Whether the 87,000 parents who would lose Medicaid coverage under Gov. Scott Walker's budget can afford private insurance in a government-subsidized exchange might be summed up by Jessica Jaglowski's uncertainty.

"We can afford to pay some kind of premium," said Jaglowski, a stay-at-home mother of three whose husband earns about $38,000 a year. "But if it turns out the deductibles and co-pays are high and things aren't covered, that could be a big problem for us."

The affordability of the exchange is one of several Medicaid-related questions being raised after Walker introduced his 2013-15 budget proposal last week.

Other questions involve reduced coverage for pregnant women and state benefits for 82,000 childless adults.

"There's a lot we don't know yet," said Bobby Peterson, executive director of ABC for Health, a Madison nonprofit that helps people get health care.

Jaglowski's family has been on BadgerCare, the state's main Medicaid program, for five years. Walker's plan would shift her and her husband, but not their children, to the exchange.

They'd likely face a combined premium of about $95 a month — plus out-of-pocket costs of up to $4,200 a year when seeking care.

"I hope there's something affordable on the exchange, but I don't feel certain about that," said Jaglowski, of Milwaukee.

About 82,000 childless adults who make less than the poverty level — $11,490 for an individual and $27,570 for a family of five — would gain BadgerCare coverage through a partial Medicaid expansion.

But Walker plans to shift 87,000 parents with incomes above the poverty level from BadgerCare to the federal exchange. Enrollment is to begin Oct. 1, with coverage starting Jan. 1.

The state assumes about 80,000 of the affected parents would enroll in the exchange, said Claire Smith, spokeswoman for the state Department of Health Services.

But after the state added exchange-like premiums in July for 48,835 BadgerCare members who make more than 133 percent of the poverty level, 15,819 people affected dropped out by December, Smith said.

It was not known how many of them got other coverage or were uninsured, she said.

Democrats and health care advocates say a significant portion of the 87,000 parents losing BadgerCare won't be able to afford the exchange, leaving them uninsured and relying on expensive emergency rooms for care.

They also want the state to accept the 100 percent federal funding available to fully expand Medicaid to about 175,000 adults who make up to 133 percent of the poverty level, as allowed under the health reform law. But Walker and many Republicans say the full Medicaid expansion is too risky because federal funding might fall through, forcing the state to pay its usual 40 percent share for the new enrollees.

Walker said he's returning Medicaid to its "intended purpose as a safety net for the neediest."

Above poverty, but still poor

Jaglowski, 40, said she her family aren't among the very neediest. They make a little over 133 percent of the poverty level.

But the insurance offered by her husband's workplace, an educational nonprofit, would cost them more than $14,000 a year in premiums.

"There's no way we could afford it," she said.

The family, including three children ages 2 to 7, hasn't had to pay a premium for BadgerCare.

Jaglowski said she's glad the exchange will be available, but she worries about out-of-pocket costs.

"We may be above poverty level, but we're still pretty low income for five people," she said.

Peterson said it will also be confusing for parents to have one kind of insurance on the exchange and for their children to remain on BadgerCare.

"It's important to keep parents and kids in the same health care if they can," he said. "This puts a big wedge in."

Change in pregnancy coverage

Another concern is reduced BadgerCare coverage for pregnant women.

Currently, pregnant women with incomes up to 300 percent of the poverty level get full BadgerCare coverage.

Walker's budget would give those making more than 133 percent of the poverty level only prenatal services, including labor and delivery care, Smith said.

The women no longer would be covered for postpartum care or dental care, said Sara Eskrich, health care policy analyst for the Wisconsin Council on Children and Families.

"This is a disappointing change," Eskrich said. "The whole health of the mother, pre- and post-natal, has a direct impact on the health of the unborn child."

It's not clear what benefits the 82,000 childless adults would get under the state's partial Medicaid expansion, said Jon Peacock, research director for WCCF.

Smith said they would get "full" benefits, including mental health services. But childless adults covered now receive partial benefits through the BadgerCare Core Plan, which expires this year.

The federal government has to approve the state's changes, and "it's far from certain that Wisconsin's waiver for a partial expansion would be approved," Peacock said.

Smith said the state expects the changes to be approved.

Need to build infrastructure

Some wonder if the exchange will be ready to enroll people by October and start coverage in January, as required by the health reform law.

Insurance companies will offer various levels of coverage for individuals and small groups, with government tax credits available for people with incomes between 100 percent and 400 percent of the poverty level.

Insurance plans wanting to participate must be certified by the end of July, said J.P. Wieske, spokesman for the state Office of the Commissioner of Insurance. They'll likely start applying in April, he said.

The federal government is setting up exchanges in Wisconsin and 25 other states that decided not to establish their own.

The government is preparing a website and hotline for people to enroll, said Kenneth Munson, regional director for the U.S. Department of Health and Human Services. People also will be able to sign up in person, he said.

By June, grants will be awarded to "navigators" to help consumers use the exchange, Munson said.

Participating plans will be reviewed to make sure they provide "essential health benefits," he said, and it's likely many plans will be available in Wisconsin.

"We're talking about insurers competing for business," Munson said. "It's hard to imagine insurers not offering policies for sale on the exchanges."

You might also like

(57) comments

mouser

Did this Gov ever come to realize that IL. residents are flocking to WI for our Medicaid program because it's so much better than IL? He will never be able to to keep it in check, so face it. He may throw 82K off the program, but he will get 8200 needy families from IL so it will come back haunt him one way or another. Or is he going to give them a bus ride back to IL? All it takes is 30 days to establish residency. So, while Mom & Dad have to on some exchange the kiddies go on the Medicaid system as usual. I've seen it happen so often where I used to work. Just what are we going to do with the people that are just released from the prison system? They aren't going to have the money right away to be paying for the premiums? Some of them don't have enough skills to get a job after being locked up for 15 -20 yrs or more. So, Gov what do we do with these people? Pretend they don't exist? Just what are the unemployed people suppose to do for insurance come 2014? That's another thing this Gov has yet to discuss openly. Go onto an exchange? As we all know COBRA is outrageous. Mine was over 900 bucks a month and I couldn't afford it. There's a lot of unanswered questions and no answers and nothing is coming out. It's like a big dark secret brewing and this leaves room for a lot of people to ponder the future. Some good journalist really needs to sit this guy down and needle him left and right about the ins and outs about his"hybrid" plan and let the people of Wisconsin voice their opinion! This guy could screw up a one car funeral! Heaven help us he doesn't get in again in 2016. He doesn't have my vote!

array1

Scot Walker has rejected federal money that would have covered these people. He rejects not only the opportunity for increased coverage but also the chance for Wisconsinites to recoup taxes paid to the federal government. And now her wants to charge the tax payer again for his version of the coverage.

Banjo

Don't worry about it just go clog up the emergency rooms and rack up the medical bills and don't pay them; hell ain't that the thinking behind Walkers policies. File for bankruptcy let the rest of the policy holder premiums go up or put the burden onto those that can afford it, after all isn't that what Obama care was supposed to eliminate.

Wisco_1

Scott Walker is the most politically vain candidate I have ever seen. Every decision he makes is about positioning himself as the ultimate conservative. He has taken a number of political risks when it comes to the Healthcare act. First stalling on planning for the implementation of the exchanges at a State level, then punting to the Feds. This latest gamble is to set the Feds up to fail by giving them this extra demographic to contend with as they set up the exchange for Wisconsin. Perhaps a win-win for the Governor, if the exchanges deliver an affordable product, he can claim victory over making the correct decision on his hybrid model. If there ends up being a large group of the 87,000 who can't buy insurance, then he can blame the Feds.

Shake
Shake

Canada covers 99% of it's population at a cost of 12% of GDP.
The US spends 18% of GDP and leaves tens of millions uncovered.
Percentage of bankruptcies caused by medical bills in Canada: 0%
Percentage of bankruptcies caused by medical bills in US: 62%
Percentage of sociopaths in the Republican Party: 100%

196ski
196ski

Apples and oranges
US spends 18% GDP and has an obesity rate of 32%,
Canada spends 12% GDP and has an obesity rate of 16%.

75% of national health spending is attributable to chronic diseases that are largely preventable
– 80% of cardiovascular disease
-80% of diabetes
– 60% of lung diseases
– 40% of cancers
(not counting injuries, vaccine-preventable diseases)

It wont' matter what system is in place, single payer, Obamacare, or private care, our current disregard for personal responsibility in health care will make sustaining any system impossible.

And even if it could we we be willing to accept the tax rates of Canada on our middle class? Forget the rich, middle class rates would skyrocket if we actually wanted to pay for the benefits we currently receive, let alone the ones that single payer would bring.

