Wisconsin Council on Children and Families

Our Blog Has Moved!

noreply@blogger.com (Wisconsin Budget Project) — Fri, 19 Dec 2014 17:13:00 +0000

The WCCF blog has moved! We've upgraded our website (www.wccf.org), and our blog is now integrated right into the site. Please visit us soon at www.wccf.org/blog/!

Study Demonstrates Health Gains in Massachusetts from Health Care Reform

noreply@blogger.com (Wisconsin Budget Project) — Wed, 11 Dec 2013 01:56:00 +0000

There were at least a couple of positive news items relating to health care reform today. At the top of that list, I would put a new study released today by The Milbank Quarterly, which found significant improvements in health status in Massachusetts following health care reform implementation. The Massachusetts experience illustrates the potential of the federal health care reform to achieve similar gains in other states, although the rocky rollout of the online application process may slow that progress.

The new study is the first to examine the effects on health outcomes of the Massachusetts health care reform law – sometimes referred to as “RomneyCare” – which served as the model for the federal Affordable Care Act (ACA). The Massachusetts law passed in 2006, and researchers found that insurance coverage improved within just one year, and personal doctor visits were up within two years.

The study published today shows that by 2011 the health of Massachusetts citizens was significantly improved, especially among those below 300% of the poverty level who were able to gain health insurance after the law’s enactment. The findings are based on a comprehensive analysis of health status measures in Massachusetts and other New England states before and after 2006. The primary data came from telephone surveys during 2001 through 2011 that asked 345,211 New Englanders questions about their health status and their use of and access to health care services.

The authors found that compared to other states in the region, Massachusetts had greater improvement in a series of measures of general health, physical health, and mental health, as well as prevention measures such as Pap screening, colonoscopy, and cholesterol testing. In addition, Massachusetts citizens were more likely to have a personal doctor and more likely to report that healthcare costs were not a barrier to treatment.

"Our results demonstrate the potential benefits of health care reform in Massachusetts that may also be achieved through the implementation of the federal Affordable Care Act," says author John Z. Ayanian, formerly of Harvard Medical School and now director of the University of Michigan Institute for Healthcare Policy and Innovation.

Read more in this University of Michigan press release.

Jon Peacock

Finance Committee Approves Delaying BadgerCare Changes, after Rejecting Dem. Amendments

noreply@blogger.com (Wisconsin Budget Project) — Tue, 03 Dec 2013 00:14:00 +0000

The Joint Finance Committee (JFC) voted today for the Special Session bill that delays all the BadgerCare changes until April 1, 2014, and also extends the state’s high risk plan (HIRSP) until that date. The bill was approved by a vote of 11 to 2, with two Democrats voting against the proposal because of the delay in coverage for childless adults. You can read about the debate in the committee on the WisPolitics Budget Blog.

Democrats on the committee offered two amendments, both of which were rejected on party-line votes. The first of those would have increased BadgerCare eligibility for adults to 133% of the poverty level, thereby enabling the state to get full federal funding for coverage of childless adults over the next three years. The Legislative Fiscal Bureau calculated that change would save the state $86.4 million GPR during the current biennium, while covering 85,000 more adults after April 1 than the budget bill and the Governor’s current plan.

The second amendment offered by the Democrats would have changed the bill by initiating the childless adult coverage in January rather than delaying it until April (while delaying the other BadgerCare changes). That would allow the state to fulfill the Governor’s promise not to create a “coverage gap” for people below the poverty level, and would cost the state about $21 million GPR.

The committee did approve one amendment, which makes some uncontroversial changes regarding the disposition of any leftover funding for the HIRSP program, after it is ended on March 31. That amendment was approved unanimously.

I wasn’t able to attend the public hearing before the committee vote, which I regret because I would have liked to raise a couple of issues that I didn’t hear addressed during the executive session. For one, I would have liked to hear a discussion of the implications of delaying by three months state implementation of the new federal definitions for measuring income and family size. That delay means that the state and federal computer systems will be making significantly different determinations of family income (relative to the poverty level) during the first three months of 2014. I think that’s going to be extremely confusing for applicants, providers, caseworkers, assisters, insurance agents and everyone else involved.

Also, I was disappointed that during the executive session there was no discussion of why the Special Session bill is going to make the Dept. of Corrections swallow the $2.8 million cost they will incur because it delays obtaining federal Medicaid cost-sharing for the state’s spending for hospitalized inmates. Considering that the bill saves the state $23 million GPR, it would have been easy to provide the money needed by DOC to offset the lost Medicaid funding. Based on past experience, I worry that DOC will shift their fiscal problem to the counties by cutting the Youth Aids allocations that offset some of the costs of local juvenile justice programs.

The Assembly is scheduled to take up the bill this Wednesday, December 4, but it appears that the Senate won’t act on it until Dec. 19. You can read more about the bill and the committee debate in a good Journal Sentinel article by Patrick Marley.

Jon Peacock

Advocates and Elected Officials Ask Governor to Keep His BadgerCare Promise to Non-Custodial Adults

noreply@blogger.com (Wisconsin Budget Project) — Mon, 02 Dec 2013 01:44:00 +0000

For the past few months, Governor Walker has been talking with pride about the fact that the biennial budget bill ensures that Wisconsin’s health insurance system won’t have a gap in coverage for adults below the poverty level. For the first several months of 2014, that won’t be the case if the legislature approves the Governor’s proposal to delay expanding BadgerCare to childless or noncustodial adults below the poverty level ($11,490 for a single individual).

A number of elected officials and advocates sent letters to the Governor last week asking him not to finance the three-month delay in reducing BadgerCare eligibility by also delaying the long-overdue expansion of coverage for adults who don’t have dependent children. One of those letters was sent last Wednesday by Senator Tim Cullen, who said he could find “no humane rationale” for the proposal to delay coverage.

Senator Cullen’s letter urges the Governor to accept the enhanced federal funding for three months to allow the state to delay the reductions in eligibility until April 1, 2014, without also postponing the childless coverage. Cullen wrote that the legislature “need not follow the ‘Sophie’s Choice’ mentality offered by the Governor.”

Last week several county leaders also expressed their disappointment with how the Governor proposes to fund the delay in BadgerCare eligibility changes. The Outagamie, Winnebago, and Fond du Lac County Executives faulted the funding mechanism because it helps one group of poor people at the expense of an even poorer group.

Five advocacy groups also sent a letter to Governor Walker last week thanking him for delaying BadgerCare changes that would cut an estimated 77,000 people off BadgerCare, but asking him to keep his promise to non-custodial adults below the poverty level. The letter was co-authored by AARP, Community Advocates Public Policy Institute, WCCF, ABC for Health, and Wisconsin Alliance for Women’s Health.

Although advocates support the delay in reducing BadgerCare eligibility, they are concerned about several effects of funding it by delaying all of the BadgerCare changes by three months. One very problematic aspect of the Special Session bill is that it will result in inconsistent income and family definitions in state and federal law, which is likely to create a tremendous amount of confusion over the next few months. How those differences are handled will be a key question for state officials to answer before the legislature passes the Governor’s proposal.

As a WI Budget Project Blog post explains, another unfortunate aspect to the bill is that it opens up a $2.8 million hole in the Department of Corrections budget by delaying Wisconsin’s ability to get federal Medicaid matching funds for payments to hospitals for treating inmates.

The Joint Finance Committee is holding a public hearing and executive session on the BadgerCare bill on Monday, and the full Assembly may vote on it on Wednesday.

Jon Peacock

Thanksgiving Provides Brief Break in the Food Stamp Debate

noreply@blogger.com (Wisconsin Budget Project) — Wed, 27 Nov 2013 21:54:00 +0000

New WCCF Analysis Examines the Recent Cuts and Pending Proposals for Deeper Cuts

As we are enjoying Thanksgiving this weekend, millions of people across our bountiful country will be struggling to feed their families and find reasons to be thankful. Many Americans, including almost 900,000 Wisconsinites, recently took a financial hit when their food stamp benefits dropped on November 1.

What’s even more worrisome for those of us who track nutrition issues is that the House leadership is pushing for another round of substantial cuts in food stamp benefits that could hurt as many as 6 million Americans. The House version of the Farm Bill would cut the Food Stamp program, known as Supplemental Nutrition Assistance Program or SNAP (and in Wisconsin as Food Share), by nearly $40 billion over the next 10 years.

