There are a variety of factors that impact the overall health of each state’s residents. Current and future residents of Wisconsin will be particularly interested in how the state fares in terms of public health and the political leadership’s approach to healthcare reform. The following is a summary of overall health and health care reform in Wisconsin.
Wisconsin health ratings
The Commonwealth Fund’s Scorecard on State Health System Performance 2014 rated Wisconsin 7th out of the 50 states and District of Columbia – up two spots from their 2009 ranking of 9th place. Wisconsin’s Scorecard includes details that explain how the rankings are decided.
The 2013 edition of America’s Health Rankings also considered Wisconsin to be above average, but less so than the Commonwealth Fund, putting the state in 20th place. Factors that boost Wisconsin’s rating include the state’s low uninsured rate, and high rates of high school graduation and childhood immunizations. It’s weighed down by low per capita public health funding, and high rates of infectious diseases and binge drinking.
The 2014 edition of Trust for America’s Health also summarizes a large amount of public health information; available at Key Health Data About Wisconsin. You can also review county-by-county health rankings for Wisconsin, from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.
Wisconsin and the Affordable Care Act
In 2010, both of Wisconsin’s US Senators – Russell Feingold and Herbert Kohl – voted yes on the health reform law. In the House, the five Democratic Representatives voted yes, while the three Republicans voted no. Paul Ryan is among the nay votes, and has been vocal on the national stage in his opposition to the ACA.
Wisconsin’s current Senators have both joined the Senate since 2010: Ron Johnson and Tammy Baldwin. Johnson is an ACA opponent, and brought a lawsuit against the federal government over the issue of subsidies for congress members and their staff (the suit was thrown out by a federal judge in July 2014). But Baldwin is a strong proponent of the ACA.
Republican Governor Scott Walker has long been strongly opposed to the Affordable Care Act, and the state defaulted to a federally-run marketplace using Healthcare.gov. But Walker has touted his approach to Medicaid as an innovative solution, even though it relies more on private health insurance and less on Medicaid than the ACA originally planned.
Although Walker is among the 24 Republican Governors who have rejected a straight Medicaid expansion, Wisconsin does not have the coverage gap that exists in most states that haven’t participated in a by-the-book Medicaid expansion.
How did the ACA help Wisconsin residents?
Prior to ACA implementation, Wisconsin’s uninsured rate was about 11.64 percent – significantly lower than the national average. That rate is projected to fall into the single digits (9.75 percent) as a result of the ACA, thanks to the premium subsidies in the exchange and the availability of BadgerCare Medicaid for people with incomes below the poverty level.
Although the state has not participated in full Medicaid expansion as written in the ACA, all low and moderate income legal residents have access to either Medicaid or exchange subsidies; there is no coverage gap in Wisconsin.
Wisconsin enrollment in QHPs
Early in the first open enrollment period, the Kaiser Family Foundation estimated the size of the potential exchange market in Wisconsin to be 482,000 residents, and that 301,000 of them would be eligible for premium subsidies.
As of April 19, 2014, after the first open enrollment period ended, 139,815 people had finalized their enrollment in the Wisconsin exchange, and HHS reported that 90 percent of them received subsidies to lower their premiums.
As a provision of the ACA, Wisconsin received $56.6 million in federal funds to create a Consumer Operated and Oriented Plan (CO-OP). Nationwide, more than $2 billion was granted for CO-OP creation, divided among the 22 states that participated.
Common Ground Healthcare Cooperative is the newly-created CO-OP in Wisconsin, offering plans for sale in the Wisconsin exchange along with twelve other carriers: Anthem Blue Cross and Blue Shield, Arise Health Plan, Dean Health Plan, Molina Healthcare of Wisconsin, Medica, MercyCare Health Plans, Health Tradition Health Plan, Security Health Plan of Wisconsin, Physicians Plus Insurance Corporation, Group Health Cooperative, Gundersen Health Plan, and Unity Health Insurance. With thirteen participating insurers, Wisconsin’s exchange has more carriers than every state but New York, which has sixteen.
Wisconsin Medicaid/CHIP enrollment
Governor Walker took a unique approach to Medicaid in Wisconsin. The state’s BadgerCare Medicaid program used to cover people with incomes up to 200 percent of poverty, but with the availability of subsidies in the exchange starting at 100 percent of poverty, Walker cut BadgerCare eligibility down to poverty level, with the intention that people with incomes between 100 and 200 percent of poverty would instead receive subsidies to purchase plans in the exchange (they would qualify for both premium subsidies and cost-sharing subsidies at that income level).
About 72,000 people lost eligibility for BadgerCare under the new rules, but 83,000 others gained access to the program. It’s not clear how many of the 72,000 who lost their Medicaid coverage were able to successfully transition to the exchange. Walker’s approach has drawn praise from conservatives, but critics have noted that a straight expansion of Medicaid as written in the ACA would likely have benefitted more people and made access to healthcare more affordable for people living just above poverty level.
Under Walker’s plan, 36 percent of the previously uninsured population in Wisconsin is now eligible for Medicaid or CHIP. As of mid-April, 81,274 people had enrolled in Medicaid or CHIP through the Wisconsin exchange. Enrollment in Medicaid is year-round, so that number has continued to increase over the summer.
Does Wisconsin have a high-risk pool?
Before the ACA brought guaranteed issue coverage to the individual health insurance market, pre-existing conditions could result in application denials, exclusions, and initial rate-ups in nearly every state, including Wisconsin.. The Wisconsin Health Insurance Risk Sharing Plan (HIRSP) was created to cover people who could not get individual health insurance because of pre-existing conditions.
Now that the ACA requires all health insurance plans to be guaranteed issue, there is no longer a need for high risk pools. As a result, HIRSP coverage terminated on April 1, 2014, and members needed to have applied for a new, ACA-compliant plan by March 15 in order to have continuous coverage.
State-based health reform legislation
Here’s a summary of recent Wisconsin bills related to healthcare reform: