Most children and families in Wisconsin are covered by private health insurance, but many people will tell you that the private insurance market is not working for children and families. Too many find themselves underinsured – losing their coverage when they need it most because they have cancer and hit their annual limit on coverage, or finding that due to a preexisting condition, the insurance they have doesn’t cover the care they need.
The Affordable Care Act (ACA) provides an opportunity to remedy some of these abuses in the insurance industry, but it’s up to states to implement many of the provisions. Unfortunately, Wisconsin has been slow and taking a bare minimum approach to ACA reforms, or ignoring the law altogether.Early in the session, a bill was introduced that would have written the consumer protections in the ACA into state law. Dubbed the Patient’s Bill of Rights, it included such non-controversial policies as not allowing rescission of plans (canceling policies) for unintentional mistakes on applications; ensuring that children (and adults in 2014) are not denied health coverage due to preexisting conditions like asthma and diabetes; removing lifetime limits for health care coverage, which some premature babies reach in only their first year of life; and complying with readability standards for insurance policies.
By failing passing this bill, the Legislature left us at the whim of the Supreme Court and Congress. The families of 58,000 children who are now protected from lifetime limits on coverage in Wisconsin could be left with debt from medical bills not covered during costly illness. Count this one in the “missed opportunity for kids and families” column.
Another major missed opportunity was the lack of progress on a Wisconsin health insurance exchange. By refusing to utilize federal funding for a state exchange to enable people to more easily purchase private health insurance, the state is likely to be left with the federally-facilitated Exchange model. A state exchange would have better enabled Wisconsin to coordinate eligibility and enrollment with private, subsidized coverage in the Exchange and to build on advances the state has made in reducing red tape and improving online enrollment. Exchanges also ensure that people aren’t underinsured by providing a set of minimum essential health benefits.
This marketplace approach to coverage would greatly benefit the underinsured and uninsured in Wisconsin, particularly those who may lose their BadgerCare coverage due to recently approved program changes. The fact that the state used a provision in the ACA that enabled them to eliminate Medicaid eligibility (or raise premiums and enhance crowd-out rules, as the state did) for parents and adults above 133% of the federal poverty level, without ensuring the alternative coverage mechanism of a state exchange and subsidies, demonstrates that lawmakers’ goal is not to ensure that “it’s working for underinsured kids and families.”
Another very disappointing change the Legislature made was to scale back the state law allowing adult children to remain on a parent’s employer coverage until age 27. Legislators and the Governor reduced that to age 26, based on the argument that they wanted to be consistent with the ACA minimum standard, which is odd given that they are unwilling to implement most aspect of that law.. This has unfortunately been the norm in the state: using the ACA floors to weaken stronger state policies. We looked at how the BadgerCare changes are inconsistent with the ACA in a recent publication.
Health care reform is currently the law of the land. We had opportunities to ensure better protections for underinsured children and families in Wisconsin by writing the consumer protections into state law, authorizing and working towards a state health insurance exchange, and ensuring dependent health coverage up to age 27. Unfortunately, the Legislature and administration have decided not to move forward with these protections, but instead to use the minimum standards in the ACA as an excuse to scale back state law.
We’ll soon learn whether the Supreme Court upholds the ACA. Regardless of the outcome of that case, health care reform is badly needed, and state lawmakers need to start working together to improve Wisconsin’s health care system. In the weeks and months ahead, please ask candidates what they will do to ensure that Wisconsin families have access to quality, affordable health insurance that doesn’t fail them when they need it most.
Sara Eskrich
This is one in a series of blog posts providing perspectives on some of the state policy changes and fiscal decisions made during the past legislative session, and the impact they are having on Wisconsin’s children and families. We hope the public will consider these impacts and will urge candidates to talk more about these issues as elections approach. The views expressed in each post are solely those of the author and do not necessarily reflect the positions of WCCF or the opinions of authors of any of the other posts.