A long and heated debate over renewal of the Farm Bill, which funds the food stamp program, now focuses largely on the question of how much deeper the cuts to SNAP are going to be. (A good article in Politico today explains that there are also some divisive issues relating to spending for farm supports, but I don’t think those disagreements are as substantial as the partisan divide relating to SNAP).

A new WCCF paper provides a short summary of the recent cuts and, more importantly, a synopsis of the concerns that nutrition advocates have about the various sorts of cost-saving measures the House has proposed. Here are a few of those concerns:

The proposal would end food assistance for many non-disabled adults who live in areas of high unemployment after they have received SNAP for three months if they aren’t working or in a job training program at least 20 hours a week – regardless of whether there is work or job training available to them.
Proponents have deliberately mischaracterized some of the bill’s provisions as “work requirements.” In reality, those provisions would terminate basic food assistance to people who would happily take any job or job training opportunity offered but cannot find one. The problem is a lack of jobs, not a lack of willingness to work.
In addition to ending an option for states to exempt able-bodied adults from the work requirement when unemployment is high, the bill would give states a strong financial incentive to terminate SNAP benefits for adults and even for whole families if the parents aren’t working or in training at least 20 hours a week. However, the proposal provides no funding for work programs or additional training slots, and it allows states to pocket the savings from requiring participation in training slots and jobs that don’t exist.

A new round of SNAP cuts would put a severe economic strain on a large segment of hard-working Wisconsinites who have been left behind after the last recession. Congress should reject the House proposals.

Jon Peacock

Governor’s BadgerCare Plan Reduces State Spending by $20 Million

noreply@blogger.com (Wisconsin Budget Project) — Wed, 27 Nov 2013 02:06:00 +0000

Finance Committee Schedules Public Hearing and Vote on Monday

The bill to delay changes to BadgerCare and the state high-risk plan (HIRSP), which will be considered in the state Assembly next week, is estimated by the Legislative Fiscal Bureau to reduce the state-funded share of Medicaid spending by $23.1 million during the 2013-15 biennium. The estimated net spending reduction drops to $20.3 million GPR if one takes into account higher spending at the Department of Corrections for hospitalization costs, which the budget bill assumed would be shared by the federal government after the state covers more low-income childless adults.

(Note: Since the proposed legislation doesn't close the $2.8 million hole in the DOC budget, the correct cost saving figure -- at least for now -- is $23.1 million.)

A copy of the bill was released by the Walker Administration today, and late this afternoon the Legislative Fiscal Bureau released their analysis. You can find both the bill and the LFB analysis here. The Governor's proposal would delay until April 1, 2014, all of the BadgerCare eligibility changes (including the unsubsidized coverage for children in families over 300% of the poverty level, and the unsubsidized BadgerCare Basic coverage for a small number of childless adults).

In addition, the Joint Finance Committee announced today that it will hold a public hearing on the bill on Monday, Dec. 2, at 11 a.m. in room 411 East. The committee will take public testimony, which will be limited to two minutes per person. The committee is expected to vote on the bill after the hearing.

The projected savings stem primarily from the fact that childless adults are considerably more expensive to cover than parents ($368 per person per month, versus $197 for parents), so the savings from delaying the initiation of coverage for childless adults surpasses the cost of the delay in cutting off adults over the poverty level. Also the fiscal analysis assumes that the delay in initiating the childless adult coverage will cause a longer term delay in the ramp-up of enrollment (resulting in $7.8 million in state GPR savings in the second year of the biennium).

The LFB analysis also estimates the cost of amending the bill to begin the expansion for childless adults in January, rather than delaying it until April. They estimate that passing the bill with that amendment would increase state Medicaid spending by $21.6 million (relative to the Act 20 level), but the net cost increase is $18.8 million when one takes into account the savings of almost $1 million per month that will be enjoyed by the Dept. of Corrections once eligibility is expanded.

The $18.8 million net cost increase would turn into a very large savings if the state decided to accept the enhanced federal Medicaid funding that would initially pick up the entire cost of covering childless adults up to 138% of the federal poverty level. The LFB paper doesn’t include an estimate of that savings (but they subsequently said it would save $86.4 million GPR during the current biennium).

The expense of the delay in terminating the HIRSP program is expected be covered in part by a $14 million surplus in that program at the end of the year.

A good Journal Sentinel article by Jason Stein contains some of the arguments for and against the proposal to take the enhanced federal funds and keep the Governor's promise that Wisconsin would avoid creating a coverage gap for many of our neediest state residents.

Jon Peacock

The Impact of the Seven-Year Freeze of Child Care Payment Rates

noreply@blogger.com (Wisconsin Budget Project) — Thu, 21 Nov 2013 14:00:00 +0000

WCCF has released a report on the impact of the 7-year freeze of child care payment rates in Wisconsin Shares: Child Care Rates

The freeze has negative implications for the quality and stability of child care programs, the services children are receiving, and the ability of parents to afford child care.

The report includes an analysis of the fiscal impact on child care programs for all counties:
Impact of Freeze Table

Key findings:
•    On average, maximum rates in 2013 cover only 23% of statewide child care slots, rather than 75%, which was the standard for rate-setting prior to the freeze in 2006.

•    Had rates not been frozen, child care providers would now be receiving significantly higher payments per week, adding up to as much as $3,400 higher per child per year in some counties.

•    DCF has begun to increase payment rates this year, with more scheduled for next year, but the increases will not come close to restoring rates that reflect the current child care market.

Here is a link to a front-page story by Doug Erickson in the Wisconsin State Journal on Nov. 18: Child care centers took a big hit with state rate freeze, study says.

ACA Opportunities to Reverse Wisconsin’s Reduced Ranking in Children’s Health Insurance

noreply@blogger.com (Wisconsin Budget Project) — Thu, 21 Nov 2013 02:58:00 +0000

Achieving the Success in Massachusetts Would Result in 43,000 Fewer Uninsured Wisconsin Kids

For many years Wisconsin ranked very near the top in the percentage of children who have health insurance, but our state’s high ranking has gradually been slipping. That ranking fell another 3 places in 2012, and we now rank 17th among states on children’s health coverage.

As I noted in a Wisconsin Budget Project blog post yesterday, employer-sponsored health insurance has dropped very substantially in Wisconsin over the last 12 years. Fortunately, BadgerCare has done a very good job of picking up the slack. As a result, the number of uninsured children in Wisconsin has remained relatively steady over the last few years. However, a new report released today by the Georgetown University Center for Children and Families (CCF), explains that while other states have made significant progress on this critical indicator of child well-being, Wisconsin has not kept pace.

These facts highlight the importance, now more than ever, of eliminating unnecessary barriers to health care coverage. Fortunately, the federal health care reform law can help Wisconsin extend affordable health insurance to many of the 61,000 children who were uninsured last year.

“Wisconsin has traditionally been a national leader on children’s coverage, driven in no small part by our smart investments in BadgerCare,” said Ken Taylor, executive director at the Wisconsin Council on Children and Families. “Taking advantage of opportunities to strengthen our homegrown coverage program by improving outreach to uninsured families and streamlining the renewal process will improve the health and economic security of more children and their parents around the state.”

Some of the ways that the Affordable Care Act (ACA) can help Wisconsin slash the number of uninsured children include:

Improving outreach and enrollment in BadgerCare for the large portion of uninsured children who appear to already be eligible for that coverage.
Insuring children in families with income above the BadgerCare ceiling (300% of FPL) through the new Health Insurance Marketplace.

The CCF report points out that another way to improve the insurance rate for children is to include all parents up to at least 138% of the poverty level in Medicaid, by using the enhanced federal funding provided by the ACA. Research shows that when states expand Medicaid for parents, the number of uninsured children falls, because parents are more likely to sign up their eligible children for coverage when the whole family can get coverage.

The 61,000 uninsured Wisconsin children in 2012 amounted to 4.7% of the kids in our state, compared to just 1.4% in Massachusetts, which has pioneered health care reform. If Wisconsin is able to use the Affordable Care Act to reach the much lower rate achieved in Massachusetts, there would be about 43,000 fewer uninsured children in our state than there are now.

