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ACA in Wisconsin, Healthcare in Wisconsin

5 Questions to Ask Yourself, Before June 5th – Question 4: What are Wisconsin leaders doing to make sure that we, as consumers, are being protected from discriminatory insurance practices?

We all have something at stake when it comes to health care reform implementation, or lack thereof – and we all have a voice through our vote. Our 5 day blog series, “5 Questions to Ask Yourself, Before June 5th” is an opportunity for you to learn and share what the upcoming election means for health care reform implementation and women’s health in Wisconsin. Wisconsin women need leaders and policymakers who are on board with giving women and their families more affordable and accessible health care options and choices. Voting is one of the most important ways you can raise your voice for women’s health. If you need more information on where to vote or how to register, visit wisconsinvote.org

In order to effectively reflect upon this question, we must first understand the reason for which protections are needed in the first place. Particularly for women, protections are needed because the status-quo is not working for women. For instance, before health care reform, insurance companies could discriminate against women – just for being a woman. These practices resulted in women being charged higher premiums for the same plans as men.

Further, insurance companies could rescind, cap or deny coverage when you got sick or had a pre-existing condition. Pre-existing conditions includes such common medical and physical conditions as pregnancy, surviving domestic abuse, and asthma. Now, insurance companies cannot deny coverage to children because they have a pre-existing condition, cancel your plan if you are sick or cap your lifetime coverage. In 2014, all women, men and children will be protected from annual coverage limits, pre-existing condition denials, and more!

And more? Yes, and more!

Medical Loss Ratio (MLR): this provision requires insurance companies to spend at least 80% of health care premiums on health care, not administration, marketing or profits. If they fail to comply, they must provide rebates to their consumers.

Q: What are Wisconsin leaders doing to make sure that we, as consumers, are protected by this insurance practice?

A: On October 25th, the Wisconsin Office of the Commissioner of Insurance (OCI) requested an exemption from the federal government that could ultimately leave consumers in Wisconsin with fewer protections and slow down an increase of quality in their care. In a letter addressed to the Department of Health and Human Services (HHS) Secretary, Kathleen Sebelius, Insurance Commissioner Theodore Nickel requested an exemption that would allow insurers to spend less money on consumers and more on profits. Thankfully, the federal government had Wisconsin consumers in mind, and denied this request.

Rate Review: this provision of health care reform requires insurers to justify rate increase that exceed 10% to ensure they are reasonable.

Q: What are Wisconsin leaders doing to make sure that we, as consumers, are protected from this insurance practice?

A: If you missed our blog on this issue, last week, here is a recap of what happened: OCI Commissioner has now officially asked to reduce accountability measures set in place by the ACA. Specifically, the state has requested that Wisconsin be allowed an exemption from the 10% mark that is currently set in place – and to conduct their own research to determine what review rate marker would be appropriate.

Wisconsin leaders have so far sided with insurance companies, rather than consumers. Wisconsin women win with health care reform – but we need make sure that we have meaningful health care implementation in Wisconsin!

Tomorrow, we will close our 5 day series with this final, food-for-thought, question: Why does my vote matter on June 5th

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