WI_Retiree

Shake, what do you know about Canadian Healthcare, probably nothing. Do a little research before you speak.

scorp

If you believed that Obama care would provide free insurance coverage and the State would be merely a conduit ,you also believe that Obama will pay your mortgage, buy you an electric car,send you on free vacations , and no limit food stamps .Well ,you elected the incompetent and are about to find out what the repubs say is true i.e. Obama is a LIAR . Now live with it! Stop blaming Walker for recognizing a devious incompetent .

Rosalie

Obamacare is based on Romneycare with little variation.

Shake
Shake

Which was based on a plan by the Heritage foundation to combat "Hillary Care".

array1

And now Wisconsin has to shell out for walkercare when we already paid fed tax for Obamacare.

cornflower

Why shouldn't we blame Walker when he is depriving tens of thousands of coverage by refusing the 100% funding from the federal government for the completely bogus reason that "federal funding might fall through, forcing the state to pay its usual 40 percent share for the new enrollees?" It's entirely on Walker. I guess you didn't read the article. Or you just don't care and want to hate on Obama for no reason at all, because that's who you are. Walker and you -- wouldn't want anyone to experience anything positive from the Obama admin and the federal govt because then they might realize what jerks you are.

scorp

When the feds are failing to pay the promised share of medicaid and even medicare ,one must be a little slow to believe the present fairy tale promoted by the fed. Walker did not "depriving tens of thousands " of coverage , he merely makes them PAY something for it like the nonpanhandlers do. Most taxpayers are tired of paying for "free" benefits for the deadbeats. Get a job!

Lionhear

He's not depriving tens of thousand of coverage, he's saying get it from the Obamacare exchanges. That's why ACA was passed. What's so hard about having the feds start setting up exchanges in Wisconsin. Call Obama or Tammy and tell them let's get the show on the road. Go get your bennies. It's not rocket science.

WI_Retiree

scorp, you are right on again.

happydays

Obamacare is a federal program - they wanted it - they should run it. They said it would be affordable - call them. It should not be up to the states to have to implement it - there is a large cost to implementing and running any program - and not having any say when it comes to financing it. I am happy that Walker is letting the Feds run it the way they wanted. If you have a problem with it - call the feds

RC
RC

Got there number?

cornflower

The article says that the federal govt would provide 100% of the funding. I guess they forgot that they needed to give Walker a commission. There had to be some money in there for him. He can't just give, he has to get too.

But hey, don't let facts get in the way of your bogus belief system.

blockhead

"Walker said he's returning Medicaid to its "intended purpose as a safety net for the neediest.""

Call it what it is: Walker is killing BadgerCare.

Thurston Howell III

How is Walker killing Bagdercare??? All he's doing is reorienting it towards those who can least afford to pay for healthcare - exactly what the program is designed to do.

Those who can get coverage under the all-encompassing and totally affordable Obamacare are being redirected to that coverage. That' all. And, it's the right way to handle it.

Walker is not taking Obama's sucker bait Medicaid financing. The feds can't afford to keep providing that level of support, and they are going to dump the costs on the states just as soon as they can.

And, if those people who are supposed to receive mircacle care insurance at next-to-nothing through Obamacare can't get it, then call the feds and ask them why. They created this mess, they can fix it.

Schlitizie

Stop lying! Badgercare is dead.

My wife and I have been on the waiting list for 5 years now and only now are discovering that we'll never be accepted into the program. I already talked to a case worker for the state who said we have no chance of getting in now because of Walker's decisions. We're screwed and so are the tens of thousands of others just like us.

Nav

Well, it is time for you and tens of thousands to band together and make sure he won't be elected again.

Thurston Howell III

Lying?? If you've been on the waiting list for 5 years now, you were on it for years under Jimmy Doyle, your Democrat hero-governor. In fact, if you've been on the waiting list for 5 years, you were on it since about 2007 - 3 years before Walker was even elected.

Find another scapegoat. Walker isn't the cause of your problems - he's trying to keep BadgerCare for those for whom it was intended. If Obamacare is the health care miracle that you've all been promised, you have not a thing to worry about. Maybe if you get your Walkermania diagnosed properly you can get some needed help now.

blockhead

yep, Doyle had a waiting list too! Only Walkers has now thown 10s of thousands more off the program, and is about to extend these throw-offs to 82,000 more...

lyla

Schlitizie- you have money to buy computer and pay for internet but no money to pay for your health insurance?

blockhead

87,000 adult parents being shifted off Tommy Thompson's Medicaid BadgerCare and shunted off to face Walker's "free market" approach. These are by definition low income working people who (1) don't have health insurance at work and (2) can't afford regular insurance. Walker's "new program" is a sham, offered to distract Wisconsin from the fact that he is turning down the greatest mdicaid deal in history to satisfy tea party suckers.

Lynne4300

On the bright side, Governor Walker works to protect the unborn, unlike liberals who strive for FREE taxpayer funded abortions.

blockhead

Gee, I'm a liberal and I never heard of "FREE taxpayer funded abortions." (As if taxes are free!!) Where do I sign up to support these imaginary "FREE taxpayer funded abortions."

Nav

I do wish Lynne would make some real contributions to this forum.

WI_Retiree

Right on blockhead.

artv427

You have got to be kidding me. You people have spent the last 18 months going on and on about how great Obamacare is and how awesome the exchange will be and how great Obama is for making the exchange affordable with the subsidies. And now you're whining about it. Isn't this what you all wanted? Now that walker is using the exchange to allow those above poverty to get coverage, now the exchange isn't good enough for you. Wow!

PennyWise

Obamacare is awesome. Make the insurance market a free-market economy. What is happening in Wisconsin is that our wonderful uneducated governor has taken the loophole of running his own exchange and letting the Federal government also run theirs "with no input from Wisconsin, in the hopes of seeing it fail". The best way is to apply different sets of rules that force the poor from our roles. How wonderful a man he is, hiuh?

What does it mean for the people caught outside the gov's attempt to discredit the government. Well, like most policies he's backed (he's not written them, even You aren't that stupid), he doesn't care. He's in it for himself and F-U the people of Wisconsin.

Master William

Really? Awesome? Really? Are you familiar with how it is going to impact the residents of this state? US citizens? Costs are increasing for all of us. If you are lower income, you will do o.k. with the exchanges as far a price but your plan may be limited in network. Heaven help you if you get really sick because your access to specialists may be limited because the best doctors won't want to be tied to the reimbursements. The federal government will also pay your premiums for you. Now lets say you have some gumption and education and if you make more money than 300 or 400 times poverty level, then you need to start to pay for your own health insurance. So you'll now need to pay the premiums and that is your problem now. Premiums are going up 30-45% higher than what they are now but for everybody. Welcome to Obamacare. More money for less. Y'all had better stay healthy!

Nav

Master William, are you aware that a bunch of Republican Governors who initially said Obamacare would destroy the nation are now coming around and thanking Obama and calling him ObamaCARES?

Obamacare is the law of the land, and gradually we will get to universal care.

lyla

Nav - Name the governors please.

Hogzilla
Hogzilla

lyla~ There are 7 states with Republican governors that are taking the Medicaid expansion money from the Fed's. Michigan, New Mexico, North Dakota, Florida, Arizona, Nevada and Ohio.

There are also 18 states that are not taking the money or leaning towards not taking the money. There are also 8 states that haven't decided. It's a pretty even split.

I haven't heard of a single Republican governor say that they now thinks Obama cares though, she made that part up.

Thurston Howell III

@PennyFoolish - Just how does allowing the "federal government run its own exchange in Wisconsin with no input from Wisconsin" set it up to fail?? The same geniuses that invented Obamacare can now set it up as they please, and run it as they please. They can also pay for it. Or is that really your beef here - Wisconsin isn't going to be dumb enough to let Obama create this fiasco and then blame the states for its failures and stick the states with the (inevitable) cost overruns? And, what an incredibly telling comment to refer to the states being able to set up their own exchanges as a "loophole". Yes, you are absolutely correct - the true purpose of Obamacare is to establish a single payer national healthcare plan. So, then do it and leave the states out of it. By the way, Foolish, aren't about 34 states opting out of creating their own exchanges?? So, the governors of all these 34 states are in it for themselves "and F-U the people" of their states? Wow, there are a lot of nasty governors out there, strung all across the country. Of course, they just might be smart enough to see this fiasco of a healthcare program for what it is and opt out of giving a fall-guy to the feds.

Walker is fully complying with the terms of Obamacare - 100%. So, if you don't like it, go screaming to the geniuses in Washington who created it.

