Put People First by Investing in Health Care
Wisconsinites need quality, affordable health insurance coverage to be healthy and productive, and to have the economic security to know that they won’t go bankrupt because of a medical emergency. Too often in Wisconsin, a person’s health depends on their zip code, race and ethnicity, or income level. We need to make sure that everyone can see a doctor when they need one, regardless of where they live, the color of their skin, or how much they have in their bank account.
The COVID-19 pandemic has made the case for improving access to health care even more compelling. We cannot hope to control an infectious disease if large numbers of people are uninsured and do not have ready access to testing and treatment. The inequitable impacts of the pandemic on people of color in Wisconsin have also illuminated the importance of eliminating gaps in access to quality, affordable health care for Black, Latinx, and Native American people in Wisconsin.
Increasing the number of people who have access to affordable health care doesn’t just help those who gain insurance; it also strengthens a state’s economy. For much of Wisconsin’s history, our state has been a national leader in providing access to health insurance, but in recent years Wisconsin has been slipping in its commitment to that critical foundation of our shared prosperity.
One way to improve access to affordable health care for many Wisconsinites, especially people of color, is to improve and expand BadgerCare. Due to systemic racism and inequities in housing, employment, health care, and education, people of color are more likely to be low-wage earners who qualify for and rely on BadgerCare. In addition, BadgerCare is crucial for children and families living in rural communities who are also more likely to rely on it for access to health care. BadgerCare and Medicaid provide health insurance for more than one million Wisconsinites, including one in three children.
We recommend that state policymakers pursue the following changes to protect and strengthen BadgerCare for children and families:
Fully expand BadgerCare to cover 95,000 more people and save hundreds of millions in state funds
Through the Affordable Care Act, Wisconsin has had a great opportunity to close a very large gap in BadgerCare—coverage for adults who aren’t custodial parents. However, instead of fully expanding BadgerCare and qualifying for 90-percent federal reimbursement of the cost of covering all adults without dependent children, state lawmakers and Governor Walker approved a smaller expansion of coverage for childless adults (limited to those below the federal poverty level). To offset part of the cost, they halved the BadgerCare eligibility limit for parents, and more than 60,000 parents and caretakers lost their health insurance coverage.
By extending BadgerCare eligibility to more low-income workers and thereby qualifying for additional federal funding, state lawmakers could improve access to critically important health services, relieve economic hardship for thousands of households, yield large savings in the state budget, and reduce our state’s very substantial racial disparities in health insurance access.
Expanding BadgerCare would significantly improve access to health care in our state. The Department of Health Services estimates that about 95,000 additional adults would be covered in BadgerCare if it is expanded to 138% of the federal poverty level, which is about $2,000 per month for a parent with one child. That would substantially reduce Wisconsin’s uninsured rate because many of those working adults cannot afford the premiums or other costs for private insurance plans.
BadgerCare expansion would also increase coverage for children because coverage of parents directly impacts coverage of kids. Knocking tens of thousands of parents out of BadgerCare in 2014 resulted in a significant drop in enrollment of kids above the poverty level. Wisconsin was once a national leader in insuring children, but is now in the middle of the pack because Medicaid expansion states have made substantial progress in coverage of kids.
Expanding BadgerCare would significantly reduce spending of state tax dollars. Department of Health Services projections issued in September 2020 estimate that covering adults to 138% of the federal poverty level and accepting the full federal funding could yield a net savings for state taxpayers of about $588 million during the next two fiscal years.
Expanding BadgerCare will help to reduce insurance coverage disparities between white people and people of color. The ACA resulted in significant coverage gains among all Wisconsinites, regardless of race or ethnicity, but coverage rates for people of color still lag behind white people. Despite gains, Latinx and Native Americans still have very high uninsured rates. Fully expanding Medicaid would substantially increase coverage for people under 138% of the federal poverty level, and would lead to more people of color being covered, especially among Latinx Wisconsinites, who are uninsured at rates three times higher than white people.
Red and Blue states across the country have voted decisively in favor of Medicaid Expansion. Utah, Nebraska, Missouri, and Idaho all passed ballot initiatives calling for expansion of Medicaid. The will of the voters is clear; they support increasing access to health care by expanding Medicaid.
