As ACA deadline looms, new numbers show more Wisconsinites may fall between cracks

The deadline to get insurance policies from HealthCare.gov is Sunday, it’s worth looking at what has been happening for Wisconsin and the ACA in recent years. With that in mind, Capitol reporter Steven Walters has a rundown which shows new research which indicates that fewer Wisconsinites are getting their insurance through the Obamacare exchanges.

One in four Milwaukee County residents who got health care through the Affordable Care Act (ACA) in 2017 did not get ACA coverage this year, according to the UW-Madison Institute for Research on Poverty.

In 2017, 242,863 Wisconsin residents statewide – including 38,843 in Milwaukee County – enrolled in marketplace exchanges for ACA health care. This year, the statewide number fell to 205,118 – a drop of 15.5 percent. That was more than twice the 6.5 percent drop in ACA enrollees nationally, according to the Kaiser Foundation.

The drop was even greater in Milwaukee County, where the number of ACA enrollees dropped to 28,320 – a 26 percent decrease – this year.

It seems likely that the number of Wisconsinites getting insurance through the exchanges will drop again for next year, as the state had less than 95,000 signups through the end of last week, down more than 106,000 at this time last year. (click here to check each state’s newly updated totals).

Walters also quotes UW researcher Donna Friedsam who says that the largest numbers of ACA policyholders aren’t young adults, but older ones.

Friedsam also said research has shown that Wisconsin residents between ages 55 and 64 are most likely to rely on the ACA for health care. Between 35 percent and 38 percent of the 205,118 ACA enrollees in Wisconsin this year may be in that age 55-to-64 age bracket, she estimated.

ACA participation “definitely skews toward that older group of people who are nearing retirement but not eligible for Medicare,” Friedsam said.

Low-income residents are now the ones struggling to be able to afford the ACA, Friedsam said. “They are the ones making $7 or $8 per hour,” and would likely have been covered by Gov. Tony Evers plan to expand Medicaid, [Wisconsin Health Services Secretary Andrea] Palm added. Republican legislators, however, killed that plan.

In other words, those low-income people might not get any kind of health coverage through the exchanges because it won’t fit their needs, either due to high premiums or insufficient coverage.

That adds up, as Wisconsin had a minor increase of 4,000 uninsured people for 2018, and that was before fewer people signed up for the ACA in Wisconsin for 2019. What’s also concerning is that more Wisconsinites should be signing up, if the state’s Medicaid enrollment is any indication.

Medicaid enrollments have generally declined over the last 2 ½ years in Wisconsin (Badgercare Plus totals are now at 774,000 vs more than 790,000 in May 2019) but what’s remarkable is how many of those enrollees have shifted into income extensions for their BadgerCare. Income extensions happen when someone makes enough money to get above the poverty level, and it is intended to keep people from getting cut off of Badger Care as soon as that happens.

A BadgerCare Plus extension is a period of eligibility given to a person when the assistance group's income increases above 100 percent FPL (Federal Poverty Level) either due to an increase in earned income and/or spousal support and otherwise meets the BadgerCare Plus eligibility criteria for people with incomes below 100 percent FPL.

A parent/caretaker relative or pregnant woman can enter an extension due to an increase above 100 percent FPL in the assistance group’s earned income, spousal support, or both. The children, stepchildren, and NLRR children of the parent/caretaker will also enter the extension at this time, provided they are under age 19, living with the parent/caretakers, and meet the income requirements outlined in Section 18.1.3 Children.

These extensions last up to a year, and the amount of Wisconsinites that are getting them in the last year have more than doubled.

At the same time, the number of children and parents/caretakers getting BadgerCare has notably declined.

Logically, those charts mean that a lot of the children and parents/caretakers were given extensions, and those extensions will be ending in the near future. This also would seem to be the group of people that would then look to the ACA exchanges to get their insurance for 2020, but the signup numbers in Wisconsin don’t indicate that.

This could be a good thing, as it may mean that Wisconsinites are getting enough money and job security to get their health insurance through their jobs. But it also could mean tens of thousands of Wisconsinites are falling through the cracks, and many might end up with no insurance whatsoever.

The figures on ACA signups and BadgerCare enrollments reiterate the foolishness of the Wisconsin GOP’s decision not to expand Medicaid for individuals that are slightly above the poverty line. Not only would we not see all of these people in danger of losing their health insurance and/or ending up with lesser coverage through the ACA exchanges, but we’d have the federal government paying another 32% of the bills for everyone that’s on BadgerCare!

Granted, nearly half of last year’s ACA signups happened in the final week of enrollment, so we’ll have a better idea of how many Wisconsinites will get insurance through the Obamacare exchanges later this month. But if it continues to lag and if the number of income extensions keep growing, there is a potential squeeze play coming up on tens of thousands of Wisconsinites that needs to be monitored.