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.
Pros and Cons of New 2014 Census Bureau Data on Health Insurance Rates in Wisconsin Outlined in New WCCF Report
The Census Bureau’s American Community Survey (ACS) will release new data reflecting the number of uninsured individuals in Wisconsin and across the nation. Many of the ACA’s major laws, including access to health coverage through both the federal and state-based insurance marketplaces went into effect in 2014 and the data will help provide important insights regarding the impact of the Affordable Care Act (ACA) on the uninsured rate in 2014. However, given our analysis of more recent enrollment data, as well as the fact that the ACS data reflects a monthly average of survey data, the new ACS data won’t fully reflect the gains in health insurance enrollment in Wisconsin since January 2014.
WCCF has prepared a new report, “New Census Data Won’t Fully Reflect Health Insurance Gains,” outlining areas in which the new ACS data will shed light on the growth in access to health insurance since major provisions to the Affordable Care Act were implemented, as well as an explanation as to why the new data won’t entirely reflect the growth in health insurance coverage in Wisconsin. Read more
The health care plan unveiled this week by Governor Walker would undo many years of progress on improving access to quality, affordable health care. My biggest concern initially was that it would reverse most of the gains made over the last 5 years under the Affordable Care Act (ACA). However, the damage caused by the Governor’s plan would go much further than that, because it would also undo much of the progress that has been made over the last decade or two as many states improved and expanded Medicaid coverage (such as Wisconsin’s creation of BadgerCare in 1999).
Under Walker’s proposal, millions of adults across the country are likely to lose their Medicaid coverage – as states restrict eligibility in response to the elimination of enhanced federal funding for Medicaid expansions. However, the damage wouldn’t stop there. By block granting Medicaid funding, states would almost certainly be compelled to dial back eligibility and the scope of services. Read more
Preliminary Figures Suggest Strong Improvement in Wisconsin
The Affordable Care Act (ACA) has dramatically reduced the number of uninsured adults, according to new data released by Gallup this week. A nationwide poll of about 88,000 people during the first 6 months of 2015 found that the percentage of adults who were uninsured dropped to 11.7% this year, compared to 13.4% in the second and third quarters of 2014 and 17.3% in 2013. More specifically, the uninsured rate among adults was 11.9% in the first quarter of 2015 and fell to just 11.4% during the second quarter.
The Gallup polling also includes state-level data, and those figures show especially large improvements in insurance coverage in the states that have expanded Medicaid and have embraced the ACA. The seven states with the largest percentage point gains in coverage (AR, KY, OR, RI, WA, CA, & WV) are all states that have expanded Medicaid and have state-run health insurance marketplaces. Read more