Monday, May 19, 2014

More in Wisconsin getting health care- which makes Walker's choice look worse

With April being the first month that had Wisconsin expanding BadgerCare Plus to all childless adults and removed all coverage for low-income parents and caretakers that were above the poverty line, as part of the state's policies in light of the Affordable Care Act (aka Obamacare). So you could expect big changes, and that the results of those changes would be looked at closely.

There is a wealth of information at the Wisconsin DHS's Medicaid Stats page, and a number of ways to break down the numbers. I would strongly suggest you give a look and do so. One of the ways to slice up the data is to look at the various categories of people enrolling in Medicaid, and the changes in those categories each month. And that certainly was the case.

Change in Enrollment, BadgerCare Plus, April 2014
Childless Adults +82,217
Children +3,140
Parents/Caretakers -44,089
Income Extensions -6,782 (these are people allowed to stay on for a few months even if their income is over the BadgerCare thresholds, since they may not have health care immediately at a new job)

This now means that more people are enrolled in BadgerCare Plus since June 2012, reversing a relatively steady decrease in BadgerCare enrollees since Governor Walker took office in 2011. Interestingly, Walker decided to crow about this, as some kind of proof that his "reforms" of Medicaid were working.
“Our entitlement reforms make sure Medicaid is a safety net for our state’s neediest citizens and protect Wisconsin’s taxpayers from the uncertainty surrounding the federal government’s implementation of the Affordable Care Act,” said Governor Walker. “Due to our reforms, 81,731 people living in poverty now have health care through Medicaid, and Wisconsin is the only state to not take the [Affordable Care Act's] expansion with no health coverage gap.”

In addition, DHS announced 62,776 people with incomes above the federal poverty level needed to transition into the marketplace at the end of March. Individuals above the poverty level are able to access federal subsidies and can choose to purchase plans through the federal exchange or in the private market.
While Walker is correct that Wisconsin stands alone among the Confederate states that refused to accept Obamacare's Medicaid expansion while still allowing all of its poverty-stricken to be covered by health insurance, that hardly leaves him off the hook for turning it down. In fact, Walker's "creative" reforms now look like they'll cost Wisconsin taxpayers even more than originally thought.

This is because the 82,000+ enrollments are well beyond what was expected, and budgeted for, when Walker and the WisGOP Legislature signed off on these "reforms."
[A]pproximately 83,000 childless adults who expected to begin enrolling in MA on January 1, 2014, would remain ineligible through March 31, 2014. Under Act 20 [the state budget], it was assumed that 50% of these individuals would enroll in the first month of eligibility, 20% in the second month, and 5.8% in the third, with the percentage decreasing in subsequent months until all newly eligible individuals would be enrolled by December, 2014. The current estimate is based on the Act 20 assumptions regarding the rate at which newly-eligible individuals enroll in the program, but enrollment would begin on April 1, 2014, rather than January 1, 2014.

When compared to Act 20, this delay in enrollment for childless adults would result in approximately 253,200 fewer member months that would be funded during the 2013-15 biennium. The average PMPM for these individuals, after premiums and drug rebates is estimated to be $368, so the savings resulting from the three-month delay are estimated to be approximately $76.0 million ($31.1 million GPR and $44.9 million FED) in 2013-14 and $19.0 million ($7.8 million GPR and $11.2 million FED) in 2014-15.
In other words, Walker's DHS projected 41,500 childless adults would sign up in the first month of the modified BadgerCare Plus, and that number was only projected to be at 63,000 by the end of June. We had double the projected amount of enrollments in the first month, and more is sure to follow as others move into the system in the coming months. And given that we're paying nearly 42% of those costs, this will throw away a whole lot of those projected "savings" in 2013-14 from delaying enrollment for three months, and lead to higher costs in the next fiscal year.

Another positive effect of Obamacare will lead to Walker's decision to TeaBag it even more costly for state taxpayers. The attention given to the signup period for the ACA seems to be driving more people into finding out what benefits they are entitled to, and this also has added to the number of people getting coverage, even if it's not directly through the Affordable Care Act. As a recent article from the Miami Herald took note of.
New Medicaid signups were expected in the 26 states that implemented the so-called "Medicaid expansion" that extended program coverage to working-age adults who earn up to 138 percent of the federal poverty level.

But in 17 of the 24 states that didn't expand their Medicaid coverage, program enrollment also increased thanks to the "woodwork effect," created by heightened public awareness of the health law.

The woodwork effect refers to Medicaid-eligible residents who weren't enrolled, but came "out of the woodwork" to do so amid national efforts to get newly-eligible Medicaid residents to sign up.
This certainly has happened in Wisconsin, as the DHS reports show a sizable increase of Wisconsinites in poverty in addition to the 82,200+ childless adults that got coverage.

BadgerCare recipients at or below poverty line
Dec 2013 290,802
Apr 2014 309,044 (+18,242, +6.3%)

Parents/ Caretakers
Dec 2013 150,646
Apr 2014 170,442 (+19,796, +13.1%)

So there's another 38,000 added to the rolls with state taxpayers shelling out 42% of those costs. And given that these people and their families are in poverty, there aren't much in terms of premiums and co-pay to offset those costs. So the $96 million in projected extra costs that state taxpayers are taking on in this budget due to the decision to TeaBag Obamacare in Wisconsin could well go higher.

It is also ironic to hear Walker try to portray himself as an expander of health coverage, because these moves reverse what he had done to childless adults in Wisconsin before this "reform." Childless adults made up 34,047 of the state's BadgerCare Plus recipients in July 2011, but it had steadily gone down to 13,923 by March 2014- a drop of more than 20,000 in no small part because of premium increases and various cuts to BadgerCare services in the name of "budget balancing."

In addition, over 65,000 parents and caretakers were on BadgerCare Plus in December 2013, and all were taken off of the program over the next four months. These were the individuals Walker "traded" for the expansion of Medicaid to adults without children, and while Walker claimed they were still able to get insurance through the federal exchanges, it still is a major, unnecessary disruption of people's lives for a most cynical reason- to overload the federal exchanges and make Obamacare "fail."

Instead, Obamacare seems to be succeeding in Wisconsin, despite Scott Walker's attempts to screw it up. Nearly 140,000 Wisconsinites were able to get insurance through the exchanges, and thousands of others came out of the woodwork to find out that they could get BadgerCare, even with Gov Walker's changes. This is a good thing, but Scott Walker deserves no credit for it happening. In fact, Walker's idiotic refusal to take Medicaid expansion seems likely to cost Wisconsin taxpayers tens of millions of dollars in the near future, and much more if the state's voters are dumb enough to keep him in office.

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