Governor’s BadgerCare Changes Raise the Stakes for New Marketplace’s Success or Failure 

The Wisconsin Council on Children and Families (WCCF) sent a letter to Governor Walker Monday urging him to fully or partially veto a provision added to the budget bill that could reduce the effectiveness of the health care reform law. The amendment in question, which was added by the Joint Finance Committee, requires the Office of the Commissioner of Insurance (OCI) to license and regulate the people who will be helping Wisconsinites sign up for health insurance through the new Marketplace that begins providing access to federally-subsidized coverage next year.

Under the Governor’s budget bill, that Marketplace will need to cover not only a large portion of the more than 500,000 uninsured Wisconsinites, but also about 90,000 parents that the bill eliminates from BadgerCare, and many of the more than 24,000 people currently in the state and federal high risk insurance pools.  Parents with incomes over the poverty level who are enrolled in BadgerCare in November will be sent letters late that month telling them their coverage will end on January 1, 2014.  They will only have a few weeks to get signed up for coverage through the Marketplace or they will find themselves uninsured in January.

Because the changes to BadgerCare in the Governor’s budget are premised upon the assumption that the federally-run Marketplace will be successful, that’s one more reason why the state needs to find new ways to help people sign up for private insurance coverage, rather than adopting restrictions on enrollment assistance that suppress participation. The letter to the Governor from WCCF’s executive director, Ken Taylor, says “The change that is currently in the bill is likely to prevent many health care organizations that already provide some of those types of assistance… from continuing to do so.” It’s unclear to me whether Governor Walker and other GOP Governors actually want the new Marketplaces to work. On the one hand, this is a very centrist aspect of health care reform, and it will significantly reduce the number of uninsured. In addition, it’s a way to bring federal dollars into the state that most fiscal conservatives find far more palatable than expanding Medicaid. On the other hand, some conservatives hate everything connected to the ACA and think it would be a political boon to Republicans if the federal law is a catastrophic failure.

It’s one thing to secretly or not-so-secretly hope for the law to fail, but it’s something else to take actions that cause or at least contribute to that failure. That’s a very high risk strategy for a politician, especially if the ACA succeeds elsewhere – in states that have been working hard to implement it effectively. And impeding the success of the Marketplace would be particularly risky for any politicians who shrink Medicaid eligibility based on the premise that the people losing that insurance will be served well in the federally subsidized Marketplace coverage.

In recent months we’ve been encouraged by statements that the Wisconsin Dept. of Health Services has made about trying to make the ACA succeed. Whether the Walker Administration truly means that could be elucidated by the types of regulations the state imposes upon enrollment assistance.

We think an important step would be to move the restrictive language from the budget bill.  As the WCCF letter to the Governor states, a veto of that language:
“would provide an opportunity outside the budget process to develop regulations and, if necessary, statutory changes that have been more carefully vetted and don’t have the unintended consequence of limiting the consumer assistance that will be so vital to making the new health insurance Marketplace a success.”

Jon Peacock