Jon Peacock

Why We Need the Affordable Care Act -- in One Graph

noreply@blogger.com (Wisconsin Budget Project) — Wed, 20 Nov 2013 02:33:00 +0000

Employer-sponsored Insurance Drops by 472,000 in Wisconsin since 2000-01.

Okay, there are scads of reasons why we need the reforms in the Affordable Care Act (ACA), including many reforms that are already in place and having very positive impacts. So one graph doesn't actually do the – which is a conclusion that was reinforced when I read Ezra Klein's Wonkbook blog post yesterday: "Change is painful. But the health-care status quo is a complete disaster."

Klein's blog post summarizes the findings of the Commonwealth Fund's latest survey of international health systems, a document that serves as a grim reminder that although the US spends a much larger share of national resources for health care (17.7% here, compared to no more than 12% in other countries), our health care system performs worse on a wide range of objective and subjective measures. With respect to the cost differential, Klein points out that, "If Americans only spent 12 percent of GDP on health care we would have saved $893 billion in 2012."

His blog post has several excellent charts illustrating that Americans have much more difficulty accessing care, we pay more out of pocket, and we are much less satisfied with our health care system than people in the other nations examined.

However, when it comes to illustrating in one graph why the status quo nationally and in Wisconsin is unacceptable, I like the following graphic. Using Census Bureau data since the end of the 1990s, it illustrates the sharp drop in employer-sponsored coverage.

As that graph shows, from 1999-2000 to 2011-12 the portion of non-elderly Americans with employer-sponsored insurance dropped by 10 percentage points. Although Wisconsin has a relatively high percentage of people with employer-sponsored coverage, that rate has been falling faster in our state – dropping almost 13 percentage points during that period.

A report released earlier this month by the Economic Policy Institute analyzes the trends in employer coverage in all 50 states from 2000/01 to 2011/12. (Two year averages are used to smooth out fluctuations in the Census Burea's Current Population Survey data.) It finds that there are now 12.9 million fewer non-elderly Americans with employer-sponsored insurance than there were 11 years earlier, including about 472,000 fewer in Wisconsin! Our state currently has the 10th highest percentage of non-elderly residents who have employer coverage, but it experienced the 5th largest percentage point drop over the past 11 years (tied with Indiana).

The very sharp decline in employer coverage in Wisconsin is driven by a number of factors, and it shows little evidence of abating – although the provision in the ACA insuring young adults through their parents’ health insurance policies has temporarily masked the continued drop in employer coverage of workers and their dependents. The trend line of rapidly falling employer coverage over the last decade or so vividly illustrates why it would be a mistake to repeal the ACA and accept the status quo.

Jon Peacock

Governor Proposes Special Session to Delay Changes to BadgerCare and HIRSP

noreply@blogger.com (Wisconsin Budget Project) — Fri, 15 Nov 2013 01:26:00 +0000

Expansion of Coverage for Childless Adults Would Also Be Delayed, along with Delay in Cutting Eligibility

At a press conference this afternoon, Governor Walker proposed to delay by three months (until April 1, 2014) the changes enacted in the budget bill to BadgerCare and the state’s Health Insurance Risk Sharing Pool (HIRSP). WCCF is very pleased that this gives about 100,000 people an additional 90 days to make the transition to Marketplace coverage.

On the other hand, we are very disappointed that the Governor’s proposals will also delay the state’s plans to expand BadgerCare to cover childless adults below the poverty level. The Governor’s desire to keep that expansion of coverage from boosting spending could be accomplished by at least temporarily increasing eligibility of childless adults to 133% of the poverty level, and accepting the enhanced federal funding that would pay all the cost for that improvement. That would actually save $119 million in the current biennium, while giving our state a far better chance of reaching the Governor’s goal of cutting in half the number of uninsured Wisconsinites.

A number of the details of the Governor’s plans are still unclear. For example, I’m not sure whether the changes that Walker is recommending will also delay by 3 months the elimination of the state’s current unsubsidized category of BadgerCare coverage for children in families over 300% of the poverty level. In September DHS sent letters to the families of about 3,600 children telling them that those kids were likely to lose their BadgerCare coverage in January.

The changes proposed today will be accomplished by calling a special session of the Legislature, which will probably be held in early December. As I explained in a blog post about a week ago, the Joint Finance Committee (JFC) added an amendment to the budget bill that was supposed to trigger a 90-day delay in the BadgerCare changes if the Marketplace wasn’t running smoothly. However, the JFC amendment failed to accomplish the stated intent, which apparently necessitates action by the full legislature to accomplish the delay.

Not surprisingly, the Governor has cited the problems with the Marketplace rollout as the reason for needing to delay the BadgerCare and HIRSP changes enacted in the budget bill. Although I have no doubt that the well-publicized shortcomings of the online portal for applications is the primary reason why opponents of the ACA would be willing to delay the sharp cut in eligibility of parents for BadgerCare, I think there are a number of other compelling reasons for a slower timetable, some of which we have been pointing out since last spring.

I’ll elaborate on those reasons at another time, and for now will just point out that it isn’t just the federal computer software that hasn’t been performing properly. The delayed timetable of the state’s software changes has meant that DHS hasn’t been accepting applications for BadgerCare coverage for childless adults. That is expected to be partially remedied next week; if all goes according to plan, the state will then be able to start making eligibility determinations for new applications that use the 2014 eligibility rules. However, the big computer run the state had been planning to make late this month to determine BadgerCare eligibility in 2014 of current participants wasn’t going to be based on the new income and family size rules contained in the federal law.

As a result of the state’s own software issues, stemming from the long refusal to begin implementing the law, many people who will be under the poverty level in 2014 (when the new standards are correctly applied) would have soon begun getting notifications from DHS they were over the poverty level and ineligible for BadgerCare. (Read more on that here.) The proposed 90-day delay gives DHS a chance to remedy that problem.

In light of the changes the Governor proposed today, state and federal officials have a lot of work ahead of them. Among other things, the state needs to scramble to get a federal extension of the BadgerCare Core plan waiver for the current coverage of childless adults, and DHS needs to delay the effective date of the Medicaid plan amendment that contracts BadgerCare eligibility. However, I don’t think they will encounter any resistance to those two changes from federal officials.

We will follow up as more information becomes available.

Jon Peacock

Preliminary Thoughts on the New ACA Enrollment Figures

noreply@blogger.com (Wisconsin Budget Project) — Thu, 14 Nov 2013 01:49:00 +0000

Figures released Tuesday by the federal Department of Health and Human Services confirm what everyone has been assuming for the last few weeks – that the number of people who have completed the process of signing up for insurance is far less than supporters of the Affordable Care Act had initially hoped for. Yet the figures are considerably better than I feared, considering the very rocky rollout of the online application portal.

Here are some of the highlights from the national data in the report covering the period Oct. 1 to Nov. 2:

More than 864,000 applications were completed, for coverage of almost 1,510,000 individuals.
Among the more than 1.5 million individuals with completed applications, more than 1,081,000 (72%) were found eligible for coverage through a Marketplace plan, including 326,000 who are eligible for subsidized Marketplace coverage.
About 396,000 people were found to be eligible for Medicaid or CHIP.
Among the nearly 1.1 million people determined to be eligible for Marketplace coverage, thus far only about 106,000 (10%) have selected a Marketplace plan.

Not surprisingly, there are significant differences between the data from the states running the Marketplaces themselves and the states relying on the federal Marketplace. However, in a couple of respects I think the differences aren’t as dramatic as I had anticipated. Here are a few key points:

The 14 states (plus the District of Columbia) that are implementing their own Marketplaces account for 34% of the people for whom applications have been completed, which is less than I would have guessed after the slow federal start, and they account for just 27% of the people found eligible for Marketplace subsidies.
On the other hand, those states account for 54% of people found eligible for Medicaid or CHIP, and 75% of the people who by Nov. 2 had selected a Marketplace plan.
Among those who were found eligible for Marketplace coverage, in the state-run Marketplaces 21% had selected a plan by Nov. 2, compared to just 3.8% in the federal Marketplaces.

The new dataset from HHS includes state-by-state numbers, and after analyzing the Wisconsin numbers, I think there a few things that are noteworthy:

About 64% of the roughly 34,700 Wisconsinites for whom applications have been completed are eligible for the Marketplace.
About 10,700 or 34% were found to be eligible for BadgerCare.
Among the 22,000 eligible for the Marketplace, 40% qualify for federal subsidies, but thus far only 877 or 4% have selected a Marketplace plan.

It’s tempting to speculate about some of the differences between states, but at this early stage in enrollment I don’t think that’s a very productive endeavor. However, I do think it’s important that the percentage of Marketplace-eligible applicants who have selected a plan is more than 5 times higher in the state-run Marketplaces than in Wisconsin and other states with federally-run Marketplaces.

That difference in getting applicants to the finish line might simply reflect that some of the state-run Marketplaces were able to get the online process operating more quickly and have had a head start in enabling applicants to use the online application process. Another possible factor may be that the states running their own Marketplaces have more Navigators who can help people complete the enrollment process. In any case, I think the figures illustrate the important point that there are time lags at various stages of the process -- which is one of the reasons why I don't think it's realistic to expect to move many of the more than 77,000 current BadgerCare participants through the enrollment process by December 15.

The HHS report provides some interesting comparisons of the slow early enrollment in the Marketplace with the lethargic early start-up months for CHIP, Medicare Part D, and the Massachusetts reforms. Read more here.

Jon Peacock

Baldwin Calls on Governor to Delay Kicking 77,000 People out of BadgerCare

noreply@blogger.com (Wisconsin Budget Project) — Tue, 12 Nov 2013 21:06:00 +0000

Senator Tammy Baldwin sent a letter to Governor Walker today urging him to provide a few more months for BadgerCare recipients to shift to insurance purchased through the new Health Insurance Marketplace. Wisconsin officials expect to send letters at the end of November to about 77,000 people now on BadgerCare to notify that they will lose their coverage at the end of December because of new eligibility limits set by state lawmakers.

Getting those 77,000 people covered in the new Marketplace is essential if the state is to fulfill the Governor’s commitment to nearly cut in half the number of uninsured Wisconsinites. Yet as Baldwin’s letter points out, those individuals will have only about two weeks from when they get their notification letter to when they have to apply for coverage, verify that any employer insurance they are offered doesn't meet the affordability test, and pay the first premium. Baldwin’s letter adds:

Given the state’s current timeline for direct outreach to these individuals, the major issues with the federal government’s ACA website, and the fast-approaching deadline, thousands of people are at risk of losing their coverage. Therefore, I am writing to raise this concern and to offer potential options in the hope that we can work together to ensure our constituents maintain the health coverage they need.

State officials such as DHS Secretary Kitty Rhoades have promised on numerous occasions that the BadgerCare changes contained in the budget bill are “tied to the exchanges being operational.” (See, for example, Rhoades’ recent column in the Journal Sentinel.) But thus far the Walker Administration shows no signs of being willing to move back the January 1 date, despite the fact that neither the state computer system changes nor the online federal enrollment system are far enough along to enable a smooth transition from BadgerCare to the Marketplace. (Read more in this recent WCCF blog post.)

Senator Baldwin’s letter offers a couple of potential solutions, including suggesting to the Governor that the state “alter your current request to the Centers for Medicare and Medicaid Services so that BadgerCare enrollees maintain their current coverage through the end of March.”

I think delaying the January 1 cutoff makes sense for a number of reasons. I’ll elaborate on those in a future blog post, but for now I'll just touch on a few of the main points. Obviously, this is a matter of fairness and compassion for the affected families, who aren’t likely to have sufficient time to pick the right plan and pay their first premium – especially for the very low-income adults who don’t even have checking accounts or credit cards that enable them to pay the premium. In addition, as David Riemer of the Community Advocates Public Policy Institute pointed out, a delay would “help achieve the Governor’s commitment to cutting Wisconsin’s uninsured rate in half.”

Delaying the BadgerCare changes is also likely to help many people who aren’t now in BadgerCare, particularly the roughly 25,000 people who are now in the state’s high risk pool (HIRSP), who also have to get Marketplace coverage by December 15. That’s a group with significant chronic conditions, and their health could be in great jeopardy if they are uninsured in January. By helping avoid a huge logjam of applications in early December, Senator Baldwin’s recommendations could improve the enrollment process for all who apply for insurance through the new Marketplace.

The Milwaukee Business Journal reported today that the Wisconsin Hospital Association has also recommended a delay in transitioning people off BadgerCare.

You can find Senator Baldwin’s press release here. I hope her letter is one step in a bipartisan effort to keep Wisconsin moving forward toward the shared goal of cutting in half the uninsured rate, rather than moving sharply away from that goal in January.

Jon Peacock

Article Takes Closer Look at MN vs. WI Differences in ACA Implementation

noreply@blogger.com (Wisconsin Budget Project) — Tue, 12 Nov 2013 02:19:00 +0000

Gannett Analysis Examines Possible Reasons for Wisconsin’s Higher Rates

USA Today and a number of local Gannett papers published an interesting story Sunday about differences in ACA implementation between Wisconsin and Minnesota. The lengthy article by Donovan Slack of Gannett says that the Gopher State, in contrast to Wisconsin, is “now enrolling individuals through its health-insurance exchange by the thousands and at premium rates that are among the lowest in the country.”

An analysis of the Marketplace rates by Gannett found that the average premium cost of a silver plan for a 50-year-old in Wisconsin is $403 per month (excluding federal subsidies), or almost one-third more than the average for such a plan in Minnesota. The disparity appears to be even larger for younger consumers. In Wisconsin the statewide average for someone in their mid-20s is $235 per month (not including subsidies), which is 57% above the $150 average in MN.

The article adds, “Wisconsin's rates are not just higher than Minnesota's, they're 21 percent higher than the average across 34 states for which the federal government released detailed premium data.”

The rate disparities calculated by the Gannett analysis seem to be somewhat lower than those found in a Citizen Action of Wisconsin report released a few weeks ago, but the article raises similar ideas for what may be accounting for the higher rates in our state – including less rigorous review of rates and the decision in our state to cover lower-income adults (between 100% and 133% of FPL) in the Marketplace, rather than in Medicaid.

One of the people interviewed for the article is Dan Schwartzer, Wisconsin’s Deputy Insurance Commissioner. He said premiums have historically been higher in Wisconsin, and cited a study that indicated private employers in our state paid premiums that were 7% higher on average than in Minnesota. However, other cost surveys referenced by the article suggest comparable or slightly lower health care costs in Wisconsin. Schwartzer disputed the argument that the Medicaid decision was a factor, but he suggested another potential cause for lower Marketplace rates in Minnesota – the Gopher state’s decision to continue their high-risk pool.

I wholeheartedly agree that the continuation of Minnesota’s high-risk pool for an additional year is probably a significant factor in their lower Marketplace rates. Keeping that population out of the new Marketplace plans for the next year is a very effective way to help keep rates down because it not only keeps an expensive population out of the new plans, it also removes a substantial source of risk for insurers. Since insurers deciding whether to participate in the new Marketplace already have lots of uncertainties and risks during the start-up year, removing one of the largest risks strikes me as a very smart decision by MN policymakers who are truly committed to making the Marketplace get off to a good start.

I don’t agree with the contention of the Insurance Commissioner’s Office that capping BadgerCare eligibility for adults at 100% of FPL is not a factor in Wisconsin’s higher Marketplace rates. According to the article, the Deputy Commissioner argued that there isn’t any evidence that low-income people being moved from BadgerCare to the Marketplace are less healthy (and more costly to insure). I disagree with that argument, but even if we assume it's true that the low-income adults (between 100% and 133% of FPL) who have been participating in BadgerCare are as healthy as higher income adults, there are still a couple of flaws with the contention that Wisconsin’s lower cap on Medicaid eligibility doesn’t increase costs in the Marketplace.

One problem with that line of argument is that many of the adults in that income range are currently uninsured and likely to be less healthy because they haven’t had regular access to preventive care. Second and more importantly, the adults in that income range won’t be subject to the mandate to buy insurance. As a result, there is a strong probability of “adverse selection” – i.e., the sicker people in that group will buy coverage, but the healthier people are much less likely to do so. Although this probably isn't as big a factor as the decision in Minnesota to continue the high risk pool, I think it’s an important variable. (Read more in this recent Budget Project Blog post.)

