It's Not Too Late to Support WCCF in 2011

For more than 130 years, the Wisconsin Council on Children and Families has been working to ensure that all children grow up in a just and nurturing family and community. No matter the year, the political climate or the state of our economy, WCCF has always put children first.

While we may not directly feed, provide child care or house people in need—we do focus on achieving lasting, long term results. WCCF works to improve outcomes for children in the areas of health, economic security, safety and education. Through research, public education and advocacy we help policy makers and government officials make changes that positively impact the well-being of children and families in Wisconsin.

The information we provide through our blog posts is just one part of our efforts to protect and support children and families, but it is a part of our work that requires the support of the people who look to WCCF to shed light on critical public policy choices.

Please join us in this important mission to protect Wisconsin’s most vulnerable. This holiday season give a gift that will touch the lives of Wisconsin’s children. Please contribute $500, $100, $50 or whatever you can afford to the Wisconsin Council on Children and Families. Your support will help us raise our voice to make every kid count.

Thank you for your support, and we look forward to working together in the coming year to assist the children and families of our state.

Confirmation of the Benefits of Being Smart on Crime

The Office of Justice Assistance just released an evaluation on the costs and benefits of implementing Treatment Alternatives and Diversion(TAD) programs in seven Wisconsin counties.  The evaluation is consistent with what we have seen well-researched in the juvenile system by showing that focused, strategic, and smart community-based alternatives to incarcerating many offenders not only lowers the likelihood of reoffending but is also cost-effective - in this case showing that for every $1 invested there is a net benefit of nearly $2 to the community in the long run.

Treatment courts, case processing reforms, and the use of evidence-based practices deliver benefits that far outweigh those of the too common “tough on crime” strategies that draw attention in the media.

Jim Moeser

BadgerCare Receives $24.5 Million Bonus from Feds Due to our Great Track Record Enrolling Kids

Wisconsin’s success in improving access to health care for children through the BadgerCare program has qualified the state for a federal bonus of $24.5 million for 2011, federal officials announced this afternoon.

“Today’s announcement is fantastic news for families in BadgerCare because these funds could be used to avoid making proposed changes that would knock more than 64,000 people out of the program,” said Ken Taylor, WCCF’s executive director.

This blog post examines the background of the bonus awards, the total amount granted today, and the anticipated reduction in future awards if the Department of Health Services is allowed to proceed with plans that sharply reduce enrollment of children in BadgerCare.

Wisconsin Budget Project’s Top Ten Blog Posts of 2011

There have been scads of interesting and important stories over the past year relating to the Wisconsin budget and the effects of budget changes on the state’s families. The Wisconsin Budget Project has blogged about many of those stories, and in today’s blog post it provides a list of and links to the project’s 10 most popular posts in 2011. 

UW System and Children’s Programs Hit Hard by Lapses (Cuts) Announced Today

This afternoon the Walker Administration announced its plans for lapsing $123 million to the General Fund. The biennial budget requires the Department of Administration (DOA) to allocate $174 million of lapses, and today’s announcement covers just the first fiscal year – meaning that there will be at least $51 million in additional lapses sometime during the next 18 months.  (Note: A lapse is essentially the same thing as a cut, except it doesn't reduce the base level of funding used as a starting point in developing the next budget.)

The biggest hit is to the UW System, which has to give back $46 million. Several programs for children and youths are also absorbing substantial blows. The lapses include almost $18.6 million from federal bonus funding for children’s health care, $8.3 million from the Department of Children and Families (DCF), and about $4.7 million from juvenile corrections (primarily Youth Aids).

Read more below and in the Journal Sentinel coverage of the story.

Report Reveals Wide Disparities in Wisconsin’s Health Insurance Costs and Quality

This week Citizen Action of Wisconsin released its 6th annual Health Insurance Cost Ranking. The report provides local information on cost, quality, and the rate of health insurance inflation. The study highlights a large disparity in health insurance costs between the different regions of the state, with some paying over $2,000 more per year for single health coverage.

This year's report finds the largest regional disparities yet reported. It concluded that La Crosse has the highest health insurance costs, followed closely by Eau Claire, Superior, Wausau, and Milwaukee. Citizen Action noted that because Milwaukee has a predominance of national for-profit health insurance companies, its coverage is both high cost and low quality. Madison has both the lowest health insurance costs and the highest quality, which vividly makes the point that the rest of the state’s residents are not getting the value they deserve.

The report also provides valuable insights into how to bring health care costs under control, and how Wisconsin can best implement the Affordable Care Act, the new national health care reform law. Unfortunately, Governor Walker said today that he was putting a hold on implementation of the health insurance exchanges required by that law, until the U.S. Supreme Court rules on the legal challenge to the law. (See Jason Stein’s article, posted this evening on the Journal Sentinel website.)

For some of the press coverage about the Citizen Action report, see the articles in the WI State Journal or the Green Bay Press Gazette.

