While Hospitals Elsewhere Back Medicaid Expansion, Wisconsin Hospitals Offer a Fallback Plan
Hospitals in Wisconsin and many parts of the U.S. are asking state policymakers to take measures to reduce the amount of uncompensated care, although the recommended measures aren’t always quite the same. In our state, the Wisconsin Hospital Association (WHA) is asking state lawmakers to renew an expiring appropriation that provides state financial relief to hospitals that care for a disproportionate share of the uninsured or underinsured.
The $30 million state appropriation, which expires in June, captures $44 million in federal funds for “disproportionate share hospitals” (DSH). Wisconsin Health News reported last week that WHA plans to ask state policymakers to renew the appropriation. Extending that funding makes sense if state lawmakers continue to refuse to expand BadgerCare to cover more low-income adults, but the expansion option could save the state close to $300 million in the next budget and do far more to improve access to insurance and help hospitals. Read more
The Affordable Care Act (ACA), while authorizing the Children’s Health Insurance Program (CHIP) through federal fiscal year (FFY) 2019, created a funding cliff for states by only providing appropriations through FFY 2015. A letter made public last week, which was submitted to members of Congress by DHS Secretary Kitty Rhoades (on behalf of the Governor), explains why the extension of CHIP funding is extremely important for children in Wisconsin.
CHIP has garnered bipartisan support since its inception in 1997 and has been instrumental in lowering the uninsured rate of children in the U.S. Now, it’s up to members of Congress to continue working together to ensure that ongoing funding for the program is approved by September 2015.
At tail end of summer, the House Committee on Energy and Commerce (E and C) and the Senate Finance Committee sent a letter to the nation’s governors requesting state-specific input on CHIP. Wisconsin, along with 38 other states, provided responses that overwhelmingly stress the importance the program plays in providing low-income children with access to affordable, quality health care. Read more
Expansion States Show Much Greater Improvement on Uninsured Rates and Uncompensated Care
The evidence in favor of expanding BadgerCare keeps growing as new analyses compare the experience of states that have expanded coverage and accepted the increased federal funding and the states that haven’t done so. Several new studies by national organizations show that Medicaid expansion states have seen much larger drops in the uninsured and in uncompensated care, yet their Medicaid costs are growing at a slower rate than in the non-expansion states.
The following is a brief summary of three recent reports:
Gallup data on changes in the uninsured rates – Gallup survey data from across the nation show that states that have expanded Medicaid eligibility and are operating their own insurance Marketplace have achieved a much larger drop in the percentage of uninsured people than the so-called “non-expansion” states. “The uninsured rate declined 4.0 points in the 21 states that have implemented both of these measures, compared with a 2.2-point drop across the 29 states that have implemented only one or neither of these actions.”
That difference is made more impressive by the fact that the expansion states already had much lower uninsured rates among non-elderly adults. Read more
A Walker campaign ad that criticizes Mary Burke for her stance relating to the Affordable Care Act (aka the ACA or “Obamacare”) is based on a false premise. It incorrectly equates supporting the expansion of BadgerCare with supporting an expansion of “Obamacare.”
Although I don’t think one can say that either candidate supports “expanding Obamacare,” I believe a strong case can be made that the Governor’s plan relies more heavily on a key part of the Affordable Care Act. For reasons I’ll explain below, his changes to BadgerCare do more than Burke’s alternative to expand the reach of the core part of the ACA – the new federal Marketplace for health insurance and the substantial federal funding to subsidize Marketplace insurance plans.
One of the major problems with the ad is that implementing part of a federal law and taking advantage of federal funding is not the same thing as supporting expansion of that law. Read more
Without intending to do so, the Department of Health Services (DHS) budget request has substantially strengthened the arguments for expanding BadgerCare and taking federal funding available for that purpose, which would erase much of the state’s currently projected Medicaid funding shortfall. There are many compelling reasons to accept the federal funding, and the DHS budget request unveiled last week adds to that list.