With respect to argument that more lenient rate regulation is a factor in Wisconsin’s higher rates, Schwartzer pointed to a part of the federal law that requires insurers to spend 80% of revenue on medical claims, which limits costs for administration, salaries and profits to 20%. I think that’s an interesting argument, but it suggests that under the ACA there is no longer a need for states to play a role in ensuring that rates are reasonable. Perhaps that’s the current perspective among Wisconsin’s insurance regulators, but Minnesota policymakers seem to have a very different perspective.

I’ve shortchanged some of the arguments on both sides, but you can find the full article here.

Jon Peacock

Cases related to Juvenile Life Without Parole (JLWOP) continue to shape an uncertain future

noreply@blogger.com (Wisconsin Budget Project) — Fri, 08 Nov 2013 15:01:00 +0000

With the relatively recent US Supreme Court (USSC) decision that prohibits mandatory life without parole sentences for individuals who committed crimes while under the age of 18, a couple key issues are making their way through state courts, including: (1) are excessively long sentences given in lieu of JLWOP essentially a life sentence anyway?; and (2) can the ruling be applied retroactively, that is to individuals receiving a mandatory LWOP sentence prior to the Supreme Court ruling.

Some states are reconstructing their statutes and some cases are moving forward related to the first question, but the most recent ruling related to the second is from Pennsylvania in which the Pennsylvania Supreme Court ruled that it could not be applied retroactively, specifically that the USSC ruling could not be used to require resentencing an individual who received a mandatory LWOP sentence for an offense committed at age 17, since that sentencing occurred prior to the ruling.

As we have seen with the prior US Supreme Court rulings and the activity and appeals around this issue, this surely is only a step along the way of defining what the USSC means for hundreds of youth serving JLWOP sentences, not only in Pennsylvania but other states as well. by Jim Moeser

Advocates Seek More Info on Timetable for Cutting Adults off BadgerCare

noreply@blogger.com (Wisconsin Budget Project) — Fri, 08 Nov 2013 01:19:00 +0000

Six health care advocacy groups sent a letter to the Walker Administration today seeking information on the state’s plans relating to BadgerCare if the online portal for the new health insurance Marketplace continues to have significant problems. WCCF was one of the six groups – along with Community Advocates Public Policy Institute, ABC for Health, Mental Health America of Wisconsin, Wisconsin Alliance for Women’s Health and the Wisconsin Primary Health Care Association – expressing concern that the state ought to have a backup plan so tens of thousands of current BadgerCare participants don't find themselves uninsured in January.

As I noted in a blog post yesterday, DHS Secretary Kitty Rhoades said just a week ago that “moving forward with the Wisconsin model was tied to the exchanges being operational.” She accurately described the intent of a Joint Finance Committee amendment to the budget bill, but that amendment contains a provision that appears to negate the intended effect. (See our blog post about the failed failsafe.) With that in mind, WCCF joined with the five other groups to find out what the state’s contingency plans are.

A WI State Journal article by David Wahlberg today does an excellent job of summarizing the letter and the preliminary DHS reaction. Rather than reiterating those points, I’d like to expand upon both the article and the letter by outlining several of the other reasons why the state ought to delay ending the insurance coverage of at least 77,000 BadgerCare participants on January 1:

The DHS determinations of eligibility later this month will be flawed because they are based on incomplete information – The computer problems aren’t just in the federal online portal. Because state officials dragged their feet in preparing for ACA implementation, the large computer run a couple of weeks from now to determine BadgerCare eligibility won’t be consistent with the revised definitions of income and family size. For example, some people who have child support income will incorrectly appear to have too much income for the adults to be eligible. (Read more here.)

Even if the computer system problems are eliminated within the next week or two, there are other impediments – Getting people enrolled in coverage through the Marketplace often isn’t as simple as enabling them to go online and complete an application. Many will need to spend time with a navigator or assister to help them understand their options, and additional time may be needed in the application process to verify income or to confirm that the applicant doesn’t have an offer of affordable employer-sponsored coverage. Our state hasn’t trained nearly enough navigators and assisters to cope with so many people having to complete the full application and enrollment process within such a short period of time.

BadgerCare participants are just one of the groups who will be adversely affected – In addition to the direct effects of sticking to the January 1 timetable for the eligibility changes, there are very substantial indirect effects. As I’ve noted on many previous occasions, the state’s timeline maximizes the logjam this month and next, as too many people try at the same time to get assistance in figuring out their options and getting enrolled. That will make it much harder to provide sufficient assistance for the 25,000 people losing their current coverage in the state’s high risk plan (HIRSP), and for tens of thousands of people who are already uninsured. Because the HIRSP participants often have significant chronic conditions, it is particularly reprehensible that the state’s choices will make it difficult for that vulnerable population to get adequate enrollment assistance.

On many occasions this year, Governor Walker and other state officials have said their plans will nearly cut in half the number of uninsured state residents. To achieve that commendable goal, a good place to start is to stick to the budget bill’s promise that the BadgerCare changes will be “tied to the exchanges being operational.” The state and federal computer problems and the limited number of people assisting with enrollment make it clear that the new Marketplace won’t truly be operational in the sense of being able to handle such a huge deluge of cases before the Dec. 15 deadline for paying premiums.

Jon Peacock

The Budget Bill’s Failed Failsafe for Avoiding an Increase in the Uninsured

noreply@blogger.com (Wisconsin Budget Project) — Thu, 07 Nov 2013 02:53:00 +0000

Despite Assurances, Bill Fails to Delay End of BadgerCare Coverage before an Effective Insurance Exchange is in Place

Should Wisconsin drop about 90,000 people from BadgerCare on January 1, even if most of them will not have been able to sign up for insurance through the new Marketplace by then? During the budget process, there seemed to be broad agreement that the proposed cut in BadgerCare eligibility shouldn’t and wouldn’t take effect until the large group of people losing their BadgerCare coverage could get insurance through a health insurance Marketplace that is running smoothly. Unfortunately, the budget bill doesn’t deliver on the promise to keep them from becoming uninsured.

Throughout the budget deliberations, state officials provided assurances that the reduction in eligibility of adults in BadgerCare to the poverty level was contingent upon having an effective alternative in place, in the form of an operational Marketplace. However, because the budget bill didn’t explicitly address that concern, the Joint Finance Committee added an amendment to the bill to allay fears about cutting people off BadgerCare before they could sign up through the federal Marketplace.

In a column in the Journal Sentinel just a week ago, DHS Secretary Kitty Rhoades reiterated the intent to hinge the cut in BadgerCare eligibility to having an operational Marketplace working by now:

“Obviously, concerns were raised over whether or not the federal government would be ready to operate the exchange by Oct. 1 — which is why moving forward with the Wisconsin model was tied to the exchanges being operational.”

Unfortunately, the failsafe amendment that the Finance Committee added to the budget fails to deliver the promised protection. What that amendment appears to say is that the state won’t cut in half the income ceiling for adults in BadgerCare until April 1, 2014, if the federal HHS Secretary hasn’t certified by October 15 that there’s a functional Marketplace for Wisconsin. But as it turns out, the fact that there has been no such certification hasn’t triggered any protection for the 90,000 people who are at considerable risk of being uninsured in January.

The problem with the JFC amendment to the budget is that there’s a caveat that wasn’t generally recognized during the budget process. The requirement that the cut in eligibility be delayed by 90 days if the new Marketplace hasn’t been certified by October 15 adds a statement saying that protection kicks in only if such certification is required under federal law. Oops! As it turns out, there is no such requirement, which appears to negate the intent of the JFC amendment.

I don’t want to say unequivocally that the Governor doesn’t have the authority to delay the effective date of the BadgerCare change. Perhaps somewhere else in his broad executive branch powers is a clause that would allow him to apply common sense in this instance. Alternatively, perhaps federal officials at HHS have a way of delaying approval of the state changes. Either of those scenarios would help explain why Secretary Rhoades said only a week ago that the BadgerCare change “was tied to the exchanges being operational.”