"Once you find out what's in it, you're going to like it." So, learn to like it already.

lyla

Thanks Mr. Howell for explaining this to the uniformed voters. Very sad to say the least that they now complain when they are the ones that voted Obama in. Now go pay your premium for Obamacare.

blockhead

Hopefully, the federal exchanges in Republican states like Wisconsin will form a basis for single payer a few years from now, since they will share the same unifying structure, softwares, rules, etc. Most easier starting point then unique state-devised systems.

Lionhear

There is a price to pay for passing laws without reading them first, and extrapolating the impact of that law in real life. Just wait until 2014 when this law really kicks in.

Schlitizie

Not having any kind of health coverage prevents me from getting out of the hole of sickness I've been in for the past 3 years, so that I may return to the workforce and be productive again. Been on the waiting list for Badgercare for 5 years now. I doubt I'm ever getting in or will ever get out of this neverending downward spiral that is my life in Wisconsin.

Bluezee

My family and I are considering moving.....along with many others. Sad. We are going to lose many more of our talented college graduates, that have gone to our universities, as they will realize Wisconsin is a dead end...and other states are recovering and blooming. downward spiral for sure!

Schlitizie

We're moving as soon as we can sell our home. We just haven't been able to do that, because of the poor housing market. We would have left Wisconsin years ago had we not been trapped here to begin with.

Thurston Howell III

Schlitzie, why don't you move out to the worker's paradise, in California. Get on Medicaid there. Jerry will take care of you there.

Be sure to report back to us on how well everything goes.

lyla

When you sell your home, you ca pay for your medical needs like most others do.

Lionhear

schlitzie--sounds like your health care insurance began during Doyle's regime.

Homer717

This issue is a direct result of Obamacare, Walker is complying with the law.

Bluezee

I call BS. Walker is putting his ideology before the well being of citizens of this state. People voted for Obama in good part because of his healthcare reform. He is addressing a problem that has plagued families for years now. Health care bankruptcy. It seems Republicans have a hard time understanding this because their agenda comes before addressing the problems of real everyday people. They often have to fabricate a problem to promote their legislation.....like voter id.

PennyWise

The day we see Walker comply with the law we see snow in Hell. He's the corporate puppet complying with big money. A fool and our money are soon parted. Or have you gotten one of those many jobs he's created and living high on the hog?

bosco

See snow in hell or "I'll give you sex when the neighbors kid becomes an astronaut"

Rosalie

This does not happen in most modern civilized countries, nor do their citizens go bankrupt after experiencing major illnesses. Greed is a major component of the US health care system.

See the latest on this discussion in Steven Brill's Time magazine cover article "Bitter Pill" http://healthland.time.com/2013/02/20/bitter-pill-inside-times-cover-story-on-medical-bills/

midwestguy

This action makes it clear. The Walker administration wishes to sanction a two-tiered society of "haves and have nots". The pathologically mean-spirited comments of his defenders only adds weight to the assertion.

brownrecluse

I might be exposing myself to some criticism here but is it "responsible parenting" to have 3 children on such a limited income? Secondly , most traditional families today rely upon 2 incomes, perhaps the Jaglowski's and others in their situation can find an additional source to augment the family income ? I am ceratinly aware that in some cases a second income is not possible but the scope of this article does seem to have a bias against Walker's proposal.

Bluezee

It is also possible that many families incomes are shrinking and the cost of living keeps rising. I know my income has gone down in the last five years. I also know of many lay offs...and they were already fathers.

Master William

Amen.

Davisra

imagine that...an article in the Wisconsin State Journal that's biased against Gov. Walker. Most articles seem slanted that way, including the one with the picture of the huge Union Fist the other day. Pretty tough being a fiscally-conservative Republican supporter in this town.

concerned_citizen

Gov Walker really does hate 47% of our fellow Wisconsinites.
and, he most obviously, hates the poor - just like Jesus, and his Baptist preacher father.

Welcome to the discussion.

Keep it clean. Exchange ideas and opinions on posted articles. Don't promote products or services, impersonate other site users, register multiple accounts, threaten or harass others, post vulgar, abusive, obscene or sexually oriented language. Don't post content that defames or degrades anyone. Don't repost copyrighted material; link to it. In other words, stick to the topic and play nice. Report abuses by clicking the button. Users who break the rules will be banned from commenting. We no longer issue warnings. Use the 'Report' link on each comment to let us know of abusive posts.