Not all individuals and families have equitable access to coverage. Uninsured rates are much higher among lower-income groups, averaging 10% or higher for those below 200% of the federal poverty level (FPL). Enrollment in the federally-operated Affordable Care Act marketplace in Wisconsin has declined over time, from a peak of 242,863 in 2015 to 195,498 in 2020. This decline is particularly steep for those with incomes between 100% and 200% of the FPL. Individuals and families still face barriers to affording coverage.
Consumers, employers, and other stakeholders continue to express concern about the high cost of health coverage nationally and in Wisconsin. While the federal advance premium tax credit reduces premiums for those at the lower end of the income scale – the out-of-pocket costs (deductibles and coinsurance) required by those lower premium plans still create a significant barrier for some Wisconsinites in accessing medical care. In these situations, health insurance coverage may be affordable, but the high out-of-pocket costs associated with many low premium plan options make it unaffordable to receive all but preventative care. When extreme health emergencies rise and care is unavoidable, enrollment in these plans often results in the accumulation of significant medical debt.
To address these issues, the governor created the Badger Coverage Plan and presents the following initiatives to improve access to, and the affordability of, healthcare coverage in Wisconsin for potential inclusion in the governor’s 2021-23 budget bill.
Expanding BadgerCare to provide coverage to tens of thousands of uninsured Wisconsinites and save more than $630 million in state tax dollars:
The governor proposes expanding BadgerCare under the federal Affordable Care Act by covering all low-income Wisconsin residents who earn incomes below 138 percent of the federal poverty level. BadgerCare Expansion will provide healthcare coverage to approximately 90,000 additional Wisconsinites while saving $634 million GPR over the biennium, funds which have been reinvested to improve the health and well-being of all Wisconsinites.
Transition to a State-Based Marketplace to Simplify Healthcare and Enroll more Wisconsinites
The governor proposes establishing a state-based health insurance marketplace by plan year 2024 to improve health insurance marketing and outreach efforts, increase state revenue and gain more state autonomy over aspects of the health insurance marketplace. Transitioning to a state-based exchange would unlock flexibilities for plan design and outreach, create a marketplace tailored to the specific needs in Wisconsin, and achieve administrative efficiencies to direct state-based marketplace revenues toward bringing down healthcare costs for Wisconsinites. Additionally, the governor proposes boosting enrollment efforts through a $1 million grant in
each year to support insurance navigator organizations that help individuals enroll for health insurance coverage.
PROMOTING HEALTH EQUITY & ADDRESSING DISPARITIES
The disparities in access to healthcare and in health outcomes, particularly for communities of color that face systemic racism, are unacceptable. Pregnancy-related mortality is 5 times higher for Black mothers than it is for white mothers, one of the stark examples of the work that must be done. In addition to initiatives proposed in the governor’s previous budget, Governor Evers established the Health Equity Council, which has convened a diverse group of leaders tasked with developing a roadmap to reduce and ultimately eliminate health disparities over the next decade. Taking bold action to address disparities is an essential component of the governor’s healthcare budget. The governor proposes:
Investing in efforts to address determinants of health like housing, nutrition, and transportation.
The governor proposes establishing a Medicaid community health benefit that invests $25 million for non-medical services to reduce and prevent health disparities that result from economic and social determinants of health. Services include housing referrals, nutritional mentoring, stress management, and other services that would positively impact an individual’s economic and social condition.
Allocating over $30 million to promote community-based health equity initiatives.
This includes grants to local, community-based organizations and health departments to implement health equity action plans, funding to support the development of community health worker care models, and staff to coordinate an enterprise-wide health-in-all-policies action team to support health equity initiatives across the state.
Expanding services and investing over $12 million to comprehensively address childhood lead poisoning
The governor presents a number of proposals to reduce the incidence of childhood lead poisoning in our state, including increasing blood lead testing by providing additional funding for lead screening and outreach grants, providing ongoing funding for the Windows Plus Program, and expanding Birth to 3 services to additional children.