Thus far, the Governor has shown little inclination to delay eliminating about 90,000 people from BadgerCare. Late last week, Mayor Barrett sent a letter to the Governor urging him to delay the eligibility reduction for a few months. In an interview with Wisconsin Public Radio (WPR), the Governor quickly rejected that suggestion – at least for now – but he didn’t completely dismiss it. According to that story, the Governor left the door open a little: “Walker says if the federal government falters, the state would re-assess the BadgerCare changes at the end of this month.”

The Governor and other state officials have asserted on numerous occasions this year that his compromise plan will nearly cut in half our state’s uninsured rate, and we commend him for that. However, if the state cuts off BadgerCare in January before the people losing coverage have an adequate opportunity to sign up for coverage through the Marketplace, the state will start 2014 moving backwards.

Even if the online enrollment system for the Marketplace is working well in a couple of weeks, that doesn’t leave enough time to get so many people the assistance they need to sign up for coverage and pay the monthly premium due by December 15 (to avoid becoming uninsured in January). Sticking to that timetable would create a logjam that will also impede efforts to get coverage for the 25,000 people losing their state high-risk coverage (HIRSP) by the end of the year, as well as for a large portion of the roughly 500,000 people who are already uninsured.

That logjam could easily be avoided by delaying the January 1 reduction in BadgerCare eligibility. Whether that can still be done administratively or has to be done legislatively is unclear to me.

Jon Peacock

Finance Committee Agenda on Wed. Includes W-2 Funding and Student Info System

noreply@blogger.com (Wisconsin Budget Project) — Tue, 05 Nov 2013 02:03:00 +0000

LFB Paper Confirms Large Gap in Budget for the State's Welfare to Work Program

The Joint Finance Committee (JFC) is scheduled to meet this Wednesday, November 6, on a number of budget issues, including a couple that we will be watching. Among those is a proposal from the Dept. of Children and Families (DCF) and Dept. of Health Services (DHS) that would close part of the large funding gap in the Wisconsin Works (W-2) program. Another one of the items on the JFC agenda Wednesday would release $7.1 million that is currently held in reserve for implementation of a student information system.

[UPDATE; The Nov. 6 meeting has been postponed, apparently because of differences of opinion about a different agenda item.]

The W-2 funding is part of a DCF/DHS plan submitted to JFC on October 1, which makes recommendations for using unallocated federal funding known as "income augmentation" revenues. These funds are received by the state as federal matching funds for state and local spending on things like Targeted Case Management and the Medicaid HealthCheck program.

The proposal identifies a total of about $12.5 million of income augmentation funds that haven't already been alloted in the biennial budget bill. The DHS/DCF plan would use that funding for the following:

$9.6 million for Wisconsin Works,
$1.7 million for a functional family therapy program called the SAFE Milwaukee Initiative, which targets high risk youth in Milwaukee.
$1.2 million as a lapse to the General Fund to meet the DCF lapse requirement for both years of the biennium.

As I noted in a Budget Project blog post in early October, we were very pleased to see the Walker administration propose closing part of the W-2 funding gap. However, it is important to note that the funding shortfall is much larger than the recommended supplement:

The proposal is intended to only address the shortfall in the first year of the 2013-15 biennium, and the Fiscal Bureau estimates the gap in that fiscal year to be at least $13.3 million, even if W-2 participation starts to fall by 1% each month.
The LFB paper projects that even under a scenario of W-2 participation declining by 1% per month, funding will fall short by $12.2 million in the second year of the biennium.
If W-2 participation stops growing and remains at its current level, rather than declining, the LFB projects that the funding shortfall will be $43.4 million during the biennium, or almost $34 million more than the DCF/DHS plan would provide at this time.

The LFB paper confirms a problem that we have been writing about since early this year, though the gap is actually a little larger than our last estimate because the cost per participant has also risen. We will continue to follow the W-2 funding issue closely.

Jon Peacock

Cuts in Food Assistance Will Harm Wisconsin Children

noreply@blogger.com (Wisconsin Budget Project) — Wed, 30 Oct 2013 18:35:00 +0000

Children in low-income families will bear the brunt of reductions in FoodShare benefits (also known as food stamps) that go into effect on Friday, according to a new Wisconsin Budget Project report. Last year, 1 in 3 Wisconsin children received food assistance through the FoodShare program.

The Recovery Act included a modest boost to food assistance benefits, aimed at both helping families hit hard by the recession, and giving a shot in the arm to local economies. That boost expires at the end of October, and all people receiving FoodShare in will experience a reduction in their benefits at that time. A family of three will have its benefit cut by about $29 a month.

Children make up a large share of those who benefit from FoodShare in Wisconsin, so the reduction in benefits will hit children especially hard. Statewide, 452,000 Wisconsin children received FoodShare benefits in 2012. In some areas of the state, SNAP is such an important support for families that more than half of the children receive assistance over the course of the year. In six Wisconsin counties – Menominee, Milwaukee, Adams, Sawyer, Burnett, and Washburn – a majority of the children received assistance at some point in 2012, as shown in the chart below. In Milwaukee County alone, 146,000 children received SNAP benefits in 2012.

For more information on how reducing benefit levels or restricting eligibility during slow economic times makes it harder for Wisconsin families to put food on the table, read the new Wisconsin Budget Project report.

DHS Figures Shed More Light on Number of People Losing BadgerCare Coverage

noreply@blogger.com (Wisconsin Budget Project) — Wed, 30 Oct 2013 00:50:00 +0000

About 15,000 Adults who are Affected Will at Least Briefly Retain Coverage in Transitional Medicaid

Don’t be surprised if you start hearing state officials citing lower figures for the number of adults who will lose their BadgerCare coverage at the end of the year. In a sense it’s good news, but it isn’t so much “news’ as an overdue correction in how we describe the effects of the budget bill on adults participating in or applying for BadgerCare.

In the last week or two, DHS has released figures on the number of people who received letters from the department in late September telling them that they are likely to lose their BadgerCare coverage at the end of the year. Here’s the tally of people who got letters:

68,567 parents or caretakers who are over the poverty level (and not eligible for Transitional Medicaid);
5,283 childless adults over the poverty level;
3,622 children over 300% of FPL;
1,222 adults in the unsubsidized BadgerCare Basic plan;
14,932 parents/caretakers between 100% and 133% of FPL who are in Transitional Medicaid and will start having to pay premiums in January (assuming that part of the waiver is approved);
163,808 childless adults on the Core Plan waiting list (about half of whom are expected to be eligible for and enroll in BadgerCare by the end of the biennium on June 30, 2015).

In short, the number of adults expected to lose eligibility for subsidized BadgerCare coverage in January is a little shy of 74,000. That’s considerably below the figure of about 92,000 adults that you may have heard on many occasions from me, DHS and others; but the difference is a bit deceptive.

The primary reason for the lower figure now is that the BadgerCare changes morphed slightly during the budget process. They changed after federal officials made it clear that Wisconsin wouldn’t be granted a waiver to eliminate Transitional Medical Assistance (TMA) coverage, which is a longstanding part of welfare reform that extends Medicaid eligibility for up to 12 months after someone is lifted above the poverty level by a new job or a raise.

As I explained in a WCCF blog post a couple of months ago, the revised DHS plan is to apply premiums to the nearly 15,000 adults in TMA and between 100% and 138% of FPL – i.e., the Transitional Medicaid participants who aren’t already paying premiums. Retaining TMA is a lot better than eliminating it, but for a couple of reasons it’s less of an improvement than you might guess:

If Congress doesn’t act soon, the law setting TMA at 12 months will expire in January and the maximum extension of eligibility will revert to just 4 months.
Imposing premiums for people in TMA who are close to the poverty level will cause many of them to drop out right away – as we saw when the state began in 2012 to apply premiums to adults in TMA over the poverty level. (Read more here.)

I think there is a second and smaller factor relating to why the new figures from DHS are lower. I believe that participation of adults over 133% of FPL has been dropping faster than expected from the changes initiated in July 2012 (though I need to study the data more carefully to be sure of that).

