State and Federal Officials Coming Closer to an Agreement on (Some) BadgerCare Changes

Changes Would Affect Adults over 133% of Poverty Level, but Preserve Children's Coverage

Letters recently exchanged between the Wisconsin Dept. of Health Services (DHS) and the U.S. Dept. of Health and Human Services (HHS) shed additional light on the status of negotiations over federal waivers and plan amendments the state has proposed, to cut spending for BadgerCare. The letters indicate that federal officials are willing to approve some of the proposed changes, and the state has dropped several others.

Although there still appear to be several significant areas of disagreement, the two sides seem to be close enough together in a few areas that it might be possible for some of the issues to be formally resolved within the next few weeks, while negotiations continue on other issues.  Based on the Feb. 15 HHS letter, the areas where federal approval seems close are the following:

• Applying premiums to adults above 133% of the poverty level, using a graduated scale starting at 3% of income and increasing to 6.3% of income for adults at 200% of the poverty level.
• Making adults ineligible for BadgerCare if they have an offer of employer coverage with premiums of less than 9.5% of household income.
• Dropping people for a year (instead of 6 months) if they fail to pay a monthly premium.
• Accelerating the termination of coverage for BadgerCare participants found to be ineligible.

Health Care Reform: Creating More Need for a Primary Care Physician Workforce, and Working to Fill the Shortage of Providers

The health care reform law is expected to create 326,000 more insured Wisconsinites. This will be a great accomplishment; however, it’s also important to think about whether the health care system will be ready to care for the increased number of patients seeking primary and preventative care because of the law. Fortunately, the Affordable Care Act (ACA) contains measures to help address that challenge.

After the Washington Post’s Sarah Kliff, posted an article entitled, “The Health Reform Law’s Biggest Threat: 30,000 Too Few Doctors,” the Milwaukee Journal Sentinel posted Steve Jacob’s opinion piece on, “What Doctor Shortage Means for Wisconsin.” Their points are well made – the US has far fewer primary care physicians than specialists, in part because medical school debt drives doctors into dramatically higher paying specialties. About one in five Wisconsin doctors is age 60 or older, and as they’re retiring we need new doctors to choose primary care, particularly in federally designated primary care shortage areas – where 10% of the Wisconsin population lives.

Health Care Reform anticipated this particular need, and has been working to address the shortage. Just this week, the Administration announced $9.1 million in funding to medical students, through the National Health Services Corps’ Student to Service Loan Repayment Program. This program was made possible by an initial investment of $300 million through the American Recovery and Reinvestment Act, and in the first five years of health care reform implementation, over $1.5 billion will be invested. The program provides loan repayment assistance of up to $120,000 to students who commit in their final year of medical school to primary care in one of the federal shortage areas after their residency. The Wisconsin Office of Rural Health also provides health professional loan assistance for those practicing in shortage areas.

Primary and preventive care is key to the success of health reform, and the health of our country overall. Encouraging young medical professionals to respond to this calling is a good way to help fill this need.

Sara Eskrich

The Case against Using Mortgage Settlement Funds to Reduce the State Deficit

Journal Sentinel and NY Times Editorials Argue against Diverting the Settlement Funding

Both the New York Times and the Milwaukee Journal Sentinel editorialized over the weekend against the use of the new mortgage settlement dollars to help close state deficits. As the Journal Sentinel wrote: “With so many families in Milwaukee - and other Wisconsin communities - hurting under the pain of the foreclosure crisis, that money should be distributed to communities around the state for remediation.”

A new Wisconsin Budget Project Blog post examines the issue and notes: "It's somewhat surprising that the Governor would make such a proposal, in light of his criticism of similar funding shifts in the past that closed deficits with one-time money, and in view of his opposition to transfers from segregated funds, such as the patients’ compensation fund."
 
