Two Articles on Healthcare Changes in Wisconsin

http://www.jsonline.com/features/health/enrolling-uninsured-in-obamacare-will-be-a-challenge-b9930926z1-211703801.html Enrolling uninsured in Obamacare will be a challenge

Statewide coalition prepares to help with health insurance sign-up

By Guy Boulton of the Journal Sentinel June 15, 2013

Ray Bochas had little reason to learn about the details of the Affordable Care Act before February. That's when the InnoWare paper napkin and plate factory in Menomonee Falls shut down, and he lost his job and his health insurance.

"The loss of insurance really hurt me," said Bochas, who takes seven prescriptions.

He has heard that he's supposed to get health insurance next year but doesn't know what he and his wife will need to do.

"It's so complicated," Bochas said.

The Affordable Care Act's main goal of increasing the number of people with health insurance could hinge on reaching people like Bochas who will be eligible next year for coverage through Medicaid or through subsidized health plans sold on marketplaces known as exchanges.

Yet one recent poll found that two-thirds of those without health insurance were unaware of how the Affordable Care Act would affect them.

It suggests the challenge ahead in reaching the hundreds of thousands of people in Wisconsin who will be eligible for coverage and helping them through the complex process of signing up for Medicaid or a private health plan.

A statewide coalition of more than 70 groups is quietly preparing to take on the challenge.

The Wisconsin Primary Health Care Association, which represents community health centers, and several other groups began working more than a year ago to create the coalition that is calling itself the Wisconsin Access Network.

"It became evident that there might not be anyone else if we didn't take the lead on this," said Lisa Davidson, director of government relations and advocacy for the Wisconsin Primary Health Care Association.

The idea is to build on the existing network of financial counselors at community health centers, hospitals, city health departments and community groups that help people enroll in state health programs.

"We need all hands on deck to make this work," Davidson said.

Money for navigators

The Wisconsin Primary Health Care Association, which represents the clinics that provide primary care to many of the state's low-income residents in urban and rural areas, has applied for the limited federal money available to help people sign up for coverage.

The application is for the $829,000 that the federal government allocated for Wisconsin for so-called navigators who will provide consumer assistance.

Funding for the program will increase in subsequent years, but it is considered woefully inadequate for the first year, given the challenge of helping potentially hundreds of thousands of people as well as small employers understand the new law and their options.

Here's how inadequate: The Wisconsin Primary Health Care Association's proposal calls for hiring six full-time navigators statewide as well as two staffers to oversee coordination. It estimates that the six navigators will be able to sign up a total of only 6,000 of those hundreds of thousands of people statewide who may need help.

That's based on each application taking an hour — an estimate that the association admits is optimistic.

The enrollment period runs from Oct. 1 to March 31.

One of the quirks in the law is that states such as Wisconsin that aren't setting up their own exchanges are getting far less federal money for consumer assistance.

Maryland, a state with a population of 5.9 million, about 200,000 more than Wisconsin, plans to spend a total of $24.6 million for its assistance program, including $8.6 million in state funds in addition to $16 million from the federal government, according to Kaiser Health News. That will pay for an estimated 300 consumer assistance counselors.

In Wisconsin, the community health centers have received a $1.7 million federal grant to help people sign up for coverage. There also will be a federal call line that may be able to help consumers, although details on its role aren't available.

And Gov. Scott Walker requested, and the Joint Finance Committee's proposed budget includes, $10.3 million in state and federal state dollars to hire an additional 88 people to implement the law, including 70 people in Milwaukee County to help people enroll in Medicaid.

Brokers, who can earn commissions on health plans sold through the exchanges, also could have a key role.

'A huge task'

All that will help. But seemingly no one underestimates the challenge.

"It's a huge task," said Bobby Peterson of ABC for Health, a public interest law firm based in Madison. "They are going to have to pull in a lot of people."

He remembers the initial glitches with the introduction of Medicare Part D, the prescription drug benefit.

"This is going to be worse," he said.

Many people will be buying health insurance for the first time. Some may need little help. But some will have limited education or problems with literacy.

People will need to provide financial information to determine if they are eligible for Medicaid or for subsidies for plans sold on the exchange for individuals and families.

Some will not have checking accounts or credit cards, which may prevent them from signing up online. And even with the subsidies, the health plans on the exchange will be costly for many people on limited incomes.

Adding to the challenge is many people without health insurance know little about the law and how it could benefit them.

