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
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
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
“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
Proposal to Alleviate “Cliff Effects” Could Significantly Reduce Assistance for Many
Two legislative leaders have proposed a resolution that could result in very significant changes in public benefits, but we don’t know what those changes will be. The resolution that was introduced yesterday – as Senate Joint Resolution 102 and Assembly Joint Resolution 109 – may be scheduled for a floor vote next week without ever getting a public hearing, and after almost no opportunity for public input!
The stated objective of the resolution sounds good – alleviating the “cliff effects” in public benefit programs. In other words, the goal is to redesign public benefit programs so people don’t hit or fall off a “cliff” when their family income reaches the eligibility ceiling. Legislators in both parties and advocates for public assistance programs agree that that’s a very worthwhile objective. But there are good and bad ways to eliminate or reduce cliff effects (none of which are easy), and the vague resolution doesn’t indicate what solution(s) the authors have in mind. Read more
[January 4th UPDATE: The quarterly Medicaid report issued today by the Dept. of Health Services estimates that the changes I discuss below and a couple of smaller items are expected to yield net savings of $72.6 million GPR by the end of the biennium.]
A couple of factors should yield significant savings in state spending for Medicaid and BadgerCare during the current biennial budget. If state tax collections don’t fall short (which is a definite possibility), Medicaid savings could be used to build up the states meager budget reserves, and I hope state policymakers will also invest a little in initiatives to make the health care system more efficient, in order to hold down the future growth of Medicaid spending.
Early next week the Department of Health Services (DHS) should release a quarterly report about Medicaid spending from October through December. I expect that report to shed a little more light on the potential savings, but DHS might focus just on the estimated savings during that specific quarter, and not on the much larger savings over the next 18 months of the biennium. Read more
Two state senators released a Legislative Fiscal Bureau (LFB) memo today that provides an updated estimate of the potential savings to Wisconsin from expanding BadgerCare to more adults. The Fiscal Bureau estimates that expanding BadgerCare for adults up to 133% of the federal poverty level would cover an additional 83,000 adults, but would yield a net savings for the state of more than $1 billion over a six-year period – by taking advantage of increased federal funding available for states that expand Medicaid.
If the expansion were to begin on January 1, 2016, the net savings for state taxpayers during the 2015-17 biennial budget period would be $323.5 million. Because that starting date is no longer a realistic option, the paper also lays out the projected fiscal effect of beginning expanded coverage a year later. Under either of those two options, Wisconsin would save an average of more than $15 million per month once the change took effect. Read more
The list of states that are taking federal funding to expand Medicaid got a little longer last week when Montana received approval from CMS for its Medicaid expansion waiver. That makes Wisconsin one of only 20 states that aren’t yet taking advantage of the federal Medicaid expansion funds that Wisconsinites have been helping contribute to the federal treasury.
The approval of the Montana plan reinforces a couple of key points about Medicaid expansions:
- First, even conservative states like Montana, Arizona and Alaska understand the merits of expanding Medicaid for more parents and childless adults. (Ten of the 30 expansion states have GOP governors.)
- Second, it’s possible for states to get federal waivers for compromise expansion plans.
Number of Uninsured Drops by 100,000 in Wisconsin in 2014
The number of people with health care coverage took an unprecedented jump last year, during the first year of implementation of key parts of the federal health care reform law. The number of uninsured Americans dropped in 2014 by 8.5 million, including 100,000 fewer uninsured Wisconsinites (a 19% drop).
The new numbers, which were released today by the Census Bureau, provide the first comprehensive data on how the federal health care reform law affected insurance rates in 2014, after key portions of the Affordable Care Act (ACA) took effect. The new figures come from the American Community Survey (ACS), and some of the highlights include the following:
- The percentage of Americans who are uninsured dropped from 14.5% in 2013 to 11.7% in 2014.
- Wisconsin went from a 9.1% uninsured rate in 2013 to 7.3% in 2014.