Number of Uninsured Kids Drops by About One Million since 2008, but Wisconsin Doesn’t Share in that Improvement

The recession has significantly increased poverty and unemployment, and with those changes there has been a large increase in adults without health insurance.  Yet despite those trends, the number of uninsured children in the U.S. dropped by 1 million from 2008 to 2010 (from 6.9 million to 5.9 million), according to a report released today by Georgetown University.

Experts attribute that remarkable improvement to several factors, including federal funding provided to states by the Children’s Health Insurance Program (CHIP) and steps states have taken to expand eligibility for, and simplify access to, Medicaid and CHIP funded coverage.  Another significant factor is federal health care reform (the Affordable Care Act), which requires states to maintain income eligibility levels and discourages other barriers to coverage.  (Wisconsin’s Department of Health Services is currently seeking a waiver of those requirements.) 

The analysis by the Center for Children and Families at Georgetown found that 34 states had a statistically significant decrease in the percentage of uninsured children.  Wisconsin was one of only three states with an increase in the number of uninsured children – joining Minnesota and Kansas in that regard – although the apparent growth in our state, from 4.8 percent of children to 5.0 percent, was not statistically significant.  For most of the last decade, Wisconsin had one of the lowest rates of uninsured kids, but since 2008 a number of other states have climbed ahead of us in the rankings, and we have slipped to having the 13^th lowest percentage of children lacking health insurance. 

Just in time for Thanksgiving - Congress Declares Pizza a Vegetable?

Well, no, not exactly. But the Republican controlled House of Representatives did bring a whole new meaning to the phrase “you say tomato…”

As we’re sitting down with family and friends this week, we are thankful for so much – including a delicious Thanksgiving meal. For many in Wisconsin, meals that are both healthy and filling are far too difficult to come by these days. This point is considered further in the following post.

Earlier this year the U.S. Department of Agriculture (USDA) released proposals –based on recommendations by the Institute of Medicine – which would limit the amount of starchy foods and sodium, and would increase the amount of whole grains and vegetables served to children in schools. Last week, the food industry declared a big win when Congress blocked the new proposals and voted to allow tomato paste on pizza to be counted as a vegetable, among other proposed changes. In a time when children need healthy meals the most, pizza and French fries are two of the unhealthy foods offered in school lunch lines that the proposed guidelines would have limited.

Giving thanks for government programs holding down poverty

When we give thanks on Thursday, let’s remember that there are many public programs providing critically important assistance to people who aren’t as fortunate. Among them are a number of government programs that are working as intended to keep low-wage Americans and unemployed workers out of poverty. Unfortunately, some of those programs are under assault.

A recent New York Times article outlines data from a special Census Bureau report that was requested by the New York Times – an analysis of those that are not considered to be poor, but have slightly greater incomes between 100-150 percent above the poverty line. Using the Supplemental Poverty Measure that we describe in our other blog post today, the Census Bureau calculated that fifty-one million people fell into this category. They aren’t categorized as being poor, but are precariously close to being so – the “near poor.”

Supplemental Poverty Measure Provides a More Comprehensive Picture of Poverty, the “Near Poor,” and the Role of Public Policy

Earlier this month the Census Bureau released a new way of measuring poverty: the Supplemental Poverty Measure (SPM). This measure revealed higher rates of poverty nationally for most groups, but a lower rate for children.

The Census Bureau also released an analysis of those with incomes slightly above the poverty line which illustrates that 51 million people are not considered poor, but are nonetheless struggling to make ends meet. Among this group, referred to as the “near poor,” 20 percent are kept from slipping below the poverty line by government programs like housing subsidies and school lunch programs. The new data reveal the importance of such programs, which are keeping millions of Americans out of poverty.

Wisconsin still below average in food stamp participation, but gaining ground

The US Census Bureau released a report late last week regarding the number and percentage of households in each state who received food stamps in 2009 and 2010.  Wisconsin’s participation rate of 11.0 percent last year was well below the national rate of 11.9 percent.  However, Wisconsin has been rapidly gaining ground on the national average.  From 2009 to 2010, the number of Wisconsinites receiving food stamps grew by 30.1 percent, which was the 6th highest percentage increase and compares to average growth last year of 16.2 percent nationally. 

