BadgerCare Protection Act Unveiled Today

Proposed Bill Would Avoid Damaging Cuts to BadgerCare by Closing Corporate Tax Loophole

At a press conference in the Capitol today, Representative Jon Richards (D-Milwaukee) and Senator Jon Erpenbach (D-Middleton) unveiled a bill that would stop the Department of Health Services (DHS) from implementing changes to BadgerCare that would result in tens of thousands of Wisconsinites losing state health care coverage. They were joined by several Wisconsin families who depend on BadgerCare for their health care.

The BadgerCare Protection Act would restore to state legislators the authority to set BadgerCare policy.  It would prohibit DHS from implementing higher cost sharing requirements and other changes to BadgerCare that could result in tens of thousands of people losing coverage and more than 260,000 experiencing reduced benefits and substantially larger co-pays.  (An overview of the changes proposed by DHS and the number of people potentially affected can be found on the WCCF website.). The bill would be funded by repealing a new corporate tax loophole in the biennial budget that costs state taxpayers about $40 million annually, without requiring the creation of a single job.

Who Should Decide State Health Care Policy?

AB 531 Would Strip the Executive Branch of Its Authority Relating to Health Care Reform

We all learned in high school that American democracy succeeds by striking a balance between the power of the legislative, executive and judicial branches of government. However, in Wisconsin that balance was disrupted last year when almost all the authority for Medicaid and BadgerCare policy making was shifted to unelected officials in the Dept. of Health Services.  Now some legislators are proposing a bill that is at the opposite end of the spectrum because it would strip our state’s executive branch of its typical duties with respect to one particular area of health care policy – implementation of the federal health care reform law.

I can certainly understand how legislators would want to ensure that they have the authority to approve the development of a health care exchange in the state.  However, I think the proposed bill, AB 531, goes much too far in shifting executive branch authority to the legislature.  For example, the governor shouldn’t have to get the permission of the legislature every time he wants to allow an agency to accept federal funding (particularly when the legislature isn’t in session).  Also, the legislature already has the authority to review and suspend agencies’ administrative rules.  It’s going too far to preclude an agency from proposing a rule unless and until the legislature passes a law explicitly allowing it to be developed.

The Impact of Concentrated Poverty on our Future: A Disconcerting Trend and an Opportunity for Change

The Annie E. Casey Foundation has released a Data Snapshot on High Poverty Communities, highlighting the growth in the number of children growing up in neighborhoods with high levels of poverty (defined by census tracts with poverty rates of 30 percent or more) around the country and in Wisconsin.  As the Snapshot illustrates, the research is clear that growing up poor is always a challenge, but that challenge is made much more difficult when growing up poor in a poor neighborhood and the outlook for children is much less promising.

Think about the things you know that contribute to positive outcomes for children – things like access to transportation, reasonable access to family-supporting jobs, safe housing and safe neighborhoods, quality early child care, quality schools, access to health care, neighborhood groceries with healthy and reasonably priced food,  and opportunities for children and youth to engage in pro-social positive youth development activities.  Now, think about how much more difficult it is for a low income family to access those things when they don’t exist in their neighborhood or community.

Over the last decade, the number of children living in low income neighborhoods nationally has increased by 25 percent, reversing the trend in the prior two decades.  In Wisconsin, an estimated 107,000 children live in poor neighborhoods, a 53 percent increase since 2000, twice the national average growth. 

Thursday Hearing on Bill to Lift Family Care Cap

And DHS Schedules Town Hall Meetings on Long-term Care Cost-Savings

The Assembly Aging and Long-Term Care Committee has scheduled a hearing for tomorrow, Feb. 23, on the bill to lift the cap on Family Care, SB 380 (and on the Assembly version of the same bill, AB 477). The hearing will be in Room 417-N and begins at 10:00 a.m.  Read more about the hearing in today's update from the Disability Advocates Awareness Network (DAWN).

After the Senate unanimously passed the bill a couple of weeks ago, advocates are very optimistic that it will be approved in the Assembly, although it’s possible that the bill might be amended.

As I have written previously, the Family Care bill does not contain an appropriation because the intent of the Dept. of Health Services (DHS) is to offset the estimated $71.9 million cost of removing the cap and expanding Family Care by adopting a number of cost-cutting changes or “efficiencies” in the state’s long-term care services. DHS has scheduled a series of town hall meetings to solicit public feedback on its plans to reform long-term care.

Assembly Advances a Constitutional Constraint on Budget Practices

AJR 100 Would Make Wisconsin the Only State to Constitutionally Require GAAP Accounting

Tonight the Assembly voted by a sizeable margin, 69-25, to approve AJR 100, which would put key details of fiscal policy into the Wisconsin Constitution.  An amended version of the resolution now moves on to the Senate.  If it is approved there, AJR 100 will still need to be approved by the Legislature in 2013 or 2014, and will then have to go to a public referendum.   

A Wisconsin Budget Project Blog post explains the resolution and the amendment to it that reduced some of the opposition to AJR 100 in the Assembly.  That blog post also lays out a number of significant questions about the resolution that Senators and the public should grapple with over the next couple of weeks, before it comes to a vote in the Senate.  

Often times, people on opposite sides of an issue will frame that issue differently.  But in this case, the proponents and opponents describe the fundamental question in essentially the same terms, yet arrive at opposite answers.  That question is whether Wisconsin should become the first state to tie the hands of future legislators by prohibiting them from passing any bill that would cause or increase a GAAP deficit in any budget fund, regardless of the state’s economic and fiscal circumstances.  Read more in the new Budget Project Blog post.

