It’s been three years since President Obama signed the Affordable Care Act (ACA) into law, and a year since the Supreme Court upheld its constitutionality. We’re now at the stage of implementation – and it’s coming with a unique set of challenges in Wisconsin.
Challenge #3: Wisconsin is going to be moving thousands of people between Medicaid and the Marketplace.
We are anticipating that the proposed changes to Medicaid in Governor Walker’s budget will have the effect of letting low-income individuals and families fall through the health care coverage gap as changes take place (as illustrated in a past blog post), especially because the majority of people don’t understand how the ACA works or affects them.
Additionally, because Governor Walker does not want to expand Medicaid to cover more of the lowest income Wisconsinites, many families are still not going to be able to access affordable coverage. Families may end up falling into a hole where they are not eligible for federal subsidies in the exchange because they have an offer of employer coverage that costs less than 9.5% of their income. However, this is a gap in affordable coverage because the 9.5% only considers the cost of individual coverage, not family coverage.
While this challenge stems from Governor Walker’s original budget proposal, our state legislators have an opportunity to fix the situation and strengthen BadgerCare as they debate and pass a final budget later this spring.
Challenge #4: The application process is going to be complex, and there is limited federal funding to support Wisconsin Navigators.
The ACA legislation emphasizes the importance of a streamlined and simplified process for health insurance enrollment. According to the Guttmacher Institute, “underlying that streamlined process are several intertwined strategies: coordination among the various programs, accessibility of the application and enrollment process, simplification of that process, minimization of gaps in coverage, and proactive outreach and assistance for enrollees”.
As a state with a federally facilitated exchange (FFE), we have limited control over the creation of our Marketplace. However, stakeholders were recently given the opportunity to give feedback on the drafted Marketplace application. The final applications were just released today – and we appreciate many of the updates HHS made to the final draft. The new application is only three pages for an individual and seven for a family.
The federal government estimates that it will take between 30-45 minutes to complete the new application, and will likely be easier than the process we go through to purchase private insurance right now. A benefit of the online application (in comparison to the paper application) is that it will generate real time verification of identity, income, and citizenship or immigrant status.
Depending on who you listen to, the online application for the new exchanges will range from the ease of Orbitz to the pain and confusion of filling your taxes experienced by some. It’s likely to land somewhere in between, but this should not discredit the importance of having Navigators: a well-trained and accessible group of individuals necessary to assist individuals in enrollment. HHS has released more info about navigators and other consumer assistance counselors, but here in Wisconsin we are unsure how such resources will be financed to meet the needs of state residents, including those transitioning from BadgerCare to the exchange. There is only enough funding to pay a small number of Navigators for the year, and therefore other groups will need to supplement assistance once enrollment begins.
Therefore, Wisconsin organizations need to be involved in implementation.
We agree with Nelson Lichtenstein when he writes,
“This is not a case of creating more voters who will support Obama because of Obamacare. This is a 21st century example of Alexis de Tocqueville’s 19th century observation that the health of American democracy depends on the vibrancy of numerous voluntary organizations. In recent history, we’ve seen the way such groups feed activism and are fed by it.” (Los Angeles Times)
It will take continual efforts on the part of advocates, health care stakeholders, and individuals to ensure that the ACA does what it was intended to accomplish, and reaches those Wisconsinites who need it. If you’re interested in being involved email us at firstname.lastname@example.org.