Walker Administration Deliberately Rigging Health Insurance System to Raise Rates

Almost as many people enrolled in substandard “lemon” health plans in Wisconsin as buy individual coverage through Healthcare.gov

Statewide: When Walker Administration’s Deputy Insurance Commissioner J.P. Wieske testified before Senator Ron Johnson’s Homeland Security Committee last week, he revealed that a much larger number of Wisconsinites than previously believed are enrolled in substandard health plans which do not meet the standards of the Affordable Care Act (ACA).

This seemingly innocuous admission actually has major implications for the availability of affordable health care in Wisconsin. In fact, it is evidence that the Walker Administration is working to sabotage the health care law.

In the hearing Wieske testified (p. 6-7) that 203,000 Wisconsinites are covered by so-called “transitional plans,” the technical term for most plans not in compliance with the ACA. These are also often referred to as “grandmothered” plans. Currently 239,034 Wisconsin health consumers are enrolled in individual coverage on Healthcare.gov. This means the ACA marketplaces in Wisconsin would be much larger if these transitional plans were prohibited.

Under the ACA, states were allowed to “grandmother” plans sold during the health care law’s implementation period, even when they did not meet the standards of the new law. The consumers in these transitional plans tend to be healthier, because the insurance corporations were still permitted at the time to discriminate against people with health conditions. Wisconsin exercised the option to continue these plans, while Minnesota and many other states working to improve health care access banned them.

Transitional plans have two highly negative consequences for health consumers.

  • Substandard “lemon” plans increase prices in the ACA marketplace by skimming healthier people. These people were able to buy insurance before discrimination against people with health conditions was banned. This deprives healthier individuals from the ACA marketplace, leaving the remaining population sicker and costlier, and raising rates.

  • Even when they are cheaper, substandard “lemon” plans can be dangerous for health consumers when they face a major injury or illness. These plans often have gaps in coverage or extremely high cost sharing.

There is strong evidence that allowing the health insurance industry to continue to sell transitional plans increases prices.

  • “Non-ACA-compliant plans...have a far more detrimental effect on the ACA-compliant market, raising premiums by as much as 10 percent and decreasing enrollment” (Rand Corporation)

  • “In states with the transition policy, ACA-compliant plans exhibited less favorable experience because lower-cost individuals were more likely to retain their prior policies.” (American Academy of Actuaries)

  • “Integrating these underwritten members into the ACA pool is expected to improve the health status of the market as a whole, which could lower the relative cost of coverage on average.” (Milliman Actuaries)

“It is hard to escape the conclusion that the Walker Administration is deliberately trying to destabilize the Affordable Care Act by allowing insurance companies to skim healthier consumers,” said Robert Kraig, Executive Director of Citizen Action of Wisconsin. “The impact of this policy is to rig the health care system against Wisconsin families who need access to quality affordable coverage. The only party who benefits from the continuation of lemon health plans is the insurance industry, which is allowed to continue to profit by separating the healthy from people with health conditions.”

Media Contacts

Robert Kraig (414) 322-5324 robert.kraig@citizenactionwi.org         

Kevin Kane (414) 550-8280 kevin.kane@citizenactionwi.org


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  • commented 2016-09-29 16:57:22 -0500
    I think that the WI state employee prescription plan should be investigated. In January ’16, for the first time ever, my coverage required that I switch from the generic to the name brand. This seems odd, and perhaps Walker is steering profit toward his ALEC friends who deal in name brand prescription drugs.
  • commented 2016-09-28 15:06:03 -0500
    I am currently on Medicare due to disability. I have no drug covereage and a 20% gap in plan. To enroll in a “silver” plan on my own through WPS or United Health I will have to pay close to $400 as a monthly premium. I am $130 off of my yearly income so I do not qualify for any state discounts and the plans I would be paying for have high out of pocket and deductables….Shame on you Scott Walker and his cronies!