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. According to DHS, the proposed BadgerCare changes that would be authorized by a waiver are very similar to some aspects of the Affordable Care Act (ACA) that will take effect in 2014, such as the restrictions on eligibility for premium subsidies for insurance purchased through the new Health Insurance Exchanges, among families that have offers of employer-sponsored coverage. DHS argues that because of the purported similarities the waiver should be approved so Wisconsin can essentially run a pre-test of parts of the ACA.

The short paper posted on our website this week provides a side-by-side comparison of the relevant portions of the ACA and the proposed changes to BadgerCare that require a waiver. It concludes that although a few of the changes proposed by DHS bear a faint resemblance to parts of the ACA, the department’s BadgerCare proposals go in a much different direction. For example, the ACA preserves and builds upon Medicaid and CHIP, to significantly reduce the number of uninsured Americans, while the DHS proposals would erode BadgerCare eligibility and participation and would knock more than 64,000 Wisconsinites out of BadgerCare.

Comparing the DHS proposals to change BadgerCare to the provisions of the ACA is like comparing Sweeney Todd to The Sound of Music.  Sure there are a few elements in common, but as you are making your entertainment plans for the holidays, would you plan to take your young children to see Sweeney Todd to test whether they are ready for the Sound of Music or the Nutcracker Suite?  If Ticketmaster tells you that the Nutcracker and The Sound of Music are sold out, but suggests Sweeney Todd instead, I suspect you wouldn’t waive your parental common sense.

Jon Peacock