The following are four aspects of the budget request that bolster the arguments for expanding BadgerCare eligibility for adults up to 138% of the federal poverty level (FPL). Although the first point noted below is reason enough to take the federal funding, a closer reading of the DHS budget request reveals other reasons why the strong arguments for expanding BadgerCare are now even stronger.
1) The $760 million in additional state revenue needed simply for a cost-to-continue budget – The DHS budget request seeks an increase of $760 million in state General Purpose Revenue (GPR) simply to maintain current Medicaid and BadgerCare benefits. Read more
In the Wisconsin debate about whether to accept federal funding for expanding BadgerCare, there has been little attention paid to a significant inconsistency used in the arguments made by many opponents of using those funds.
Expanding BadgerCare coverage to all adults below 138% of the federal poverty level (FPL) would save significantly more money for state taxpayers than previously estimated. According to a memo prepared last week by the Legislative Fiscal Bureau (LFB), expanding BadgerCare but would save state taxpayers an estimated $206 million during the 2013-15 biennium, compared to current law, but would cover 87,000 more adults than the state now expects to insure via BadgerCare at the end of the current fiscal year. That savings is $87 million more than the LFB calculated when the budget bill was being debated.
To put this news a little differently, by rejecting federal funding that would finance the full cost of providing BadgerCare to all newly eligible adults up to 138% of FPL, state lawmakers cost Wisconsin taxpayers $206 million in the current biennium and far more than that in the next biennial budget. One of the things making this news particularly significant is that the Department of Health Services estimated in late June that the state is facing a $93 million GPR deficit in the Medicaid budget. Read more
Advocates Seek DHS Help in Understanding the Decline
There have been a couple of big surprises in the recent data relating to BadgerCare. One is the much greater-than-anticipated increase in the enrollment of adults without dependent children. (Read more here.) The other is that the number of kids covered by BadgerCare has been decreasing, at a time when the budget bill assumed there would be a large increase.
A new WCCF fact sheet shows the BadgerCare enrollment trends since last September (and since the beginning of 2014), which are broken out for different categories of coverage and income levels. Here are two of the key findings relating to coverage of children:
- The number of children over the poverty level who are enrolled in BadgerCare and Transitional Medicaid (TMA) has dropped by more than 22,000 (12.5%) since September of last year.
- That decline has been partially offset by an increase of almost 13,500 children below the poverty level, yielding a net loss of more than 8,600 kids in BadgerCare and Transitional Medicaid.
Governor Walker has given state agencies guidance on how to develop their proposals for Wisconsin’s next budget, giving some glimpses into what the state’s 2015-17 budget might bring.
Wisconsin has a two-year budget. The budget process starts in the summer of even numbered years – like now — when the Governor instructs agencies in how to develop budget requests. Agencies submit their requests to the executive branch by September 15, 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 2015. For more about the Wisconsin state budget cycle, check the Wisconsin Budget Project’s Budget Toolkit.
For the upcoming budget, Governor Walker recently instructed agencies to assume there will be zero growth in General Purpose Revenue (GPR) appropriations in each fiscal year. In other words, he wants agencies to submit budget requests that are not any higher their budgets were two years ago, even though inflation and other factors have pushed costs up. Read more
Today’s Circuit Court Ruling Reinforces the Inconsistencies in State Lawmakers’ Reasoning
Should state lawmakers turn down federal funds whenever there’s a risk that the funding in question could be cut in future years? If so, why is Wisconsin proceeding with major highway and bridge construction plans at a time when Congress is using short-term gimmicks to keep the Highway Trust Fund from becoming insolvent? And why did Wisconsin cut BadgerCare eligibility in half for parents, based on reliance on federal funding to subsidize the federal health insurance Marketplace?
That last question has gotten little attention over the past year, but it will be raised more often following a ruling today by a subset of the DC Circuit Court of Appeals. Two of the three judges participating in that ruling concluded that federal subsidies for the health insurance Marketplace can only go to people in states that set up their own Marketplaces. Read more