WISCONSIN GOVERNOR LOOKS TO COVER ALL

Volume 28, Issue 485 February 19, 2007

Matthew Gever

The Badger State has joined the list of states looking to make 2007 the year of universal coverage.

In his state of the state speech to the Legislature, Wisconsin Governor Jim Doyle laid out a plan to provide health coverage to 98 percent of Wisconsinites—including all the state’s children—through new taxes, system improvements and expansions of Medicaid and BadgerCare (Wisconsin’s SCHIP).

First, Doyle would create BadgerCare Plus by combining Family Medicaid, BadgerCare and Healthy Start* into one comprehensive program for low-income children and families. If approved by the Centers for Medicare & Medicaid Services, the new program would expand coverage to seven additional populations, ranging from all children with incomes above 185 percent of the federal poverty level (FPL), to parents and caretaker relatives with incomes up to 200 percent of the FPL. Families with higher incomes would be able to buy into the program, paying premiums and/or co-pays. No co-pays would be charged for prevention services such as smoking cessation aides.

Financing for the expansions would come from a variety of sources, including increased federal matching funds, greater use of managed care and savings captured by streamlining enrollment in and administration of BadgerCare. That program current has 20 separate coverage groups, each with differing income levels and its own eligibility rules. The merger of the three programs would create three primary coverage groups with eligibility determined by a simple gross income test with two deductions.

Doyle also proposed expanding coverage (subsidized by the state and the feds) to some 71,000 low-income adults, regardless of whether they have children, and creating a purchasing pool to help businesses—particularly small businesses—afford catastrophic health coverage for employees. A similar program in New York lowered premiums for some small business by as much as 30 percent, Doyle said. “That can be the difference between your employer keeping you covered or cutting you off.”

Additional funding would come from increasing the cigarette tax from 75 cents a pack to $2.02 a pack. The Governor estimates that would raise about $500 million in revenue over the next two years. He also advocates a 1 percent assessment on net hospital revenues and transferring $175 million from the state’s malpractice insurance fund into health-care programs.

Health information technology (HIT) won a strong endorsement. The Governor proposed investing $30 million in HIT, which he said would save large amounts of money over the long run by reducing medical errors and duplication of tests. The new funding includes $20 million for creation of an eHealth grant program, and $10 million in tax credits for organizations that adopt eHealth technologies. Doyle also proposed continuing funding for the Wisconsin eHealth Care Quality and Patient Safety Board, which released a comprehensive “action plan” last year.

Mixed Responses

The proposal has drawn a variety of responses from state lawmakers. Representative Jim Kreuser praised the expansion of coverage to childless adults, asking, “Why should you have to have a child to be covered by insurance?”

“The Governor’s plan is moving in the right direction,” said Representative Chuck Benedict, who added that the plan will still leave some without coverage.

Some legislators expressed concerns over funding. “The key question the taxpayers must ask and Governor Doyle must answer is how do we afford new spending and new programs when the state faces a $2 billion deficit,” said Senator Scott Fitzgerald. Fitzgerald also commented that Doyle’s plan would not reform the health system, but merely add more people to government rolls. “That’s not the problem in Wisconsin. It’s not access, it’s affordability,” said Fitzgerald.

Representative Kitty Rhoades commented that the Governor should first demonstrate where savings exist before spending that money on expansion of programs. “Let’s do that, and show us that the savings are there,” she said.

Legislators are considering additional proposals, including a single-payer plan (the Wisconsin Health Security Act); the Wisconsin Healthcare Plan, backed by the AFL-CIO and similar to the single-payer proposal; a bill that aims to provide Wisconsinites with health savings accounts and high-deductible plans (the Wisconsin Health Plan); and Healthy Wisconsin, a bill similar to the Governor’s.

*Wisconsin’s Healthy Start is a Medicaid program that covers pregnant women, babies and children under 19 years of age.