Bob Berndt, uninsured since losing his job in January 2012, wasn't aware that he could be eligible for coverage next year. "Not at all," he said.

He isn't alone.

"Most people don't have a clue about it," said Steve Ohly, manager of Aurora Walker's Point Community Clinic, which provides care to the uninsured.

Aurora Walker's Point Community Clinic tentatively plans to train a staffer to help people through the process.

Little time to prepare

Encouraging others to do the same is the goal of the Wisconsin Access Network.

Wheaton Franciscan Healthcare and Columbia St. Mary's Health System said they plan to help with enrollment, and other health systems are expected to join the effort.

"We have to take advantage of every group in the state that's doing enrollment," said Sara Eskrich, a health care policy analyst at the Wisconsin Council on Children and Families, one of the groups that took the lead in creating the Wisconsin Access Network.

The hope is to train people as "certified application counselors" who can help people go through the process, answering questions as they fill out an application and help them determine what health plans are available and their cost.

By law, navigators and certified application counselors can't say that one health plan is better than another. But they can show people the information available to help them make a decision.

Navigators and certified application counselors will be required to take 30 hours of training under the federal regulations. They also could be required to have 16 hours of state training under a provision pushed by the Independent Insurance Agents of Wisconsin and now before the Legislature.

The Wisconsin Primary Health Care Association will not find out until August whether its application — perhaps the only one for the state — was accepted. That will give it less than two months to prepare before enrollment begins on Oct. 1.

But the real work will be done by the certified application counselors who work for the groups in the coalition.

"We are doing a lot of behind the scenes work to be prepared," said Joy Tapper, executive director of the Milwaukee Health Care Partnership, which includes the health systems in Milwaukee County, the community health centers and other groups.

"There is a real commitment by this collaborative to do the best job we can," Tapper said.

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http://www.jsonline.com/features/health/more-in-state-must-shop-for-health-care-coverage-b9930935z1-211703541.html More in state must shop for health care coverage

Gov. Scott Walker's decision means thousands more will enter new health marketplace

By Guy Boulton of the Journal Sentinel June 15, 2013

Gov. Scott Walker rejected federal money to expand the state's Medicaid program because he would like more people to get coverage through commercial health plans instead of government programs.

But the decision also means that tens of thousands more people will need to shop for a commercial health plan on the new marketplace known as an exchange.

That, in turn, will put additional demands on people at hospitals, community health centers and community groups who are expected to do much of the work in helping people sign up for coverage.

"We unfortunately are going to see a very different marketplace in Wisconsin than we have the opportunity to create," said Sara Eskrich, a health care policy analyst at the Wisconsin Council on Children and Families, an advocacy group. "And we are going to have to work with that."

One advantage of Walker's plan is that health insurance sold on the exchange will pay higher rates to doctors and hospitals and generally provide better access to care.

At the same time, people who get subsidized coverage through the exchange will have to pay a premium of as much as 3% of their income and will have higher deductibles than with BadgerCare Plus, the state's Medicaid program for families with children under 19.

They also are going to have to sign up for coverage, a process that will entail shopping for a health plan and determining the federal subsidies available to make the coverage more affordable.

Karla Ashenhurst, director of system advocacy and public policy for Ministry Health Care and Columbia St. Mary's Health System, said that conceivably fewer people in Wisconsin could have health insurance coverage a year from now, although both health systems plan to help people enroll.

The governor's proposal will cost the state almost $150 million more in the next two years — and potentially more than $450 million through 2021 — than if the state had accepted the federal money available under the Affordable Care Act, according to estimates by the Legislative Fiscal Bureau.

That includes $30 million in state dollars for the $73.5 million added to the proposed state budget by the legislative budget committee to compensate hospitals for an expected increase in people without health insurance under the governor's proposal.

The governor's proposal means that an estimated 80,000 to 90,000 people who would have gotten coverage through Medicaid will need to buy subsidized health insurance through the exchange.

Some now have coverage through BadgerCare Plus. Others previously hadn't been eligible for coverage.

The Legislative Fiscal Bureau as well as critics of the governor's proposal said that many people who would have been eligible for coverage under Medicaid will not shop for private plans.

"We know that not everyone is going to make that transition," Eskrich said.

--SaraEskrich Health Care Reform ProjectCoordinator Wisconsin Alliancefor Women's Health P.O. Box 1726 |Madison, WI | 53701-1726 |[c] 608.669.6979 | [f] 608.256.3004 www.supportwomenshealth.org rwwv.wordpress.com

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