In examining the latest figures from DHS, keep in mind that this isn’t the last word on the subject. We will find out in December how many people are sent formal notices of the termination of their BadgerCare at the end of the year. Yet even those numbers aren’t the end of the story because those terminations won’t routinely be based on accurate determinations of eligibility, since they won’t reflect all the new ACA rules on determining income and family size. And unless the online federal application process is fixed faerly soon, the people whose eligibility is incorrectly terminated will have little chance of avoiding becoming uninsured in January.

But I digress. For now, let’s take a brief moment to be thankful that the number of adults losing their BadgerCare coverage in January will be a little smaller than we expected earlier this year -- even though the extension for people on Transitional Medicaid is likely to be very brief.

Jon Peacock

Recovery from Recession Going Slowly, Shows New County-Level Analysis from WCCF

noreply@blogger.com (Wisconsin Budget Project) — Thu, 24 Oct 2013 17:33:00 +0000

Many residents of Wisconsin have yet to fully rebound from the impact of the recession that began five years ago, according to a new county-level analysis released today by the Wisconsin Council on Children and Families.

A typical Wisconsin household earned less money in 2012 than it did before the recession, according to the analysis. In several counties, such as Rock, Outagamie, and Walworth, a typical household earned as much as $8,000 less in 2012 than it did in 2008.

Poverty rates also rose dramatically between 2008 and 2012 in every county, according to the analysis. Milwaukee County has the largest number of poor residents – 208,600 people in 2012 – but in many counties, the number of people living in poverty as jumped alarmingly. For example, the number of people living in poverty in Brown County rose by more than 10,000 over this period, and by 4,600 in Eau Claire County.

The number of Wisconsin residents with private health insurance continues to decline, according to the analysis. An estimated 210,000 Wisconsinites lost their private insurance coverage between 2008 and 2012, including 64,100 Milwaukee County residents. In spite of that erosion, Wisconsin’s uninsured rate remained essentially the same, thanks to the ability of the state’s excellent BadgerCare program to pick up much of the slack.

Fortunately, there are some steps we can take to help Wisconsin families pull themselves up out of poverty and improve their access to health insurance. Wisconsin lawmakers should boost the minimum wage, make key investments in early education, and effectively implement the new insurance options in the federal health care reform law.

For more information on economic well-being and access to health insurance for residents of different Wisconsin counties, go here to access the fact sheets that WCCF has put together for 21 counties and for the state.

Looking on the Bright Side of Wisconsin’s Early Learning & Development Efforts

noreply@blogger.com (Wisconsin Budget Project) — Wed, 23 Oct 2013 11:00:00 +0000

As the fall colors begin to glow, I thought I would focus on some of the recent progress in Wisconsin’s early learning and development landscape. In the midst of increasingly partisan battles at state and national levels, and after disappointing results in the state’s biennial budget, here are six encouraging trends.

YoungStar: 65% of subsidized children are now in child care programs rated as 3, 4 or 5 stars, a significant upward trend in a short period of time.

Early Learning Grants: Wisconsin is one of 14 successful applicants for competitive federal Race to the Top-Early Learning Challenge grants, receiving $34 million to improve early learning and development.

Home Visiting: Wisconsin has also drawn down $13.4 million in federal grants (mostly competitive) to expand and improve home visiting across the state.

4K: Wisconsin now has 90% of school districts offering free, universal 4-year-old kindergarten, ranking near the top among states.

Child Care Freeze Ends: After 7 years of frozen payment rates in Wisconsin Shares, the freeze has ended, and modest increases are in the works for the next 2 years.

Increased Education: Scholarships, training, and on-site technical consulting are helping improve skills of early childhood practitioners.

Excellent work is also well underway in building an early childhood longitudinal data system, launching a public-private partnership system for improved early learning and development, and improving early screening and assessment for young children in the state.

Dave Edie

HHS Encourages Use of Alternative Options to Research and Apply for Marketplace Coverage

noreply@blogger.com (Wisconsin Budget Project) — Tue, 22 Oct 2013 23:39:00 +0000

Needless to say, the initial roll out of the online application process for getting coverage through the new federal health insurance Marketplace has been very frustrating for people shopping for insurance and also for those of us who simply want to check it out. Although some of the state-operated insurance marketplaces seem to be operating pretty well, the very rocky start for the federal Marketplace brings back memories of early troubles with the Medicare prescription drug coverage program.

As federal officials invest more resources in fixing the computer software, they have also been taking steps over the last couple of weeks to work around some of the problems with the online system and to relieve some of the pressure on that system. One of the measures is something that they should have actively promoted from the outset – encouraging people to do some online window shopping before attempting to apply and purchase coverage in the federal Marketplace. For many of us, that’s primarily what we were interested in doing at this point, and allowing us to explore the options without first setting up a personal account could relieve a lot of pressure on the online system.

You can easily explore the insurance options in your area here. Although the costs you will see there for specific insurance plans in your area don’t take into account the federal subsidies you are likely to be eligible for, the window shopping area of the Marketplace website does enable you to find out what subsidies you are likely to be eligible for.

My favorite interactive tool for exploring the options and seeing what subsidies you may be eligible for is the Kaiser Family Foundations subsidy calculator because it’s very simple to use. It quickly determines how your income compares to the poverty level and whether you appear to be eligible for Medicaid or Marketplace subsidies (based on each state's policy choices). For people who aren’t Medicaid eligible, it calculates how much your premium subsidy will be (if any), how much of the premium you are likely to have to pay for a “silver” or “bronze” level plan in your community, and what the cap will be on out-of-pocket costs for a silver plan (for in-network health care services). However, unlike the Dept. of Health and Human Services (HHS) website referenced above, it doesn’t show you a list of all the plans in your area and their costs.

Not surprisingly, the glitches in the Marketplace computer software have prompted HHS to remind people that there are also several old school options for getting covered through the Marketplace:

Apply by phone. Call 1-800-318-2596 to apply for a health insurance plan and enroll over the phone. (TTY: 1-855-889-4325)
Apply in person. Visit a trained counselor in your community to get information and apply in person. Find help in your area at LocalHelp.HealthCare.gov.
Apply by mail. Complete a paper application and mail it in. You can download the paper application form and instructions from HealthCare.gov.

It’s a shame that the launch of the Marketplace website, HealthCare.gov, has gotten off to such a rocky start. That storyline has distracted attention from many of the very positive aspects of the health care reform law and has given talking points to the law’s critics.

It sounds like the technological fixes for the online applications could be slow in coming, but in the meantime some of the states that developed their own systems are successfully enrolling many people and demonstrating the very valuable role the ACA will eventually play in making quality insurance far more accessible and affordable.

Jon Peacock

Is There an Affordable Care Act Coverage Gap in Wisconsin?

noreply@blogger.com (Wisconsin Budget Project) — Mon, 21 Oct 2013 22:55:00 +0000

Wisconsin's Unique Medicaid Solution Necessitates that Diverse Parties Work Together

Over the last couple of months, there have been numerous reports about a large hole in the Affordable Care Act – stemming from the Supreme Court’s decision to make it optional for states to expand Medicaid coverage to all citizens below 138% of the poverty level. Some of the reports and media stories have incorrectly suggested that Wisconsin was among the states where the ACA will leave a gap for people below the poverty level. A new report from the Kaiser Family Foundation (KFF) rebuts that misconception.

It’s important to examine this issue closely – to clear up the confusion about the gap in coverage and to clarify that this significant problem for other states was not one of the concerns being raised by groups like WCCF that were advocating for Wisconsin to expand Medicaid and accept the increased federal funding. Even more importantly, the Wisconsin approach to the Medicaid issue highlights why we need to work together to make the Health Insurance Marketplace successful in our state.

The KFF report explains the scope of the problem in the 26 states that, as of late September, did not plan to implement the Medicaid expansion:

In states that do not expand Medicaid, over five million poor uninsured adults have incomes above Medicaid eligibility levels but below poverty and may fall into a “coverage gap” of earning too much to qualify for Medicaid but not enough to qualify for Marketplace premium tax credits. Most of these people have very limited coverage options and are likely to remain uninsured.

Although Wisconsin is one of the 26 states that have chosen not to provide Medicaid coverage to all citizens up to 138% of the poverty level, and that are not taking advantage of the enhanced federal funding for that expansion, our state is different than the others on that list. The KFF report indicates that Wisconsin is the only state among the 26 that will be covering all adult citizens up to the poverty level.

