standards
This week has been Sunshine Week, which is the annual nationwide celebration of access to public information. That makes this a good time to bring up an area where Wisconsin needs to let in considerably more sunshine – health care quality measures for children served by Medicaid and the Children’s Health Insurance Program (CHIP). Federal law encourages voluntary reporting of those measures, but Wisconsin is lagging well behind most other states in reporting that information. Read more
“Benefit cliffs” in public assistance programs have suddenly become a pressing topic for legislators who contend that safety net programs penalize work and deter people from taking higher paying jobs. A new report analyzes those arguments and shows that the structure of public benefits is not the deterrent to work that some people seem to believe. It explains why eliminating benefit cliffs could hurt substantially more people than it would help.
In the Wisconsin legislature, Republican leaders have put a resolution relating to cliff effects on a fast track. Their open-ended proposal, AJR 109, would direct two state agencies (DHS and DCF) to develop plans for reducing or eliminating benefit cliffs. It was approved by a voice vote in the Assembly within a week of being introduced, without ever getting a public hearing, and it now awaits a vote in the Senate (also without a hearing).
[Update: The state Senate finished up its session on March 15 and did not take up AJR 109, so the proposal is dead for this year. Read more