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
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.
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
At least 13 Wisconsin counties may include an advisory referendum on the November ballot asking voters whether Wisconsin should expand BadgerCare and take the federal funding that would cover the full cost of newly eligible childless adults. The proposed ballot measure, which has already been approved in 4 counties and enjoys broad support, has generated debate about whether the Medicaid expansion topic is an appropriate matter for an advisory referendum.
There are many strong arguments in favor of taking the federal funding (see WCCF’s “Top Ten” list); however, some people who argue against including the BadgerCare question on the November ballot contend that it’s not a concern of county government. But even if we assume for the moment that an interest in county residents’ access to affordable health care isn’t reason enough for counties to allow voters to weigh in on the issue, counties also have their own reasons to be very interested in whether the state expands BadgerCare and accepts the federal funds:
- One very important consideration for counties is they bear the financial responsibility (rather than the state) for some community-based Medicaid services.
National data released last week show that there has been a sharp increase in Medicaid enrollment since last September, and that trend continued in April. One surprising aspect of the latest HHS data is that the growth in Wisconsin trails that in most other states, even among the states that haven’t expanded Medicaid eligibility.
Nationally, 6 million more people were enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) in April, compared to the 3-month period before open enrollment under the Affordable Care Act began last October. That includes growth of 1.1 million additional people in April, as compared to March (in the 48 states that reported data for both months).
The following graph illustrates that the increases have been much higher in the 25 states that have accepted federal funds to expand Medicaid eligibility for adults to 133% of the federal poverty level. The average increase of 10.3% for all 50 states compares with a jump of 15.3% in the expansion states in April (relative to the average enrollment in those states from July through Sept. Read more
The U.S. Census Bureau is making a long-overdue improvement in the questions they ask about health insurance in their annual Current Population Survey (CPS). Contrary to some recent news reports and commentary, the change in the survey is not going to be a significant impediment to understanding the effects of the Affordable Care Act (ACA) on the percentage of Americans who are insured.