Wisconsin was starting from a very different position than the other 25 states on the “non-expansion” list because BadgerCare was already covering roughly 90,000 parents between 100% and 200% of the federal poverty level, as well as about 5,000 childless adults in that income range. However, the BadgerCare Core program for childless adults has a waiting list of well over 150,000 people and it was not a full Medicaid benefit. The decision in the budget bill to provide full BadgerCare coverage to all childless adults below the poverty level is expected to add 80,000 people to BadgerCare, but it is being financed by ending BadgerCare eligibility for an even larger number of adults currently in the program.

The decision to cap eligibility of parents and childless adults at the poverty level is justified on the basis that those adults can get subsidized coverage in the Health Insurance Marketplace. That’s true – at least in theory – as we show in this WCCF infographic illustrating the coverage options in 2014 for Wisconsinites who don’t have access to affordable employer-sponsored coverage.

In short, by embracing a key part of ObamaCare – the new Marketplace – Governor Walker was able to turn down the Medicaid expansion funding, while still being able to reduce the number of uninsured Wisconsinites. It’s not a terrible plan, although I think there was a far better alternative. State lawmakers could have covered far more people at much less cost to state taxpayers by expanding BadgerCare to all adults up to 138% of the poverty level and accepting the enhanced Medicaid funding (saving nearly $150 million of state funding during the 2013-15 biennium).

A significant problem with the budget plan is that many of the low-income adults who are over the poverty level will end up uninsured because they won’t be able to pay the premiums and other cost-sharing for Marketplace coverage. The federal cost-sharing structure for coverage through the Marketplace wasn’t intended to serve that population. In addition, many adults in that income range don’t have checking accounts or credit cards and will have great difficulty simply with the logistics of paying premiums and co-payments.

I’ll probably elaborate on those concerns at a later date, but the much more important thing is to look forward and focus on the issues that join us, rather than the ones where we have disagreed. Because the Governor has embraced the Marketplace as a way to reduce BadgerCare eligibility for some, and thereby finance expanded and improved coverage for childless adults, Wisconsin is in a very different place than the other states that have been resisting implementation of the Affordable Care Act.

In our state, unlike many others, advocates, health care providers, employers and politicians have many reasons to roll up our sleeves and do whatever we can to make the Marketplace successful – not only for tens of thousands of Wisconsinites who are now uninsured, but also for about 90,000 people who will be losing their BadgerCare coverage in January, and about 25,000 even more vulnerable people losing coverage in the state high risk plan.

A DHS press release today reiterates that the Governor’s plan is expected to reduce “the number of uninsured adults by an estimated 224,580, cutting the uninsured rate nearly in half.” I think that will be a stretch because it assumes that more than 90% of the adults losing BadgerCare coverage will be insured in the Marketplace. Yet regardless of whether we think that specific goal is realistic, I think we need to join forces in trying to maximize that percentage and the effectiveness of the ACA in reducing the number of uninsured Wisconsinites.

Jon Peacock

Journal Sentinel Endorses Delay in Removing People from BadgerCare

noreply@blogger.com (Wisconsin Budget Project) — Fri, 18 Oct 2013 00:59:00 +0000

WCCF has been arguing all year that Wisconsin shouldn’t push 90,000 people off BadgerCare in December – at the same time that hundreds of thousands of uninsured Wisconsinites are trying to enroll in the new insurance Marketplace. Also at that time, about 25,000 people now in the state’s high risk pool will have to try to buy coverage through the new Marketplace – adding to the to the logjam of applications.

Expecting that many people to get the assistance they need to explore their options, choose the right plan for their family, and pay their first premium before December 15 seemed to us to be a recipe for very substantial problems, even if the state and federal computer systems were working properly. Unfortunately, the online version of the federal Marketplace has had extensive problems getting going, and the state doesn’t anticipate having its computer programing done until late November. Even then, the state concedes that it won’t be able to correctly determine eligibility for many of the people that it will remove from BadgerCare at the end of the year. (See this WCCF blog post.)

At about the beginning of December, tens of thousands of BadgerCare participants will get termination letters from the state saying they have until December 15 to reapply through the Marketplace, verify their eligibility, and pay their first premium for private coverage. The state seems relatively unconcerned that some of the people receiving those notices will actually be below the poverty level under the new eligibility standards – arguing that they can be restored to BadgerCare coverage when they apply to the Marketplace. Yet even if the federal computer problems are resolved in the next couple of weeks, expecting all the people being removed from BadgerCare to navigate the new enrollment process by December 15 seems extremely unrealistic.

For those reasons and others, an editorial this week in the Milwaukee Journal Sentinel endorsed WCCF’s recommendation that “legislators should change the law so they can delay by a couple of months when the 92.000 people are moved from BadgerCare to private plans.” As the editorial states: “That would immediately lower the number of people trying to sign up for insurance on the exchange and give state officials more time to ensure people are properly transitioned from BadgerCare to private plans.”

We still strongly support the Affordable Care Act, which has already made substantial improvements, such as greatly expanding access to insurance for young adults, removing coverage restrictions in private insurance, and removing fees for preventive care. It’s extremely frustrating that computer problems are delaying the process of giving people access to coverage through the new Marketplace, but those issues are similar to the challenges that created rough going for the Medicare prescription drug coverage in its early stages.

The computer problems will eventually be sorted out, but in the meantime state lawmakers could and should change the timing of the changes to BadgerCare, in order to take some pressure off the snarled application process and avoid substantially increasing the number of uninsured Wisconsinites.

Jon Peacock

Property Tax Relief Targeted at Low-Income People Should be Part of Tax Cut Legislation

noreply@blogger.com (Wisconsin Budget Project) — Tue, 15 Oct 2013 21:37:00 +0000

$11 Million Drop in Homestead Credit Offers Opportunities

Governor Walker’s proposed $100 million property tax cut is on a fast track through the legislature, with the Senate voting to approve the measure today and the Assembly set to consider the measure as soon as Thursday. The rush to cut property taxes is a bit ironic considering that the legislature recently raised property taxes by chipping away at a property tax credit aimed at keeping property taxes manageable for low-income people. Legislators could improve the tax cut proposal currently on the table by making sure that targeted property tax relief for low-income people is included as part of the legislation.

Back in 2011, the legislature raised property taxes for low-income people by freezing many of the factors used in the formula for calculating the Homestead Credit. This action means that some people, especially those who rely on Social Security benefits to make ends meet, are pushed out of eligibility for the property tax credit, and others receive a smaller credit. (See this Wisconsin Budget Project report for the details of how that happens.)

The good news is that lower-than-anticipated spending on property tax relief for low-income people this year creates a window of opportunity for legislators to make structural changes to the program that will help preserve property tax relief in the future, and to piggyback those changes in the property tax cut legislation currently under consideration. In 2012, it was anticipated that spending on the Homestead Credit would stay at about the same level as it was in 2012, but in fact spending on the Homestead Tax Credit fell to $122.8 million in 2013 from $133.7 million in 2012, as shown in the chart below. That represents a drop of $10.9 million. The sharp decline in spending means that the legislature could lift the freeze on the Homestead Tax Credit formula and give greater property tax relief to low-income owners and renters, possibly without actually spending any more money than originally anticipated.

But if the legislature is set to approve a new property tax cut, then why is it important that we also boost the Homestead Credit? Because the property tax cut advocated by the Governor isn’t targeted, and unlike the Homestead Credit, his tax cut doesn’t seek to provide relief to the people for whom property taxes are the greatest burden. In addition, residents in some 65 school districts will not receive any tax relief from the Governor’s plan, because the proposed tax cut is delivered through school districts, and those districts do not receive any general school aid from the state. Yet there are certainly low-income people in those districts that could benefit from property tax relief.

Legislators seem to be nearly unanimous in their desire to pass a property tax cut. However, there are still some important questions that need answers, such as whether Wisconsin can afford this tax cut and whether it would hinder the state’s ability to help build a favorable environment for creating new jobs. But if the legislature is set on approving a new tax cut, they should consider the favorable conditions that exist right now for making sure that part of the property tax relief goes to the people who need it the most.

Tamarine Cornelius