Wisconsin hopes to be leader in health care reform
(Published Monday, February 19, 2007 09:28:30 AM CST)
A d v e r t i s e m e n t
By Scott Bauer Associated Press
MADISON, Wis. - Even though other states are further along in providing universal health care, Wisconsin Gov. Jim Doyle believes his proposal will reach more people and do it faster than any place else.
And he may have an easier path given that Wisconsin has one of the lowest rates of uninsured residents in the country at 10 percent. Doyle, a Democrat, wants to see that down to 2 percent next year.
Doyle's plan, which has drawn both praise and criticism for its reliance on the Medicaid program, focuses on simplifying the process for enrolling the uninsured, raising taxes on tobacco and hospitals, and tapping into federal matching funds.
It's far from a done deal.
Republicans in the Legislature have taken aim at the proposed tax hikes, the Wisconsin Hospital Association has vowed to fight the proposed 1 percent tax on hospitals and the tobacco lobby is lined up against the $1.25 per-pack cigarette tax increase. The plan would also need federal approval.
But Doyle said he senses an urgency to get all children in the state, and childless adults, covered by insurance.
While most Americans get health insurance through employers, the rising cost of providing coverage has resulted in some employers getting out of the market. Family incomes have also not kept pace with the rising cost of health care coverage, resulting in state Medicaid and other government programs trying to bridge the gap.
Wisconsin is one of more than a dozen states looking at expanding health insurance coverage.
Massachusetts, Vermont and Maine have enacted universal coverage plans, while California and Pennsylvania have put forward detailed proposals, said Jennifer Tolbert, policy analyst for the Kaiser Commission on Medicaid and the Uninsured in Washington, D.C.
Unlike the Massachusetts plan being implemented in July, the Wisconsin proposal is not a mandate. Instead, Doyle wants state-sponsored health insurance made available to 98 percent of residents. Maine and Vermont also do not require people get insurance but they have universal coverage as a goal.
While the Wisconsin plan doesn't have universal coverage as its goal, even those that profess to get to 100 percent will fall short since some people will fall through the cracks, Tolbert said.
Nationwide, the number of people without insurance is put at about 46 million, with two-thirds from poor families making less than $19,971 for a family of four. Eighty percent are from working families, according to the National Council of State Legislatures.
Maine has enrolled about 19,000 out of its 120,000 uninsured people, while the Vermont plan takes effect in October, Tolbert said. The Massachusetts mandate starts in July, but the state has already moved about 100,000 people off its rolls of about 650,000 uninsured, Tolbert said.
The Doyle plan would extend coverage to 185,500 of about 250,000 people who don't have insurance now, said Jason Helgerson, executive assistant and policy director for the state Department of Health and Family Services.
Doyle is not interested in mandating coverage yet, Helgerson said.
"Before we think about mandates, the key thing is we need to make sure that those programs have no impediments built into them that make it hard or impossible for people to get health care," he said.
Once fully implemented, the cost of the expanded coverage would be about $185 million, with all but about $75 million paid by the federal government, Helgerson said.
One of those who is watching the progress of Doyle's proposal is dairy farmer Amanda Heisner of Mineral Point. She, her husband and their two sons, ages 5 and 6, are covered by the state's health plan for the poor called BadgerCare.
But because of depreciation of their farm equipment and a loan they received, Heisner said they expect to no longer be eligible for the program this year.
Buying private health insurance will be a financial challenge, with even a high-deductible plan coming with about an $800 per-month premium. Under the state program they pay $150 a month.
Under Doyle's plan, the person's contribution toward the insurance would increase based on their income. People who earn poverty wages or lower would not pay any premiums, Helgerson said.
"It's time that we do something," Heisner, 31, said. "We can spend all day talking about theory. This is a proposal that is going to help citizens in Wisconsin."
And while the Doyle plan may not be a long-term solution, Heisner said, it would be a step in the right direction.
"There could be a million different solutions, but it's time to pick something and try it and evaluate it," she said.
Not everyone is enamored with Wisconsin's approach.
Putting more people into underfunded state Medicaid programs won't work, said J.P. Wieske, director of state affairs for the Council for Affordable Health Insurance, a research and advocacy group in Alexandria, Va.
"This is, in comparison, a pretty frivolous proposal," he said. "It really doesn't do a heck of a lot."
He said the initiative sets a nice goal, but is unrealistic.
"We're going to put more people into Medicaid and BadgerCare and we're going to pay doctors less, which is going to mean we're going to see private rates go up, which is going to make the uninsured problem worse," Wieske said.
A better solution, Wieske said, is to move people off of Medicaid while allowing them to keep their private coverage.
"The focus should be on people who are chronically uninsured and people who cannot afford insurance," Wieske said.
Tolbert praised the Wisconsin approach.
"This is a solid effort and I think given the market situation in Wisconsin, the populations that the governor seems to be targeting actually are the populations that need assistance in getting coverage," Tolbert said.
Uninsured people in Wisconsin
The uninsured Wisconsin residents Gov. Jim Doyle has targeted for health insurance coverage are:
-- 71,000 low-income childless adults who earn less than $20,420 individually or $27,380 as a couple, which is twice the federal poverty level.
-- 54,500 parents.
-- 38,000 children.
-- 13,000 farmers or the self-employed.
-- 5,000 caretaker relatives.
-- 4,000 pregnant women.
Source: Wisconsin Department of Health and Family Services