Improve maternal and infant health by expanding BadgerCare coverage for postpartum mothers
Extending health insurance coverage for mothers will help maintain continuity of care and help ensure women and babies are receiving the health care services they need. Currently, pregnant women in Wisconsin are eligible for BadgerCare while they are pregnant, but that coverage ends after only 60 days. Without continuous coverage new mothers are at risk of becoming uninsured and not being able to get care for any medical conditions that arise, such as complications from childbirth, depression, or pain, Wisconsin lawmakers should put women first and guarantee continuous coverage for women for 12 months after the birth of their child.
Lawmakers could dedicate a small portion of the savings from Medicaid expansion to provide continuous coverage for mothers for 12 months, which would help address our state’s stark inequities in maternal mortality.
Ensure more immigrants can receive urgent health care by expanding emergency services under BadgerCare
Emergency services through BadgerCare allow non-US citizens who are otherwise eligible for BadgerCare to get coverage to treat serious, emergent health conditions. Wisconsin is perhaps the only state in the nation that restricts eligibility by denying this coverage to adults without dependent children when they are Medicaid eligible. This pandemic has shown us that we are all only as well as those who are most vulnerable. Emergency services is one of very few supports available to people regardless of their immigration status, and yet our state only provides this safety-net to parents, pregnant women, and children.
Wisconsin should align itself with other states and allow otherwise eligible adults access to emergency services BadgerCare, so that more immigrants can receive urgent medical care. In order to help respond to this health crisis, Wisconsin should also clarify that COVID-19 treatment qualifies for emergency services under BadgerCare.
Strengthen the Affordable Care Act by limiting coverage of “junk” insurance plans
Short-term health insurance plans are being marketed more aggressively in part because of policy changes by the Trump administration that have largely eliminated federal regulation. Short-term plans can offer lower-premium options because they offer skimpier coverage and pay for less care. However, luring healthier people away from ACA-regulated plans threatens to increase costs for everyone else. As healthier people leave, those who rely on comprehensive coverage, such as sicker people and those with pre-existing conditions, end up getting charged more and more.
Short-term plans are not a viable alternative to ACA coverage. They provide less coverage, little to no consumer protections, and likely have higher out-of-pocket costs. Wisconsin should join states like Colorado, Illinois, and New Mexico that provide meaningful protections for people with pre-existing conditions and strengthen their health care landscapes by passing a law that bans short-term plans or limits coverage to no more than three months.
Create a BadgerCare buy-in
Everyone deserves access to affordable, quality health care regardless of where they work or where they live. State lawmakers could use the Affordable Care Act as a foundation for moving toward giving all Wisconsinites access to health insurance by creating an option for people to purchase BadgerCare through the ACA Marketplace.
A public option with robust enrollment would likely serve to lower premiums for private health insurance, and it’s possible that Wisconsin could get federal approval to reinvest dollars that would have come from premium tax credits to help fund the program through additional discounts or higher reimbursement rates.
Invest in public health and health equity
The COVID-19 pandemic has made it abundantly clear that we need to have strong state and local public health departments. We cannot hope to protect people from infectious diseases without robust programs to coordinate virus testing, contact tracing, and public education. Unfortunately, Wisconsin currently ranks just 39th nationally in per capita spending for public health.
The CARES Act gave states a large infusion of federal funds to combat spread of the virus, but that funding is running out. The DHS budget request seeks more than $1.3 billion in state funding during the 2021-23 budget to replace the federal funding that the state will lose if Congress and the next President do not approve a new round of federal dollars for personal protective equipment, virus testing, and contact tracing.
Looking beyond the current pandemic, there are many other reasons to boost our state’s investment in the public health system. Local health departments have a very important role to play in addressing the factors contributing to the severe racial disparities in health outcomes in Wisconsin. Increasing state funding for public health is a key investment in health equity
Conclusion
The COVID-19 pandemic has clearly demonstrated the immense importance of access to quality, affordable health care. The gaps in our health care system have contributed to an alarming death toll, sharp racial disparities, and huge economic costs.
A very important first step Wisconsin can take to improve access to health care is to use the Affordable Care Act to expand BadgerCare eligibility for adults. Although the next state budget will be a very challenging one, that is all the more reason to expand BadgerCare and capture the additional federal funding available for expansion states. BadgerCare expansion is estimated to save the state nearly $300 million per year, which can be used to improve public health services and to avoid Medicaid cuts. That will help low-income families, bolster our efforts to combat COVID-19, reduce racial disparities in health outcomes, and provide a boost to our economy.