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Wisconsin health insurance

No Medicaid expansion, but no coverage gap; State has one of only four remaining CO-OPs in the nation

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, Wisconsin was among the states that saw an increase in exchange enrollment for 2017, with 242,863 people signing up during open enrollment — an increase of 1.6 percent over 2016 enrollment.

And for 2018 coverage, 64,974 people signed up in the first 18 days of open enrollment, which was 30 percent higher than the number of enrollees during the first 19 days the year before — although it’s noteworthy that open enrollment is half as long for 2018 coverage, running from November 1, to December 15, 2017 (as opposed to prior years, when open enrollment extended through January).

No Medicaid expansion, but also no coverage gap

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.

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 August 2017, Wisconsin’s average monthly Medicaid enrollment increased by 5 percent (this was unchanged from late 2016).

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 2017 “You can’t cut Medicaid. There’s just no way about it.” The various ACA repeal bills that Republican lawmakers proposed in 2017 would  have cut Medicaid funding significantly, but none of them had enough support to pass. For the time being, the ACA remains intact, as does Medicaid funding.

2018 health insurers

Anthem, Molina, and Health Tradition Health Plans are not offering coverage for 2018 in the Wisconsin exchange, although Anthem will continue to offer one off-exchange plan in one county (Menominee County, with a population of just 4,500 people).

Gunderson, which offered coverage in the Wisconsin exchange in 2017, is not offering plans for 2018, but they merged with UnityPoint/HealthPartners, and HealthPartners plans are available for 2018.

Despite the departure of a few insurers, Wisconsin’s federally facilitated exchange offers a robust number of carrier options for 2018 when compared with most other exchanges. 11 insurers are offering plans for 2018, albeit with localized coverage areas (northeastern Wisconsin has only one insurer offering coverage in several counties, while the southern part of the state has three or more insurers in each county). They have implemented the following average rate increases for 2018 (before premium subsidies, which will grow to offset the rate hikes for subsidy-eligible enrollees):

  • Aspirus Arise: 33.26% (Aspirus Arise HMO); 33.16% (Aspirus Arise POS)
  • Common Ground Healthcare Cooperative: 63.03 percent
  • Children’s Community Health Plan: 23.18 percent 
  • Dean Health Plan: 49.68 percent 
  • Group Health Cooperative of South Central Wisconsin: 13.8 percent or 32.3 percent, depending on the product 
  • HealthPartners Insurance: 20.58 percent
  • Medica Health Plans of Wisconsin: 30.23 percent 
  • MercyCare HMO Inc: 35.1 percent 
  • Network Health: 54.73 percent 
  • Security Health Plan of Wisconsin, Inc: 29.72 percent.
  • Unity Health Insurance: 34.9 percent 

The rate increases for 2018 were based on the assumption that cost-sharing reduction (CSR) funding would not continue in 2018, and indeed, the Trump Administration eliminated that funding in October 2017. The cost of CSR has thus been added to 2018 premiums for silver plans, which in turn results in larger premium subsidies, since those are based on the cost of a silver plan (specifically, the benchmark plan).

The larger subsidies are keeping the cost of the benchmark plan roughly comparable with 2017 prices, but they’re also making bronze and gold plans more affordable than they were in 2017 for people who are eligible for premium subsidies (subsidies are available to an individual in 2018 with income between $12,060 and $48,240, and to a family of four with income between $24,600 and $98,400 — although the upper limit is reduced if the cost of coverage in your area is already considered affordable without a subsidy).

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 operational and is offering coverage for 2018. It is one of only four 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 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.


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.

Helpful Wisconsin health insurance links

Other state-level health reform legislation:

More Wisconsin coverage


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