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Wisconsin's uninsured population could grow by 350k by 2024 under the AHCA

  • By
  • healthinsurance.org contributor
  • March 20, 2017

Wisconsin is doing fairly well in terms of insurance coverage and access to health care: An analysis by the University of Wisconsin Applied Population Laboratory showed that 94.3 percent of Wisconsin’s population had health insurance in 2015; The state ranked seventh among all states for percent of residents covered in some way.

And although there was an average enrollment decline for 2017 across the 39 states that use HealthCare.gov, Wisconsin was among the states that saw an increase in exchange enrollment for 2017. By the time open enrollment ended at the end of January, 242,863 people had enrolled in coverage through the exchange, an increase of 1.6 percent over 2016 enrollment.

Wisconsin has not accepted federal funding to expand Medicaid under the ACA, but Wisconsin Medicaid is available to adults with income up to the poverty level, so there’s no coverage gap in Wisconsin (unlike every other state that hasn’t implemented the ACA’s Medicaid expansion). U.S. Census data indicates that Wisconsin’s uninsured rate (5.7 percent in 2015) was the lowest of any of the states that had not expanded Medicaid at that point.

But the future of the ACA is uncertain at this point, as Congress considers the American Health Care Act (AHCA), the Republican reconciliation bill introduced in March 2017 to repeal and change various spending-related provisions of the ACA.

the CBO projects that the AHCA would result in 24 million additional uninsured people in the U.S. by 2024. Some would drop coverage voluntarily if and when the AHCA eliminates the individual mandate penalty, while others would find coverage unaffordable. Some would lose access to Medicaid, and others would lose access to employer-sponsored insurance with the elimination of the employer mandate penalty.

The Center for American Progress has calculated the coverage losses by Congressional district, and reports that 350,700 people in Wisconsin would become uninsured by 2024 under the AHCA. Although Wisconsin’s Medicaid program wouldn’t be in as much of a financial bind as states that have accepted federal funding to expand Medicaid under the ACA, the elimination of high-dollar premium subsidies for people with income a little over the poverty level would be a blow to the state.

Although Wisconsin Governor Scott Walker has been vocal in his opposition to the ACA, he wants the federal government to maintain current funding for Medicaid, saying in February “You can’t cut Medicaid. There’s just no way about it.” The AHCA would cut Medicaid funding, by $880 billion, according to the CBO’s analysis.

2017 health plans and carriers

Compared with other states’ Obamacare exchanges, Wisconsin’s federally facilitated exchange offers a robust number of carrier options for 2017. While there were slightly more (16) participating in 2016, there are 14 in 2017. Furthermore, rates increased at an average of 15.9 percent versus an average of 25 percent nationwide.

Wisconsin’s 2017 carriers include the following:

  • Anthem Blue Cross Blue Shield (CompCare Health Services)
  • Aspirus Arise
  • Common Ground Healthcare Cooperative
  • Children’s Community Health Plan
  • Dean Health Plan
  • Group Health Cooperative of South Central Wisconsin
  • Gunderson Health Plan Inc.
  • Health Tradition Health Plan
  • Medica Health Plans of Wisconsin
  • MercyCAre HMO Inc.
  • Molina
  • Network Health
  • Security Health Plan of Wisconsin, Inc.
  • Unity Health Insurance

Ambetter, Physician’s Plus, WPS (Arise) and UnitedHealthcare exited the individual market in Wisconsin at the end of 2016. Children’s Community Health Plan and Aspirus Arise are new to Wisconsin’s exchange for 2017.

Wisconsin health ratings

The Commonwealth Fund’s Scorecard on State Health System Performance 2017 ranked Wisconsin 11th out of the 50 states and District of Columbia, the same spot the state held on the 2015 report. From 2013 to 2015, the Scorecard indicated that Wisconsin improved on 12 metrics, while showing worse performance on just three metrics. The state is in the top quartile for uninsured adults and uninsured children. It’s also in the top quartile in terms of having a low percentage of people who went without necessary health care due to cost, and a low percentage of people who had no dental visits in the past year.

The 2016 edition of America’s Health Rankings put Wisconsin in 20th place, up from 24th in their 2015 edition. The state’s best performance in the analysis was for high school graduation rate and the percentage of residents with health insurance — on both metrics, Wisconsin was ranked 6th. But on the other end of the spectrum, the state was ranked 49th for excessive drinking, and 47th for public health spending.

The 2015 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.

How has Obamacare helped Wisconsin residents?

