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
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
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.