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Wisconsin health insurance

CCHP joins WI exchange for 2017, CO-OP among last standing

  • By
  • healthinsurance.org Contributor
  • September 13, 2016

When it comes to health and access to healthcare, Wisconsin has many successes. It performs well in healthcare rankings and has single-digit uninsured rates that are lower than most states’.

The following is a summary of Wisconsin’s healthcare landscape, including what the state does well and its political atmosphere may have shaped its performance.

Wisconsin health ratings

The Commonwealth Fund’s Scorecard on State Health System Performance 2015 ranked Wisconsin 11th out of the 50 states and District of Columbia. The state fared best in health indicators related to prevention and treatment, ranking 4th overall and in the first quintile for this dimension. Its next-highest category ranking was related to access, in which it placed 13th overall due to lower than average uninsured rates, percentage of adults who went without care due to cost, adults without a routine doctor visit in the past two years, and adults with a dental visit.

The state’s scorecard saw a few improvements from 2014 to 2015 and no drops. See Wisconsin’s scorecard for more details that explain how the rankings are decided.

The 2015 edition of America’s Health Rankings also considered Wisconsin to be above average, but less so than the Commonwealth Fund, putting the state in 24th place. The state performed best in the core measure Lack of Health Insurance, with an uninsured rate of 8.2 percent – the 6th best in these rankings.

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.

A Gallup Well-Being poll found that Wisconsin’s uninsured rate went from 11.7 percent in 2013 to 5.9 percent by late-2015. In the same time period, the national uninsured dropped from 17.3 percent to 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.

2017 health plans and carriers

Wisconsin’s rate proposals and plan details will not be publicly available until October 7, according to the Wisconsin Office of the Commissioner of Insurance.

We do know that Humana and UnitedHealthcare will exit the individual market in Wisconsin at the end of 2016.

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.

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.

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 many co-ops are struggling and shuttering under financial strain, Common Ground CO-OP Wisconsin remains in operation as of September 12, 2016 with no closure announcements.

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.

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 2013 to June 2016, Wisconsin’s average monthly Medicaid enrollment increased by 6 percent. Enrollment in Medicaid is year-round.

CCHIP Wisconsin

Children’s Community Health Plan (CCHP) is an HMO owned by Children’s Hospital of Wisconsin that currently offers coverage through the BadgerCare Medicaid program. CCHP will offer plans in the Wisconsin exchange when 2017 open enrollment begins on November 1, 2016. Details will become available later this fall.

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 2015. Of all Wisconsin Medicare recipients, 41 percent enrolled in Medicare Part D prescription drug plans.

Other state-level health reform legislation: