Allison Espeseth

The Affordable Care Act, also known as Obamacare, has gone a long way in insuring folks who previously weren’t covered by health insurance. In just two years, from 2013 to 2015, the percentage of Wisconsinites not covered by insurance dropped from 9.1 percent to 5.1 percent. That’s 195,000 people who have insurance that didn’t before.

And the law has become entrenched in the insurance market. Current enrollment for Obamacare for the period that ends at the end of the month is 234,000, ahead of last year’s total of about 225,000. That’s two-thirds of Wisconsinites who are holding individual insurance plans.

Nevertheless, Republicans, now in control of Congress and the presidency, are moving quickly to repeal the law, creating an uncertain future for newly covered residents, as well as nearly every other health care consumer in the state.

Not only are Republicans expected to dismantle the 4-year-old health insurance exchanges, but other significant provisions like making insurance carriers cover pre-existing conditions and the mandate for residents to purchase insurance – which could mean an exodus of young “invincibles” from the market -- could disappear.

Covering Wisconsin is a UW-based initiative that helps people navigate the complicated health care landscape, which, with the expected Obamacare repeal and no definite replacement, gets more complicated all the time.

Allison Espeseth, Covering Wisconsin’s development and operations manager, talks about some of the issues Wisconsin health care consumers might confront.

With all the uncertainty in health care policy, what are you telling the people you work with?

When people ask what the situation is and what they can expect, we don’t say that we know. Nobody does at this point. We tell them we will continue to work on their behalf, to understand what the policy is and what their options are, and communicate that in a way that they can understand. Our organization aims to educate everyone, though we give particular attention to those who are lower income and likely lower literacy, because this is really confusing for anybody.

What are some of the most likely elements of a replacement plan?

I think there are some common characteristics that we’re seeing: HSAs (health savings accounts), looking at reintroducing high-risk insurance pools, pre-tax credits, looking at allowing purchase of coverage across state lines. I think there are some things you’re seeing in common across a few of the proposals. Right now the details are missing.

Making insurers cover pre-existing conditions has been a popular component of Obamacare. But one proposal allows insurers to exclude pre-existing conditions if coverage lapses. Is there a lot of concern over possibly rolling that back?

We’re watching that closely to see where that goes. We’re looking at some of the questions about including the continuous coverage provision and also using the high-risk insurance pools. We want to make sure that if the high-risk insurance pools do come into play that we’re really paying attention to our consumers who would fall into that because they have pre-existing conditions. Would they be offered coverage at an affordable price? Because for us, for Covering Wisconsin, that’s most concerning. Making sure that those consumers who are in plans now can find options for themselves that allow them to access care at an affordable price.

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Those in the 18 to 34 age range, the so-called “invicibles,” make up about 26 percent of Wisconsin Obamacare plan holders, a low-risk pool that gives the marketplace stability. If the mandate is dropped, isn’t there the worry that many of them will discontinue their policies?

I think keeping young adults in the pool will continue to be something that’s of great concern to all these different proposals moving forward. It looks like Republicans are considering this and suggesting that the age band ratio go from three to one to five to one (meaning a 64-year-old could pay five times as much as a 21-year-old, as opposed to three times as much) as a way of reducing costs for younger and healthier adults. If it were to be put into place, the concern is it would end up increasing costs for older adults. We’re always making sure that the younger adult population is aware of their options, making sure that they know that injury and illness can happen at any time, and that they need to learn how to become an effective consumer of the health system.

Health care navigators played a big part in helping people understand and utilize health care under Obamacare. And that’s a large part of what Covering Wisconsin does. Is there any talk of continuing that service under a new plan?

We certainly hope that it will be included as part of the package. When the marketplace was actually rolled out across the country, here in Wisconsin the state actually played a pretty significant role in establishing regional enrollment networks. These networks were meant to bring together professionals across all types of agencies, businesses and organizations, so that they could work together to make sure they were all up to speed on what the policies were, where consumers could get assistance and helping to spread to the word in their own community -- a resource really for consumers and professionals. We’re hopeful that something similar would happen.

Unlike many states, Wisconsin didn’t expand the number of Medicaid recipients. So most of the decrease in the uninsured rate is due to participation in Obamacare. Does that make the state more vulnerable upon repeal?

It’s really going to depend on what the full package looks like and how things are going to shift and what the transition time is going to be. We’re always concerned about making sure that those who currently have coverage can hopefully keep some sort of coverage. So we’re going to look at what is put out there and how we can shift people to whatever their options might be without any kind of gap.

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Steven Elbow joined The Capital Times in 1999 and has covered law enforcement in addition to city, county and state government. He has also worked for the Portage Daily Register and has written for the Isthmus weekly newspaper in Madison.