Many Wisconsinites could lose their access to health care services if a new set of Walker administration proposals is approved by federal officials.  The proposals formally unveiled today by the Wisconsin Department of Health Services (DHS) would adversely affect thousands of childless adults who have incomes below the poverty level and who rely on BadgerCare for their health care.

These proposals (summarized here) would significantly increase the number of uninsured Wisconsinites, make our state less healthy, and impede efforts to increase the Wisconsin workforce. There are far more effective ways to use scarce state funding to remove barriers to employment and expand the number of Wisconsin workers.

DHS is seeking federal approval to waive laws that currently prevent Wisconsin from implementing these changes to BadgerCare for adults who don’t have dependent children:

• Charging monthly premiums for almost all childless adults below the poverty level;
• Imposing a 48-month eligibility limit;
• Requiring drug screenings as a condition of eligibility; and
• Making referrals to treatment programs for those who test positive for drug use.

The proposed waivers would impede our state’s ability to achieve three key goals set by Governor Walker: expanding the Wisconsin workforce, avoiding having a coverage gap in our state’s health care system, and cutting in half the number of uninsured Wisconsinites.

The 48-month time limit is likely to cut off care for some of the people who need Medicaid the most – adults with chronic conditions.  Although it includes some exemptions, those do not apply to individuals with substance abuse diagnoses.  Substance abuse is a chronic disease, and many BadgerCare participants may need some kind of treatment beyond the 48-month lifetime limit in order to help them stay drug free and participate in the workforce.

The proposal that is likely to have the largest negative effect on insurance coverage is the plan to charge premiums for almost all childless adults participating in BadgerCare.  Dozens of studies have found that even small increases in premiums cause many low-income people to lose their insurance coverage.

This proposal would require monthly premiums to be paid by single childless adults making more than $200 per month, so it would adversely affect people who are nearly destitute and who often do not have checking accounts or credit cards.  For many of those adults, it would be easier for them to go back to the ranks of the uninsured and rely on emergency rooms as their fallback source of health care, which will cost all of us much more in the long run. Trying to collect small monthly premiums will also be a tremendous headache for the local agencies charged with that task.

The drug screening/testing measures, like the required premiums, will be expensive to administer. The state could use the funding far more effectively to remove barriers to employment, including the shortage of drug treatment and prevention programs.  Since we already have waiting lists of people who need and want drug treatment, spending scarce state dollars on new screening and treatment requirements will add to the waiting lists and divert resources from more effective solutions.

In short, the proposed waivers wouldn’t only hurt low-income adults now participating in BadgerCare.  Those changes would also result in a less healthy workforce and a significant increase in the uncompensated care costs that hospitals shift onto their insured patients. And they will waste state funds that could be used to implement far more effective strategies for expanding the Wisconsin workforce by removing barriers to work.

A short WCCF summary of the proposals can be found here. DHS is accepting comments on the proposals until May 19, and plans to hold two public hearings (April 26 in Wausau, and May 1 in Milwaukee).  You can submit comments on the proposals by attending one of the hearings or by going to this WCCF webpage.

Jon Peacock