Rumored Plan Would Improve Access for Childless Adults, But at What Cost for Low-income Working Parents?
Governor Walker will make an announcement Wednesday regarding his plans with respect to Medicaid and BadgerCare. The Milwaukee Journal reported this afternoon that the Governor is expected to announce that the state won’t take the federal funding provided by the Affordable Care Act (ACA) to close the current gap in BadgerCare for low-income adults who don’t have dependent children. But the article says the Governor will propose an alternative, which will extend BadgerCare to a smaller number of childless adults.
When we see the details tomorrow, perhaps we will conclude that the Governor’s plan is at least a modest step toward improving access to care – albeit a very disappointing missed opportunity to use the federal health care reform law to do much more. But whether it’s a positive step in the right direction will depend on whether and to what extent the proposal eliminates existing BadgerCare coverage for low-income working parents and causes significantly more parents to become uninsured.News of the Governor’s decision was initially leaked to conservative blogger Christian Schneider, who works for the Wisconsin Policy Research Institute. According to the Journal Sentinel article, Schneider “cited anonymous sources Tuesday in first reporting that Walker will propose taking a middle path to dealing with the health programs in his budget bill being introduced on Feb. 20.” Schneider wrote:
“The centerpiece of Walker’s plan will be lowering eligibility standards for some categories of Medicaid recipients, pushing those recipients into the new federal exchanges that will be set up under the ACA. That move opens more slots for childless adults in the Medicaid program.”
The tradeoff Schneider describes doesn’t sound unreasonable, at first blush. However, I fear that it could result in a large increase in uninsured parents and very large boost in costs for many other families who are barely scraping by. There are two major problems with the argument that we will simply move parents into the new exchange marketplace – especially if that change is applied to all adults over the poverty level:
1) Many families, even very low-income families, won’t be eligible for the exchange subsidies. – A family is ineligible for those subsidies if a parent has an offer of an employer sponsored plan with premiums (for employee-only coverage) costing less than 9.5% of family income. That standard may exclude the family regardless of how expensive the co-pays and deductibles are and regardless of the cost of premiums for a family-based plan.
2) Families eligible for the subsidies may still be unable to afford private coverage through the exchange. – The cost-sharing plan that Congress developed was not intended by Congress to apply to low-income parents with income barely above the poverty level. The intent of Congress was that parents below 138% of the poverty level would get Medicaid coverage with minimal cost sharing.
There are close to 90,000 Wisconsin parents in BadgerCare or Medicaid who have incomes over the poverty level (about 68,500 in BadgerCare and roughly 21,000 in Transitional Medicaid). Depending on what the Governor proposes, many of them could lose their BadgerCare eligibility and become uninsured. If that’s the case, the Governor’s plan will hardly look like a “middle path” to those parents and their families.
Jon Peacock