Jon Peacock

A Closer Look at the Medicaid Audit, DHS Response and Senator Vinehout’s Reaction

As we noted in yesterday’s blog post, the Legislative Audit Bureau issued a comprehensive audit of the Medical Assistance (MA) program Tuesday. The LAB audit recommends that DHS should report to the Legislature’s Joint Audit Committee by next July on the department’s efforts to address the following seven issue areas raised by the audit:

• Ensuring adequate funding for contractual services before authorizing expenditures.
• Using bids to solicit the most appropriate and effective administrative services at the most competitive price.
• Reviewing existing contracted services to identify if cost savings could be achieved by using state employees.
• Considering potential benefits of enrolling recipients into HMOs more quickly.
• Developing separate accounting codes for administrative expenditures for the MA and FoodShare programs.
• Accounting for all Medical Assistance expenditures in determining total program costs.
• Developing a more detailed biennial budget request and financial reporting structure to allow for routine budgeting and accounting of all Medical Assistance costs by subprogram.

Audit of Wisconsin’s Medical Assistance Programs Released: Suggests Improvements in Program Administration and Transparency

Today, the Legislative Audit Bureau released their 100+ page report on Wisconsin’s Medical Assistance (MA) programs, including BadgerCare Plus, Medicaid, and long-term care programs. The economic downturn, as well as eligibility expansions, has increased the number of MA recipients to 1.2 million in January 2011 – boosting expenditures from $5 billion in fiscal year 2006-07 to $7.5 billion in fiscal year 2010-11. The vast majority of that $2.5 billion increase, 87%, was federally funded.

The audit report highlights a few key areas of MA, including program expenditures, administration, managing service delivery, and confirming eligibility. One particular area of interest, especially considering the national and state emphasis on managed care, was the finding that in January 2011, 61.3% of all recipients received services through managed care. Some people are not able to enroll in managed care because there aren’t HMOs serving their area, and others use fee-for-service care for things their HMO doesn’t offer. However, the audit recommends, to the extent possible, enrolling people more quickly in managed care, to control costs.

From Uninsurable to Covered: ACA a Lifesaver for Those With Pre-Existing Conditions

We are all familiar with the phrase “big things come in small packages.” For some, a specific provision in the health care reform law is just that.

In a blog post on Wednesday, we examined the impact of one of the better know parts of the health care reform law, which has enabled 2.5 million young adults to be included on their parents’ insurance plans. Today we’re turning our attention to a more obscure part of the law, which has created an insurance option for people who have pre-existing conditions that insurance companies typically won’t cover.

The value of the law’s implementation of a Pre-existing Condition Insurance Plan (PCIP) has garnered more attention over the past week – thanks to an op-ed column by a California woman, Spike Dolomite Ward. In her December 6 column in the LA Times, titled “Obamacare to the rescue,” Ms. Ward describes her experience after she recently found out she has breast cancer. Ward had been uninsured, but thanks to reforms to the healthcare system she was able to find coverage through a PCIP program in her state.

The Supreme Court Takes up New Cases on Juvenile Life Without Parole

The US Supreme Court has agreed to take up two new cases in which young juveniles (age 14) were involved in crimes that led to a life without parole sentence. Recall that through prior cases (Graham v. Florida, Roper v. Simmons) the court has ruled that offenders under the age of 18 cannot be executed and that youth under 18 in non-homicide cases should not be subject to life without parole. Some have interpreted the more recent decision to imply that life without parole for a youth at any age involved in a homicide is acceptable constitutionally, but the language of these decisions was not as conclusive, leaving open the possibility that there are other distinctions courts should make based on age, development, and culpability in a particular offense. After all, could the Supreme Court actually rule that someone as young as 10 or 11 or 12 – or in these cases as well as the Wisconsin v. Ninham case age 14 – should be subject to a life without parole sentence?

There is an excellent summary of these cases and the issues involved through the State Bar of Wisconsin – nice job by Joe Forward!                                                                                 by Jim Moeser, WCCF

2.5 Million More Young Adults Insured Because of Health Care Reform

New data released today shows that 2.5 million more young adults are covered by health insurance due to health care reform, the Affordable Care Act (ACA). Traditionally, young adults have been the population least likely to have health insurance. To address this, the ACA ensured starting in September 2010, that all young adults are able to stay on their parents’ health insurance coverage through age 26.

The National Centers for Health Statistics, at the Centers for Disease Control and Prevention, analyzed the data from September 2010 through June 2011, and found that the percentage of 19-25 year olds with health insurance coverage increased from 64% to 73%, which translates to an additional 2.5 million young people.

At a time when we’re increasingly hearing about the difficult job market for young people, it helps to know that parent’s health insurance coverage is still an option. This “big policy gift” from the ACA is one 2.5 million young adults and their families are incredibly thankful for this holiday season.

Stay tuned for a blog later this week on another gift from the ACA. Also, check out our friends at the Wisconsin Alliance for Women’s Health, who are blogging about “12 Days of Gifts from the ACA.”

Sara Eskrich

Are the Proposed BadgerCare Changes an Appropriate Test of Health Care Reform?