The rapid growth in Wisconsin reflects several different factors.  First, it’s part of the national trend of increasing poverty rates.  Second, it results in part from the fact that Wisconsin’s poverty rate has been growing slightly faster than the national average.  Finally, Wisconsin has improved food stamp enrollment processes and for several years our participation rate has been gaining ground on the national average.

Jon Peacock

MJS editorial: “DHS should go back to the drawing board on Medicaid”

An editorial in the Milwaukee Journal Sentinel Sunday urges federal officials to deny Wisconsin’s current request for a “maintenance of effort” waiver that would result in more than 64,000 people losing their BadgerCare coverage:

We urge the federal Department of Health and Human Services to hold off on that waiver until the state does more to ensure that fewer of the poor are affected.

Advocates surprised by Supreme Court announcement that it will review Medicaid’s expansion

Case might pivot on studies relating to state costs and savings

Is it unconstitutional for Congress to enact a law expanding Medicaid coverage to everyone below 133% of the federal poverty level?  About half the states (via their Attorneys General or Governors) contend that making them participate in a large expansion of Medicaid, which is slated to be part of health care reform in 2014, amounts to an unconstitutional coercion of state governments. The U.S. Supreme Court surprised many people early this week when it announced that its review of the federal health care reform law will include consideration of the constitutionality of compelling states to participate in the broadening of Medicaid coverage.

That expansion, which is expected to add about 17 million people to the Medicaid rolls, is probably the single most important component of the Affordable Care Act’s strategies to make quality, affordable health insurance accessible for nearly all Americans. That’s one of the reasons why advocates are very concerned that the Walker Administration is seeking waivers that would harm Wisconsin’s Medicaid coverage (especially BadgerCare and Family Care), and why many people are worried that the Supreme Court is entertaining the argument that the Medicaid expansion violates states’ rights.

OCI Emergency Rule Implements a Portion of the Health Care Reform Law

We’ve reported a couple of times this fall on a bill that would have put several important health care consumer protections from the Affordable Care Act (ACA) into state law. The bill, AB 210, has had strong backing from the Office of the Commissioner of Insurance (OCI) and from insurance companies who have been worried about potential problems that might result from having inconsistent state and federal laws. They were particularly concerned that the state’s failure to have a consistent state law would mean that consumers would be able to take their grievances to two different independent appeal boards – one at the state level and one at the federal level – and could get conflicting rulings.

Progressives have had reservations about the bill, mostly because it sunsets (repeals) the new consumer protections being put into state law if the ACA is struck down by the U.S. Supreme Court.  AB 210 was approved by the Assembly on Oct. 18, by a vote of 57-39, with only 5 Republican legislators voting against it.  Notwithstanding the bill’s vigorous support from the Insurance Commissioner and its endorsement by the vast majority of Assembly Republicans, Senator Frank Lasee (R., De Pere) announced on Nov. 1 that he wouldn’t schedule the bill for a vote in his Senate committee, where the bill currently resides. 

On November 11, to the consternation of Senator Lasee, the Insurance Commissioner issued an emergency rule that adopts some of the provisions of AB 210 and the federal law.

Public Input and Sharing Stories on the BadgerCare Waiver

As we’ve been sharing on this blog, the Wisconsin Department of Health Services (DHS) recently submitted a proposal for federal approval that will result in tens of thousands of working Wisconsinites losing BadgerCare and Medicaid coverage.

Despite attempts from the public and advocacy groups to call on DHS for a transparent process and adequate public input, they held only two public hearings on the proposals prior to Thursday’s vote by the Joint Finance Committee (JFC).  In addition, those hearings were held before DHS answered basic questions about what they were proposing and how many people would be affected.  We didn't get the answers to many of those questions until the Fiscal Bureau analysis of the proposals was released two days before last week's JFC meeting.  The proces has left many unanswered questions on how the proposals will be implemented as well as their overall effects.

Democratic members of the legislature have organized public hearings to brief their constituents about the proposals and take public testimony.   (We shared those dates in a previous blog post.)  Here’s some great coverage of the hearings in La Crosse and Eau Claire.

MOE Waiver: What's the Difference Between Approval and Denial for the Future of BadgerCare?