Prior to ACA implementation, Wisconsin’s uninsured rate was about 11.64 percent – already significantly lower than the national average. That rate was projected to fall into the single digits (9.75 percent) as a result of Obamacare, thanks to the premium subsidies in the exchange and the availability of BadgerCare Medicaid for people with incomes below the poverty level (BadgerCare was already available to people with income up to 200 percent of the poverty level, but eligibility was trimmed down to the poverty level once premium subsidies and cost-sharing subsidies became available in the exchange as of 2014).

According to U.S. Census data, 9.1 percent of Wisconsin residents were uninsured in 2013, and that dropped to 5.7 percent by 2015. During the same time period, the uninsured rate for the whole country fell from 14.5 percent to 9.4 percent.

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 qualified health plans

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 Feb. 15, 2015, after the second open enrollment period ended, 207,349 people had finalized their enrollment in qualified health plans through the Wisconsin exchange, and HHS reported that 90 percent of them received subsidies to lower their premiums. By the end of March, some had canceled their plans or failed to pay their initial premiums, leaving a total enrollment of 183,155 — nearly 91 percent were receiving advanced premium tax credits.

The city of Milwaukee won the White House “Healthy Communities Challenge” to build outreach efforts and enroll as many uninsured residents as possible during the 2016 open enrollment period. Milwaukee had 38,000 newly enrolled residents.

Statewide, exchange enrollment reached 239,034 during 2016 open enrollment. By March 31, effectuated enrollment stood at 224,208. Of those enrollees, 85 percent were receiving subsidies that averaged $322 per month.

During the 2017 open enrollment period (November 1, 2016 through January 31, 2017), 242,863 enrolled in private plans through the Wisconsin exchange.

Wisconsin Common Ground CO-OP

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.

Wisconsin’s Common Ground Healthcare Cooperative was created under the ACA ‘s Consumer Operated and Oriented Plan (CO-OP) Program. While the majority of the co-ops have closed under financial strain, Common Ground CO-OP Wisconsin remains in operation as of March 2017. It is one of only five CO-OPs still operational, out of 23 original CO-OPs.

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. Ryan is pushing the American Health Care Act, introduced under his leadership by House Republicans in March 2017, as an alternative 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.

In the House of Representatives, representation from Wisconsin has switched to a Republican majority. As of 2017, there are five Republicans and three Democrats representing Wisconsin in the U.S. House.

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 Wisconsin is among the 19 states that have not expanded Medicaid, Wisconsin does not have a coverage gap. In the other 18 non-expansion states, there are a total of 2,625,000 people caught in the coverage gap — ineligible for Medicaid, but also ineligible for premium subsidies in the exchange (subsidies in the exchange aren’t available for most applicants with income below the poverty level). But in Wisconsin, Medicaid (BadgerCare) is available to people with income up to the poverty level, which eliminates the coverage gap.

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 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 health care more affordable for people living just above poverty level.

Under Walker’s plan, 36 percent of the previously uninsured population in Wisconsin became eligible for Medicaid or CHIP. In 2015, an estimated 27,628 Wisconsinites were determined or assessed eligible for Medicaid or CHIP through the Wisconsin exchange. From 2013 to December 2016, Wisconsin’s average monthly Medicaid enrollment increased by 5 percent. Enrollment in Medicaid is year-round.

CHIP Wisconsin

Wisconsin’s Children’s Health Insurance Program (CHIP) is provided via BadgerCare Plus.

Children’s Community Health Plan (CCHP) is an HMO owned by Children’s Hospital of Wisconsin, and is the largest BadgerCare health plan in the state. CCHP also began offering qualified health plans (QHPs, as opposed to BadgerCare/Medicaid/CHIP plans) in the Wisconsin exchange during the 2017 open enrollment period.

Does Wisconsin have a high-risk pool?

Before Obamacare 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.

Medicare in the state of Wisconsin

Wisconsin Medicare enrollment tends to be fairly close to the national average of 17 percent. In 2015, the number of Wisconsinites enrolled in Medicare reached 1,050,020 – about 18 percent of the state’s total population. About 85 percent of Medicare enrollees in Wisconsin qualify based on age, while 15 percent are eligible due to disability.

Wisconsin ranks 21st in the nation when it comes to overall Medicare spending. In 2014, the state spent an average of $7,726 per enrollee – national spending averaged $8,970 per enrollee.

Wisconsinites can enroll in Medicare Advantage, private plans that provide benefits beyond what Original Medicare offers. Of all Wisconsin Medicare enrollees, 38 percent selected a Medicare Advantage plan in 2016. Of all Wisconsin Medicare recipients, 41 percent enrolled in Medicare Part D prescription drug plans.

Other state-level health reform legislation:

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