Jon Peacock

Just What Are Our Youth Up To? Youth Risk Behavior Survey Shows Positive Results as well as Areas that Need Improvement

Too often our public policy and investments related to youth are informed not so much by fact as by myth, popular media, and catchy headlines.  What we do know is that the vast majority of youth today are responsible, productive, pro-social, and engaged in the business of growing up to be contributing members of our communities.  Understanding the challenges they face, the decisions they are making, and the opportunities we need to provide that promote positive youth development can be informed by the latest results from the WisconsinYouth Risk Behavior Survey recently released by the Department of Public Instruction (DPI). The survey has been conducted every year since 1993. It is part of the Centers for Disease Control and Prevention’s nationwide endeavor to assess health and risk behaviors among high school students.  These data indicate that there are some positive trends, but also many areas that could use some work, including:

Ever Wonder How Many Youth are in Placement around the State on a single day?

The National Archive of Criminal Justice Data has recently released census information for 2010 of the number of juveniles placed in juvenile residential facilities in each state. The data can be reviewed through Easy Access to the Census Juveniles in Residential Placement 1997-2010, including data for both secure (juvenile corrections, juvenile detention) and non-secure (group homes, residential treatment centers, etc.). The data is a snapshot of youth in residence on a single day in 2010, and for Wisconsin the data highlights:

• The continuing racial disproportionality of youth in placements, with approximately 61% of children in placement being children of color;
• Nearly one-half (45%) of juveniles in placement have listed some form of person offense as their most serious offense;
• The vast majority (84%) of youth in placement were boys.

Within this website, there are tools you can use to further define some of the data, although it is not available on a county-by-county basis. So, you can go into the site and select various tables/data to highlight.

What we do know from the best available research is that while out-of-home placements can be a useful tool to use to help stabilize and support a youth getting back on track, removal from their community also has some negative impacts. Therefore, supporting efforts to keep kids living in the community, where they need to learn to grow up, is the best strategy in most cases.  Enjoy!!!       by Jim Moeser

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.

Hearing Set for Thursday (Feb. 9) on Family Care Bill

The Senate Committee on Health announced today that it will hold a public hearing this Thursday, Feb. 9, on SB 380, which removes the cap on enrollment in Family Care and other long-term care programs. The hearing is scheduled to start at 11:00 a.m. in Room 201-SE in the Capitol.   Note that there are also two other bills on the agenda, which I suspect the committee will take up first (to get those done before considering the bill that is likely to draw a lot more testimony).   

Happy Birthday to CHIPRA: A Time to Celebrate—and Maintain—our Progress on Covering Kids

February 4 is the third anniversary of bipartisan legislation that strengthened the Children’s Health Insurance Program (CHIP), the federal program that, in tandem with Medicaid, makes BadgerCare possible in Wisconsin. This anniversary provides a great opportunity to reflect on our progress in making sure kids have access to health care, and focus on what it will take to finish the job of extending health coverage to all children in the state.

In the three years since the reauthorization of CHIP, the nation has made dramatic gains in covering children. Thanks to BadgerCare and Medicaid, 469,000 Wisconsin children can get the preventive care they need to stay healthy, and see a doctor when they get sick or injured.  Big improvements in streamlining the process of obtaining coverage have been made nationwide. In the past year alone, 25 states have reduced the amount of red tape in their CHIP and Medicaid programs. Here in Wisconsin, over 90,000 children have gained coverage in the past three years -- progress worth celebrating, even as we recognize that there is more work to be done.

Feds Issue 2012 Poverty Level

Three Percent Increase May Help Some Families Qualify for Benefits

Late last week the federal government released the 2012 Federal Poverty Income Guidelines, better known as the "federal poverty level" (FPL). Wisconsin uses the guidelines to determine eligibility for a number of public assistance programs, such as BadgerCare and child care subsidies (Wisconsin Shares). See the new guidelines on the WCCF website: Tables for Annual, Monthly and Hourly Earnings at Various Percentages of the Poverty Level.   

The new guidelines are about 3 percent higher than the ones used in 2011, which had grown only 0.6 percent in the previous two years combined (relative to the 2009 level). In the short run, the increase in the poverty level may make additional families eligible for public benefits, such as BadgerCare, or may decrease their cost-sharing. Of course, over the longer haul such gains usually evaporate – if or when families enjoy wage increases that track the cost of living.

The Budget Bill’s Hidden Tax Hike for Struggling Wisconsinites

Low-wage Workers and Seniors Will Pay Millions More in Property Tax

The 2012 poverty level was announced late last week, and the new income level for a family right at the federal poverty level (FPL) is now about 3 percent higher than it was in 2011, which reflects an increase in the cost of living. The change in the poverty level raises the eligibility ceiling for most public benefits, such as BadgerCare, child care subsidies, Wisconsin Works (W-2) and Food Share.

One very important program for low-income households that is not being adjusted to reflect the cost of living is the Homestead Tax Credit. That credit provides targeted property tax relief for nearly 250,000 Wisconsinites with annual incomes of less than $24,680. A new issue brief by the Wisconsin Budget Project examines how the decision in the last budget bill to stop adjusting the credit each year will be very costly for low-income Wisconsin households.

Proposed Bill Would Deny Child Tax Credit to Immigrant Families and Children

As tax time is approaching, and the next round of negotiations regarding the payroll tax cuts are gearing up, a bill to deny the Child Tax Credit for those filing with an individual taxpayer identification number (ITIN) is also moving in Congress. The bill, titled Refundable Child Tax Credit Eligibility Verification Reform Act, would require a Social Security number to receive a cash refund through the Child Tax Credit. Currently, those filing with an ITIN can also receive the child tax credit. This has been proposed as a way to fund the payroll tax cut.