Why Wisconsin Should Seriously Consider Iowa's Medicaid Model

With the November elections behind us, numerous elected officials opposed to Wisconsin accepting the federal funds for BadgerCare announced that accepting these funds will not happen. Yet the results of the various referendums prove that the public is with us on the issue of Medicaid/BadgerCare, that failure to accept the funds will cost ~$315 million in this upcoming state budget, and more and more GOP-led states are looking to take the Medicaid funds. (Pennsylvania, Tennessee, Indiana, Utah, Wyoming, and New Hampshire all moved toward in 2014)

Many of these states are accepting the federal funds on their own terms, asking for a waiver from the federal government to do so. One of these states, Iowa, asked for a waiver in very similar terms how Wisconsin changed BadgerCare, but convinced the federal government to not only pay for it but make coverage actually affordable for citizens.

This makes Iowa a model worth considering. Those immediately over the poverty line, who should have been in BadgerCare/Medicaid, are enrolling in private Healthcare.gov style plans in both states. But in Iowa, unlike Wisconsin, the federal funds have been used to ensure that people enrolling in these private plans can actually afford them. Here is a comparison of what a 40 year old applicant earning $12,000 a year would pay in Iowa compared to cities across Wisconsin.

Table: Comparing 40 year old applicant just over federal poverty line, Iowa vs Wisconsin geographic areas

 

Premium monthly1

Out-of-Pocket2

Per Person, more than Iowa, annually

Eligible3,4

Iowa, statewide5

$06

$0

-

148,000 people

Milwaukee

$20

$50 - $760

+$290 - $1,000

21,959

Madison

$20

$0 - $700

+$240 - $940

4,489

La Crosse

$20

$500 - $700

+$740 - $940

4,193

Eau Claire/Chippewa Falls

$20

$250 - $500

+$490 - $740

2,680

Central Wisconsin7

$20

$500

+$740

7,091

Green Bay

$21

$50 - $760

+$302 - $1,012

3,367

Appleton/Oshkosh

$20

$0 - $1,200

+$240 - $1,440

4,324

Twin Cities area, WI side8

$20

$50 - $1,000

+$290 - $1,240

2,036

Dubuque area, WI side9

$20

$400

+$640

1,288

Waukesha

$21

$400

+$652

2,506

Superior

$20

$250 - $500

+$490 - $740

800

Sheboygan/Manitowoc

$21

$50 - $760

+$290 - $1,000

2,628

Janesvillle/Beloit

$20

$0 - $700

+$240 - $940

3,115

Fond du Lac

$20

$400

+$640

1,244

Racine/Kenosha

$20

$50 - $760

+$290 - $1,000

6,282

Rhinelander

$20

$500

+$740

644

1 – Monthly premium for 2nd lowest cost silver plan, 40 year old applicant, $12,000 annual income, source Healthcare.gov
2 – Range between deductible and out of pocket maximum, 2nd lowest cost silver plan, 40 year old, $12,000, source Healthcare.gov
3 – Iowa Medicaid eligible, source
4 – Wisconsin County level Medicaid eligible, source
5 – Results the same for all counties within Iowa, source Kaiser Family Foundation
6 - $0 for first year, $10 second year but waived with wellness check, source Kaiser Family Foundation
7 – Includes Marathon, Wood & Portage counties
8 – Includes St Croix, Pierce & Polk Counties
9 – Grant County, Wisconsin

 

If Wisconsin requested a federal waiver like the Iowa model, the state budget could save up to $315 million and ensure tens of thousands purchasing private plans could actually afford them. This would be a strong boost to working families budgets, as each dollar freed from excessive healthcare costs is available to spend on the basics in the community - shelter, food, amenities and more. Too many have been forced to choose between the healthcare they need and the basics they require. Mirroring Iowa's model could ensure tens of thousands of residents could solve that dilemma and afford quality healthcare.

Read more about Iowa's Medicaid expansion waiver here

 

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