The Wisconsin Department of Health Services (DHS) recently submitted a request to federal officials for approval to make sweeping changes in the BadgerCare program.  Most of those changes conflict with provisions in the federal health care reform law requiring states to maintain current standards relating to eligibility and enrollment.  So DHS is seeking a waiver of these so-called “maintenance of effort” (MOE) requirements in order to implement it's plan for dramatic cuts to BadgerCare spending. 

Here's the catch: If Wisconsin is not granted an MOE waiver by federal officials by December 31, 2011 (an arbitrary, self-imposed deadline), the state budget bill directs DHS to lower the BadgerCare income limit for adults from 200% of the federal poverty level (FPL) to 133%. That would result in 53,000 adults losing their BadgerCare coverage. So it's important to understand what's at stake in the federal government's decision regarding the DHS waiver request. Neither outcome is appealing. Regardless of whether or not the waiver is granted, tens of thousands of people in Wisconsin are going to lose their health insurance. But there are significant differences between how the two decisions would affect participants, such as who will lose their coverage, how coverage will change, how much less money the state will spend, and how much more it will cost families to stay covered.

Based on analysis from the nonpartisan Legislative Fiscal Bureau, approval of the MOE waiver will result in nearly 65,000 Wisconsinites losing their BadgerCare coverage. Nearly half of those (over 29,000) would be children. As noted above, if the waiver is not granted and the income limit is lowered to 133% of the poverty level, about 53,000 people--all of them adults--would lose their BadgerCare coverage.

Another key difference is in the total number of people affected. If the waiver is rejected, those 53,000 adults would be the only people affected for the time being. The impact of a successful waiver would be felt by more than triple that number (over 168,000), in the form of higher premiums and copays, reduced services covered, and a variety of other changes.

These are just a few of the differences between what will happen if the waiver is granted and what will happen if it not. The Legislature could also choose to push back the self-imposed December 31 deadline in order to work out a better solution, but that does not seem to be a likely scenario. We have posted to our website a more complete comparative analysis of the waiver /no waiver impacts in handy, easy-to-read table form.

Finance Committee Approves Plan to Reduce BadgerCare by 65,000 People

The Joint Finance Committee met today to consider the Department of Health Services plan to cut the state’s Medicaid spending by making changes to BadgerCare that will result in tens of thousands of Wisconsin families becoming uninsured. The DHS plan was approved on a party-line vote of 11 to 4, with one of the Republican committee members absent.

A Journal Sentinel article does a nice job of summing up the debate and the effects of the committee’s action. (But I’m biased because I was quoted in the article; so check it out for yourself.)  The proposals approved by the committee today will now be forwarded to federal officials, who must review proposed Medicaid plan amendments and waivers of provisions that conflict with federal law.

One of the arguments DHS has been making is that the proposed BadgerCare changes requiring federal waivers of “maintenance of effort” (MOE) requirements (which restrict the power of states to reduce eligibility) are preferable to the fallback plan in the budget repair bill. That plan, which can be implemented without a federal waiver, would cut off BadgerCare for 53,000 adults with income over 133% of the poverty level. However, more than 8 months after the budget repair bill passed we finally learned that the proposals requiring waivers are expected to lower BadgerCare enrollment even more. According to the Department’s own estimates, which we think are conservative, the changes to BadgerCare approved today will reduce enrollment by nearly 65,000 people, including more than 29,000 children! 

Finance Committee Meeting Thursday on Proposed BadgerCare Changes, and Concurrent Public Hearing

The Legislature’s Joint Finance Committee (JFC) will meet this Thursday (Nov. 10) to consider the proposals by the Department of Health Services (DHS) to make dramatic changes to the BadgerCare Program. Although the JFC is not taking public testimony, Democrats are hosting a public hearing in the Capitol Thursday at about the same time (beginning at 10:30 a.m. in Room 400 NE), as well as several other hearings over the next couple of weeks.

According to a lengthy (51 page) analysis released by the Legislative Fiscal Bureau today, DHS estimates that the proposed BadgerCare changes will reduce enrollment by more than 64,000 people, including more than 29,000 children.

The JFC meeting is scheduled to begin at 10:00 a.m. in Room 412 Northeast. The BadgerCare proposals are the fourth and last item on a substantial agenda.