Increasing access to dental services in the state and addressing dental provider shortages
The governor proposes working to increase access to dental service and care in Wisconsin by creating and licensing dental therapists, providing over $35 million in Medicaid dental incentive payments through reimbursement rate increases to dental providers that serve Medicaid recipients, and $120,000 to increase funding for dental loan repayments for dentists who provide services in rural areas.
LOWERING THE PRICE OF PRESCRIPTION DRUGS
Governor Tony Evers’ 21-23 budget includes bold policy solutions for reducing the cost of prescription drugs and expanding access to medications for Wisconsinites. The governor proposes over 20 innovative and effective policy solutions to reduce the price of prescription drugs and ensure Wisconsinites can access and afford needed medications by controlling costs, increasing transparency and oversight, strengthening consumer protections, and bolstering programs designed to support Wisconsin’s most vulnerable.
Lowering Prices & Controlling Costs
Many insured individuals, despite having coverage, experience high out-of-pocket expenses that strain family budgets. Cost increases to employers and other plan sponsors over the past several decades have resulted in increased cost-sharing, increased member contributions to premiums, and even elimination of some employer or other sponsored health plans.
Increasing Transparency & Protecting Consumers
The prescription drug supply chain is complex. There are detailed and often opaque agreements between entities throughout the supply chain, making it difficult to fully understand profit margins and where potential savings could be realized.
Ensuring Access for Wisconsin’s Most Vulnerable
Free and charitable clinics are consistently faced with challenges to remain a reliable safety net for those who cannot afford prescription medications on their own; for example, helping consumers access manufacturer offered coupons, collecting unused prescription drugs through donations, leveraging state funding, and relying on volunteers and other community support.
STRENGTHENING WISCONSIN’S PUBLIC HEALTH INFRASTRUCTURE
Governor Evers has led the way in implementing critical public health measures and doing what it takes to tackle this pandemic and save lives. Over the last few months, the governor has provided $2 billion in federal Coronavirus Relief Funds to support the response and recovery effort, developed and implemented programs that have purchased and distributed PPE and millions of tests and labs supplies, provided grants to over 25,000 businesses and 15,000 farms, and invested hundreds of millions of dollars in rent abatement, childcare, food security, and healthcare providers.
The past year experiencing a global pandemic has underscored the importance of a robust, statewide public health infrastructure as well as supporting our hospitals, healthcare systems, and clinics.
SUPPORTING OUR CAREGIVERS & LONG-TERM CARE COMMUNITY
Wisconsin is currently experiencing a caregiving crisis. Challenges associated with workforce shortages and a growing population of Wisconsinites seeking long-term care services have been exacerbated by the pandemic. Governor Evers’ 21-23 budget delivers on several policy recommendations proposed by the Governor’s Task Force on Caregiving and invests more than $600 million in Wisconsin’s long-term care infrastructure, the direct care workforce, and family caregivers.
Investing in Wisconsin’s Long-Term Care Infrastructure
Wisconsin is currently experiencing a shortage of direct care providers and caregiver support services, especially in Wisconsin’s rural communities. According to a report issued by the Governor’s Task Force of Caregiving, 24 of Wisconsin’s 72 counties, one-third, have five or fewer personal care provider agencies. As providers continue to struggle amidst challenging financial situations exacerbated by the pandemic, Wisconsin families will be left with fewer and fewer options for receiving the care that they need.
Strengthening Our Caregiving Workforce
Due to low wages and challenging work, many home health and personal care workers leave direct care or choose not to pursue these jobs at all. When direct care worker positions remain unfilled in-home, residential, and facility-based settings, the burden on existing workers increases, contributing to burnout and higher rates of turnover. The lack of economic viability of caregiving positions also reinforces race, class, and gender economic disparities.
Supporting Family Caregivers
The Governor’s Task Force on Caregiving reports that an estimated 64% of Wisconsinites with intellectual and developmental disabilities live with family and that 25% of these family caregivers, who are often parents, are over 60 years old. The pressures on younger family members and the paid workforce can be expected to increase when a greater number of elderly parents are no longer able to continue providing care. As a result, a growing number of siblings of adults with intellectual and developmental disabilities are taking on caregiving responsibilities. More must be done to support family caregivers.