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 healthcare 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 2014 edition of America’s Health Rankings also considered Wisconsin to be above average, but less so than the Commonwealth Fund, putting the state in 23rd place – down two places from 2013. Factors that boost Wisconsin’s rating include the state’s low rates of diabetes and physical inactivity and a high rate of high school graduation. It’s weighed down by low per capita public health funding, and high rates of infectious diseases and binge drinking.
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.
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 Obamacare help Wisconsin residents?
Prior to ACA implementation, Wisconsin’s uninsured rate was about 11.64 percent – 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. A Gallup Well-Being poll found that Wisconsin’s uninsured rate went from 11.7 percent in 2013 to 5.6 percent in 2015 – a continued improvement over 2014 when the U.S. Census Bureau report showed an uninsured rate of 7.3 percent, which was still well below the post-ACA national average of 11.7 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 cancelled their plans or failed to pay their initial premiums, leaving a total enrollment of 183,155 — nearly 91 percent are receiving advanced premium tax credits.
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.
In 2015, two new carriers – UnitedHealthcare and Managed Health Services Insurance Corporation – joined Wisconsin’s federally-facilitated exchange, bringing the total number to 15. Wisconsin’s other 13 exchange carriers include:
- Common Ground Healthcare Cooperative,
- Anthem Blue Cross and Blue Shield
- Arise Health Plan, Dean Health Plan
- Molina Healthcare of Wisconsin
- MercyCare Health Plans
- Health Tradition Health Plan
- Security Health Plan of Wisconsin
- Physicians Plus Insurance Corporation
- Group Health Cooperative
- Gundersen Health Plan
- Unity Health Insurance
Wisconsin’s exchange tied with Pennsylvania as having the greatest number of number of carriers after Michigan, Ohio and Texas in 2015.
Wisconsin’s Common Ground Healthcare Cooperative was created under the ACA ‘s Consumer Operated and Oriented Plan (CO-OP) Program..While many co-ops are struggling and shuttering under financial strain, CMS is allowing Wisconsin’s co-op to count loans as surplus in order to help it survive.
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 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 July through September 2013 to February 2015, Wisconsin Medicaid enrollment increased by 6.89 percent. Enrollment in Medicaid is year-round.
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 – 16.6 percent of the Badger State’s total population compared with 16 percent across the U.S. About 83 percent of Medicare enrollees in Wisconsin qualify based on age, while 17 percent are eligible due to disability. Wisconsin ranks 21st in the nation when it comes to overall Medicare spending.
Wisconsinites can enroll in Medicare Advantage, private plans that provide benefits beyond what Original Medicare offers. Of all Wisconsin Medicare enrollees, 35 percent selected a Medicare Advantage plan in 2014. The state also offers 31 Medicare Part D, and nearly half (48 percent) of all Wisconsin Medicare recipients enrolled in one of these prescription drug plans.
State-based health reform legislation
Recent Wisconsin state-level legislation related to health reform:
- In September, Wisconsin state Sen. Chris Larson and Rep. Debra Kolste introduced legislation that would require Wisconsin to adopt a stricter rate-review process. This bill would increase the state’s regulatory oversight for health insurance premiums by requiring the Insurance Commissioner to hold public hearings on proposed rate increases exceeding 10 percent and giving that individual the ability to deny rate increases not justified by claims costs, among other things. Wisconsin’s health insurance rates are known for being high, especially in comparison with neighboring Minnesota as well as the national average benchmark plan.
Other state-level health reform legislation: