BadgerCare Cuts Have Made Wisconsin More Reliant on the Federal Marketplace
The latest Supreme Court case relating to the federal health care reform law is particularly important for Wisconsin. Our state has a lot at stake because of the decision to rely on the Affordable Care Act (ACA) to make subsidized private health insurance available to tens of thousands of people formerly eligible for BadgerCare. In addition, as the Star Tribune reported, Marketplace premiums are higher in Wisconsin than in most other states, which makes subsidies more important here.
Oral arguments in the case, King vs. Burwell, were heard today. The case calls into question whether low and moderate income people using the Federal Exchange (Marketplace) to purchase health insurance are allowed to receive the subsidies that currently help them pay for that insurance coverage.
The plaintiffs argue that there is language in the ACA that seems to say subsidies are available only to people living where Marketplaces are “established by the state.” If their argument is accepted by the Court, eligibility for the subsidies would end in Wisconsin and up to 36 other states (unless they move quickly to establish their own insurance Marketplaces). Read more
The proposed budget bill contains a very substantial increase in state funding for Medicaid programs in Wisconsin, including BadgerCare, but it also makes a number of negative changes to BadgerCare and SeniorCare, as well as to other health care services for the elderly and people with disabilities.
A new Wisconsin Budget Project summary of the major health care portions of the budget bill explains that the largest factor in the increased spending is the much greater-than-anticipated growth in BadgerCare participation among adults without dependent children. The following chart uses Legislative Fiscal Bureau data to illustrate the comparative role of different parts of Medicaid in boosting the cost of maintaining current health care programs by $643 million during the 2015-17 budget.
As that bar graph shows, the state’s share of spending for childless adults is expected to grow by almost $383 million over the next two years, relative to the amount appropriated for the current fiscal year. Read more
Iowa-based Plan Offers Option to Mitigate Deep Budget Cuts
A bill unveiled today offers a compromise on how to expand BadgerCare, while helping to avoid or scale back some of the deep cuts in the budget bill. The proposed legislation could save an estimated $241 million in Wisconsin’s 2015-17 budget, while expanding BadgerCare to an estimated 81,000 adults between 100% and 138% of the federal poverty level.
The compromise legislation, which is now being circulated for cosponsors by Representative Daniel Riemer (D – Milwaukee) and Senator Jon Erpenbach (D – Middleton), is similar to the Medicaid expansion plan being implemented in Iowa because the new BadgerCare coverage for adults over the poverty level would be private insurance plans purchased through the health insurance exchange or “Marketplace,” rather than the current public plan for BadgerCare recipients. This compromise would essentially continue the sort of coverage that adults over the poverty level can now get through the Marketplace, but the subsidies would be delivered through BadgerCare, rather than through the federal premium tax credits. Read more
Now that the Governor’s budget bill has been introduced, we can begin to see the painful consequences of policy choices that state lawmakers made last session, such as enacting large tax cuts on the basis of overly optimistic revenue projections. But the deep cuts in areas such as the UW System budget aren’t inevitable if the state reconsiders the rejection of federal Medicaid funds, stops digging the budget hole deeper by passing more tax cuts, and closes tax loopholes.
It will take quite a while to carefully dissect and analyze the Governor’s budget bill, but here are some initial comments relating to major items in his plan – to the best of my abilities in the very brief time I’ve had to study the Dept. of Administration (DOA) documents. [NOTE: After reviewing the bill more carefully, I’ve added an update in the portion about school funding, because the blow to public schools is much greater than I initially thought.] Read more
New survey figures released by Gallup this week show that the number of uninsured adults dropped again in the last quarter of 2014 and is down sharply since 2013. Even as Paul Ryan and some other members of Congress argue that the Affordable Care Act is “beyond repair,” the Gallup survey data show the law has been quite successful in achieving a key objective. As the Gallup analysis concludes:
“The Affordable Care Act has accomplished one of its goals: increasing the percentage of Americans who have health insurance coverage.”
According to the new Gallup findings, the portion of Americans between 18 and 64 who are uninsured declined from 21.2% in the third quarter of 2013 to 15.5% in the fourth quarter of 2014. By my calculations, that amounts to a reduction of more than 10.8 million non-elderly adults who are uninsured – a drop of about 27%.
Here are some of the other highlights of the new Gallup data:
- The uninsured rate for adults of all ages, which peaked at 18% in the third quarter of 2013 (as shown in the graph above), declined to 13.4% a year later and to just 12.9% in the last quarter of 2014.
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