Affordable Wisconsin health insurance

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Wisconsin Medicaid expansion will be a referendum issue on several county ballots in November

By
July 13, 2014

The 2014 Obamacare open enrollment period ended in April, but enrollment in the Wisconsin exchange has continued throughout the summer thanks to qualifying events that trigger special enrollment periods.  HHS will issue an update enrollment total in November, and open enrollment for 2015 plans will also begin in November. 139,815 people had purchased private plans in the Wisconsin exchange by April 19 – nearly a 96 percent increase over the number who had done so by March 1.  In addition to the private plan Obamacare enrollments, Wisconsin’s exchange has also enrolled 81,731 applicants in the state’s BadgerCare Medicaid program.

Thirteen health insurance carriers are offering policies in the Wisconsin exchange.  But despite the robust competition, rates are relatively high in 2014.  The average premium for the lowest-cost bronze plan in Wisconsin is $287, compared with $249 nationally.  In late October, Citizen Action of Wisconsin created a report highlighting the very different ACA paths taken by Minnesota and Wisconsin, and placed some of the blame for Wisconsin’s high rates on the fact that the state ultimately took a hands-off approach to the exchange and also refused to accept federal funds to expand Medicaid.  Rates in Wisconsin are double the rates of neighboring Minnesota.  Rate filings for 2015 plans had to be submitted to the Wisconsin Commissioner of Insurance by the end of June, and the rate review process will be completed by the end of July.  In most states that have released 2015 rates so far, there have been at least modest rate increases, but some carriers have been requesting rate decreases, so it remains to be seen how Wisconsin’s rate will compare to other states next year.

Wisconsin has not expanded Medicaid under the ACA, but has taken a more proactive approach than most non-expansion states in providing coverage for people living in poverty.  Wisconsin dropped the existing BadgerCare Medicaid eligibility to 100% of poverty level, which resulted in 72,000 people losing BadgerCare eligibility.  Since subsidies for private Obamacare plans purchased in the exchange begin at 100% of poverty level, the residents who lost BadgerCare eligibility were able to purchase heavily subsidized plans in the exchange instead.  However, critics have noted that a lot of those 72,000 people (with incomes just over 100% of poverty) were probably unable to afford a private plan, even with the available cost-sharing and premium subsidies.  Several counties in Wisconsin are adding referendum questions to their ballots this November, asking citizens to weigh in on Gov. Walker’s decision to not fully expand Medicaid under the ACA.

However, an additional 83,000 childless adults with incomes below 100% of poverty level are newly eligible for BadgerCare in 2014.  The total BadgerCare Medicaid enrollment was just shy of 82,000 people by mid-April, but could continue to climb throughout the year as Medicaid enrollment is year-round.  Wisconsin created their own version of Medicaid reform without using the federal funds allocated by the ACA.  As a result, the state was able to make its own rules, and people in Wisconsin with incomes between 100% and 138% of poverty level are expected to purchase subsidized private plans – they are not eligible for Medicaid.  Technically, Wisconsin has not expanded Medicaid under the ACA (if it did, those individuals would be eligible for Medicaid and the state would receive federal funding for Medicaid expansion).  Although Governor Scott Walker has received criticism from consumer advocates, among states that have not expanded Medicaid, Wisconsin is the only one without a coverage gap, since BadgerCare was expanded to cover everyone up to 100% of poverty level (in most states that did not expand Medicaid, eligibility limits are far lower than that).

Gov. Walker had previously expressed a preference for a state-run exchange rather than a “one size fits all” federally operated exchange. In 2011, Walker used an executive order to create the Office of Free Market Health Care to plan for a Wisconsin exchange.  Walker’s plan for a “free-market, consumer driven approach” leaned heavily on an insurance marketplace implemented by former Gov. Jim Doyle. According to one state insurance expert, the only notable change proposed by Walker was to put the exchange online.

However, Walker showed a changed mindset in 2012, returning a $38 million federal grant and closing the Office of Free Market Health Care. In announcing his November 2012 decision to accept a federally operated exchange, Walker said the state would have no real control and much higher financial risk with a state-run exchange.

The fight against Obamacare is on-going in Wisconsin.  US Senator Ron Johnson, a Wisconsin Republican, has brought a lawsuit against the federal government over the issue of congress and congressional staffers receiving subsidies to purchase health insurance through the exchanges.  A federal judge heard the suit in early July, and the federal government believes that the case should be thrown out, as they believe that Johnson has no legal standing since he’s not being harmed by the rule that allows congress and staffers to receive subsidies in the exchange.  The whole issue stems from language that Chuck Grassley (R – Iowa) added to the ACA when it was being drafted.  His addition requires that congress and congressional staffers lose their employer-sponsored health insurance and switch instead to exchange plans.  But those who earn too much to qualify for subsidies would be taking a significant financial hit.  They would have gone from having 75 percent of their premiums subsidized (under their government group plan) to paying 100 percent of their own premiums.  As such, the Office of Personnel Management intervened and said that congress and staffers could keep their existing subsidies and apply them to the exchange plan premiums.  Sen. Johnson is attempting to repeal that ruling.

According to Kaiser’s statehealthfacts.org, about 10 percent of Wisconsin’s population lacks health insurance — about 560,000 people. An Associated Press story included estimates that about 60 percent of them will gain coverage through the exchange and that 63,000 small employers in the state will use the exchange.

Wisconsin health insurance exchange links

HealthCare.gov
800-318-2596

Wisconsin Office of the Commissioner of Insurance
Assists consumers who have purchased insurance on the individual market or who have insurance through an employer who only does business in Wisconsin.
(800) 236-8517 / ocicomplaints@wisconsin.gov

State Exchange Profile: Wisconsin
The Henry J. Kaiser Family Foundation overview of Wisconsin’s progress toward creating a state health insurance exchange.

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Wisconsin Governor Scott Walker
115 East Capitol
Madison, WI 53702
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