Steps toward Health Care Reform: Part One

“We have got to figure out how to fix health care. I think we need to look at what we are doing other places.” The man called my office to share ideas on how to reform health care. “Yes,” I agreed.

What have we done in other places? My constituent was thinking about ideas like workers compensation, unemployment compensation and the state employees’ health plan. Wisconsin has several examples of initiatives taken to solve insurance problems. But so have other states and Wisconsin is actually lagging behind many of those states.

I recently returned from a national gathering of state officials working on health care reform. I spoke with officials from New Jersey, Alabama and Rhode Island and learned first hand how far we are behind these states. (Yes, even Alabama.) This past week I met with government officials and business people to share what I learned and encourage their commitment to reform.

At least 42 states are looking at ways to expand health insurance coverage. Seventeen states have been successful at some type of expansion.

Usually the states first acted to bring in as much federal money as possible by expanding Medicaid – the health program funded by the state and federal government.  Currently states must ask permission of the federal government to expand their Medicaid program. This is necessary to capture matching money from Washington.

It is important for Wisconsin to take such action because we bring back to our state far less than we send to Uncle Sam. More than eighty percent of states bring back more in federal dollars than Wisconsin.

Last year, we took the step to expand our Medicaid program with BadgerCare Plus. 

BadgerCare Plus provides health care for low income families (and ‘families’ include children age 18 or under). The federal government kicks in at least 60% of the money - helping our state dollars go much farther. We expanded eligibility and now have 70,000 new people enrolled. Interestingly, most of the new enrollees were eligible under the old plan but just now heard about it.

We still have significant problems: BadgerCare Plus (as all state child health insurance programs) was designed to cover children and families.  But adults account for 80% of the uninsured.  Many have no children or adult children, making them ineligible.

Officials are now working with the federal government to expand our BadgerCare Plus program to include people with no children age 18 or under. Permission to do this, we hope, will be granted by the end of September. It will take about six months to put the new program in place.

This is a big step forward and will help many who now cannot find affordable coverage in the private insurance market.

The steps Wisconsin is taking helps address the problem of the uninsured but not the problem of rising health care costs.  To do this we must grapple with changes to our insurance system. I recently learned that Wisconsin has some of the most lax rules in the county on insurance companies. 

For example, thirty two states have rules limiting how pre-existing conditions are used to rate individual insurance plans. Not Wisconsin.

Thirty states require an advance review by the state of proposed individual plan rate increases before they can be changed. Not Wisconsin.

Perhaps this is why we see so much variation in premiums and so many people every year going back to the market to find a better deal on health insurance.

Next week I will explore the steps we can take to bring down our health care costs.

If you have ideas, please do not hesitate to call or write. Senator Kathleen Vinehout State Capitol P.O. Box 7882 Madison, Wisconsin 53707-7882 or 877-763-6636 (toll free). If you have missed a column, check out www.legis.wi.gov/senate/sen31/news/ or email me at sen.vinehout@legis.wisconsin.gov .