Wisconsin Among Six States Joining Federal Pilot Project to Streamline Approval of Affordable Housing

Federal and state officials announced at a press conference Monday (Nov.7) that Wisconsin will be one of six states taking part in a new federal pilot program to expedite the approval of affordable housing projects. 

Developers of federally subsidized multifamily housing complexes typically rely on multiple sources of state and federal funding, and each funding agency currently has its own inspection requirements and other procedural checks.  The pilot program removes the need for redundant inspections and other repetitive regulatory practices. 

The initiative announced today, which is part of the Obama Administration's commitment to better coordinate federal rental policy, is being piloted in Wisconsin, Michigan, Minnesota, Ohio, Oregon and Washington.  Read more in an article today in Housing Wire. 

Jon Peacock

The Harmful Consequences for Kids from the Sweeping BadgerCare Changes Proposed by DHS

Sweeping changes to BadgerCare have been proposed by the Department of Health Services (DHS) and are expected to be reviewed this week by the Legislature’s Joint Finance Committee (probably on Thursday). A new WCCF issue brief examines how the proposed BadgerCare changes would have very negative consequences for Wisconsin’s children.

The new WCCF issue brief explains the numerous ways in which the DHS proposals would result in tens of thousands of children and parents becoming uninsured and would reduce the scope of BadgerCare services for those who are able to remain in the program. It also explains several factors that make the DHS proposals even more harmful for kids than for parents.

Eau Claire Area Legislators Plan Nov. 11 Hearing on Proposed Medicaid Changes

Joint Finance Committee Meeting Also Expected Next Week on the DHS Halloween Package

Senator Kathleen Vinehout (D-Alma) announced this week that she will host a public hearing to invite comments on Governor Walker’s proposed cuts to the Medicaid and BadgerCare programs. The hearing will be next Friday, November 11, from 4:00 to 6:00 p.m.

WHERE: Chippewa Valley Technical College

Eau Claire Clairemont Campus

Business Education Center – Room 30A

620 West Clairmont Avenue

Eau Claire, WI 54701

The Senate Takes Action on FY2012 Juvenile Justice Funding

This is a text of a message that worked its way through from others related to the Senate’s action related to juvenile justice funding. Sen. Kohl voted in favor of this bill – Sen. Johnson voted against, presumably because he thinks it should be essentially zero. Even at this level of funding, there will be reductions in the amount of funds available for grants to counties, system reform efforts, and perhaps even compliance.

Moments ago (now yesterday) , the U.S. Senate passed H.R. 2112 as amended which, among other things, provides federal funding for juvenile justice programs in FY 2012 at the following levels:

• Title II at $45 million
• Title V at $33 million (entirely earmarked for non-JJDPA programs)
• JABG at $30 million
• Mentoring at $55 million
• Violence prevention at $8 million

The bill passed on a vote of 69-30 (Senator McCain didn't vote), with 14 Republicans voting yes. That gives us some good momentum heading over to the House.

H.R. 2112 is no where near the bill that states need to maintain and advance their delinquency prevention and juvenile justice reform efforts. We remain very concerned about the impact these dramatically reduced amounts will have on youth and community safety. Without the collective efforts of CJJ members and allies, however, the outcome thus far could be worse.                                                    by Jim Moeser



The bill now moves on to the Conference Committee, which will include 3-6 Members of the Senate and 3-6 Members of the House. The word on the street is that the Conference Committee will try to complete its work within the next week or so.

Contradictory Releases: Walker Administration Releases Comments Pushing for ACA Repeal, while Families USA Releases Report Outlining Benefits of the ACA for WI Families

Wisconsin households will save an average of $1,467 per year after full implementation of the Affordable Care Act (ACA), yet the Walker Administration continues to push for repeal. Yesterday, the Walker Administration released copies of their comments to the U.S. Department of Health and Human Services (HHS) on the ACA Health Insurance Exchange regulations. Their comments, and corresponding press release, continue to push for repeal of the ACA. However, today, Families USA released a report, “The Bottom Line: How the Affordable Care Act Helps Wisconsin Families," which outlines the significant health care cost savings in store for Wisconsin families (as noted above).