Jon Peacock

A Few of the Reasons to Reconsider Pulling the Plug on Health Care Reform Planning

Small Businesses Could Buy Health Insurance for Nearly 10 Million People Through New Health Insurance Exchanges

There are a number of reasons why I think Wisconsin should resume planning for the possibility that the Supreme Court upholds the Constitutionality of the federal health care reform law (known as the Affordable Care Act or ACA). In fact, even if the law is overturned, planning efforts are needed to pave the way for a bipartisan state effort to make much-needed health care reforms.

An editorial Wednesday in the Appleton Post Crescent lays out some of the reasons why it was short-sighted to turn back the federal funding for ACA implementation of health care reform.  Another significant reason was elucidated by an article in the February issue of Health Affairs, which explains that state health insurance exchanges for small businesses are estimated to cover nearly 10 million people, in addition to the 15.3 million who will gain coverage through the individual exchanges when the ACA is fully implemented. The article, by Fredric Blavin and colleagues at The Urban Institute, is one of a group of articles in the journal examining the Small Business Health Care Options Program (SHOP), the formal name for the small business exchanges.

New HHS Grant Opportunity for Innovative Approaches to Reduce Preterm Births

This week the federal Department of Health and Human Services (HHS) announced a new grant opportunity relating to reducing preterm births. The intent of the “Strong Start” initiative is to test maternity care options that improve birth outcomes for women with Medicaid coverage who are at risk of having a preterm birth. In light of the high rate of preterm births in some parts of the state and the very substantial racial disparities, I hope providers and health agencies in Wisconsin develop strong proposals.

HHS will award up to $43.2 million through a competitive process to providers, States, and managed care plans to achieve better care, improved health, and lower costs for pregnant Medicaid beneficiaries and their newborns. The goal of the initiative is to determine if these approaches to care can impact the rate of preterm births, improve the health outcomes of pregnant women and newborns and decrease the anticipated total cost of medical care over the first year of life for children born to mothers in the Medicaid program.

An Update on the AB 210 Saga: Rep. Petersen Urging Passage

Early in December, we predicted that the Governor’s decision to halt the Office of the Insurance Commissioner’s (OCI) emergency rule implementing AB 210 was telling, to say the least, and raised questions as to whether the Governor planned to implement health reform provisions. Weeks later, the Governor indicated that he was halting all implementation of health reform (the Affordable Care Act, or ACA) until the Supreme Court decides on its constitutionality in June.

So here’s the rundown on AB 210: The bill was passed by the Assembly with strong Republican support, including the backing of the Insurance Committee chair, Representative Petersen. However, the bill was blocked in the Senate by committee chair Frank Lasee. As a fallback plan, OCI attempted to make the slight technical change to Wisconsin law that enjoyed the strongest support from OCI and the insurance industry – ensuring WI law complied with federal external review processes for health insurance - but the Governor directed OCI to withdraw the rule.

In a recent press release, Rep. Petersen brought attention back to this bill and external reviews. Though he notes that he does not support the ACA, he advocates recognizing that it is currently the law of the land and – until that is no longer the case – Wisconsin law should be made consistent, as would be done with AB 210.  As of March 1^st, Wisconsin insurers will be out of compliance with federal standards for external reviews and will need to use the federal appeals process out of Chicago.

Separating Families Because of Immigration Status?

There has been increasing media attention paid to the separation of families due to immigration status. A recent ABC news special discusses the experience of one undocumented mother in Arizona who was accused of a misdemeanor charge, arrested and placed in a detention center, and separated from her children for 2 years before being able to see them again. Later, she was deported to Mexico despite fighting deportation for 2 years.

Meanwhile, her children were placed in foster care. Because of timelines put in place to achieve permanency for the child sooner rather than later, the court terminated her parental rights, and the children are in the process of being adopted. This is a heartbreaking case of a family being separated simply because of immigration status, not because of child maltreatment or severe neglect.

This issue is not isolated. A report by the Applied Research Center titled Shattered Families details the extent of the problem when parents are deported and children end up in foster care. Often, the only reason for removing the child is lack of immigration documentation. The ARC estimated that there are 5,100 children in foster care whose parents have been detained or deported.