Health care advocates in the Save BadgerCare Coalition agree with the Department of Health Services (DHS) on at least one thing – that the BadgerCare changes proposed by DHS can’t be made without a waiver of the “maintenance of effort” (MOE) requirements of the federal health care reform law. Those provisions of the Affordable Care Act (ACA) require states to maintain their current eligibility standards and enrollment procedures until 2019 for children and until 2014 for adults, except that states with deficits may be allowed to reduce eligibility of adults to 133% of the federal poverty level.

Where many advocates disagree with DHS is on the issue of whether the Centers for Medicare and Medicaid Services (CMS) can or should give Wisconsin an MOE waiver. DHS contends the MOE standards can be waived pursuant to the portion of federal Medicaid statutes (sec. 1115) that allows CMS to approve demonstration waivers. A new WCCF brief explains why we strongly disagree with the DHS argument.

Fact-checking PolitiFact

W-2 Costs Far Less than Article States

The Journal Sentinel ran a PolitiFact column Sunday on the subject of Tommy Thompson’s statement on December 1 (while announcing his candidacy for the U.S. Senate) that while he was governor, "we ended welfare." For what it’s worth the Journal Sentinel gave that statement a rating of “mostly true,” but that’s not what caught my attention.

The PolitiFact column states, “In October 2011, the number of people in W-2, which is budgeted to cost $626 million in state and federal funds in 2010-2011, was nearly 16,000.” The $626 million figure is actually the total budgeted in that fiscal year for W-2, child care and a variety of other programs funded from the federal block grant that replaced the old welfare program (Aid to Families with Dependent Children). The largest share, $341 million, was for child care subsidies.

Feds approve a portion of DHS changes to BadgerCare, but other parts will have to wait

A federal official at the Centers for Medicare and Medicaid Services (CMS) announced today that the agency probably won’t be able to act as quickly as the Walker Administration had hoped on a long and complicated waiver request that would allow the state to make sweeping changes to BadgerCare. However, the letter from CMS to Secretary Dennis Smith of the Wisconsin Department of Health Services (DHS) clears the way for the state to begin implementing some portions of its proposals.

Walker Administration Vacillates on Response to Health Care Reform

Continued Debate over a Slight OCI Technical Change Is Telling

Although officials in the Walker Administration have said on a number of occasions that they plan to implement the Health Insurance Exchanges required by the Affordable Care Act (ACA), we still haven’t seen the Exchange legislation that they said we could expect in the fall. Whether they still plan to carry through on their commitment to introduce such legislation is no longer clear.

One of the few visible signs of activity relating to ACA implementation has been Assembly Bill 210, which is the derailed bill that was developed by the Office of the Insurance Commissioner (OCI) and would fold into state law several health insurance industry reforms in the federal Affordable Care Act (ACA). The debate relating to that bill has taken a couple of surprising twists in recent weeks, as the Walker Administration approved and then rescinded an emergency rule to put a key part of AB 210 into place.

Medical Loss Ratio: A Recent Win for Consumers, and Hopeful News for Wisconsin

What may sound like a wonky insurance industry term is poised to have a real impact on health care consumers through the health care reform law. Recent regulations and developments around implementation of the medical loss ratio (MLR) standards have been in the news both nationally and in Wisconsin in recent weeks and months.

The Affordable Care Act (ACA) ensures that insurance companies are spending 80 to 85 percent of premium dollars on medical care and health care quality improvement – rather than administrative costs and profit. This past Friday, the final rule from the federal Department of Health and Human Services (HHS) regarding the MLR provision of the ACA was released.

Fifty Groups Sign Letter Opposing Waiver for Proposed BadgerCare Changes

Fifty Wisconsin organizations sent a letter to HHS Secretary Kathleen Sebelius late last week urging her to deny the recent request from the Wisconsin Department of Health Services (DHS) for a waiver of federal maintenance of effort (MOE) requirements. As WCCF explained in a short summary of the DHS proposals, the proposed waiver is expected to adversely affect more than 168,000 Wisconsinites, including more than 64,000 who DHS expects to lose their BadgerCare coverage.

According to the December 1 letter:

“The effects of the changes proposed by DHS are clearly at odds with congressional intent to significantly reduce the number of uninsured Americans by building on the Medicaid and CHIP coverage that states already have in place. …Approval of the DHS waiver request would be very damaging for Wisconsin and a dangerous national precedent.”

New Study Finds Copays Are Harmful for Heart Patients

Just as Wisconsin was submitting proposals to federal officials to significantly increase BadgerCare premiums and copays, a new study added to the evidence that increased cost-sharing can be counterproductive.

The study published in the November 14 New England Journal of Medicine examined the effects of drug copays for patients who have been discharged from a hospital after experiencing a heart attack. The study found that eliminating copays had the following effects:

• The patients who didn’t owe copays for their heart medication were more likely to take the drugs they were prescribed.
• They experienced “fewer heart attacks, strokes, and other vascular events.”
• The improved outcomes were achieved without a significant change in spending by the insurer.