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With election season and health insurance enrollment overlapping this fall, recent state and federal health policy decisions — and others that might come soon — could inform voter attitudes about coverage and care.

Gov. Scott Walker’s reinsurance plan to curb premium increases on the Affordable Care Act marketplace was approved by the federal government last month. It will reduce rates next year, insurers say.

The Trump administration relaxed rules on association health plans, spurring two large groups in Wisconsin to start them, and on short-term plans. The alternatives could help some people find cheaper, though less comprehensive, insurance — but pull healthy people off the marketplace, potentially increasing its rates, critics say.

With $200,000 in federal money available in the state to help people enroll in the marketplace this year, down from $1.3 million two years ago, assistance will be scaled back.

Meanwhile, Walker’s plan to require childless adults on Medicaid to work and undergo drug screening could be approved by the federal government soon.

Democratic gubernatorial candidate Tony Evers says he would take the Affordable Care Act’s full Medicaid expansion, which Walker refused. That could bring more federal money to the state.

Scott Walker Tony Evers mashup (copy)

Gov. Scott Walker, left, and State Superintendent Tony Evers are facing off in the 2018 governor's race on Nov. 6.

For the vast majority of people who get insurance through employers or Medicare, the developments don’t have a direct impact. But they could influence the availability and affordability of coverage for low-income people and those who buy insurance on their own — topics that could resonate with many voters.

“Do people feel like they have insurance coverage, they can keep their coverage, and they can afford their insurance and their health care? Those are the questions that are going to be asked,” said Donna Friedsam, health policy programs director at UW-Madison’s Population Health Institute.

Health coverage is the third most important issue among voters in the state, behind the economy and K-12 education, according to a Marquette Law School poll last week.

Health care systems want stability, said Eric Borgerding, CEO of the Wisconsin Hospital Association. “It’s been a fairly challenging year or two of uncertainty,” he said.

Premiums going down

Statewide, about 225,000 people signed up for health insurance this year on the marketplace, also known as Obamacare. That’s down from 243,000 last year.

Premiums this year rose an average of 44 percent, and three insurers left the marketplace: Molina Healthcare, Anthem Blue Cross Blue Shield and Health Tradition Health Plan.

Walker, in January, proposed a $200 million reinsurance program — $34 million from the state and $166 million in federal funding — to cover 50 percent of medical claims on the marketplace between $50,000 and $250,000, saying it would stabilize premiums.

Following federal approval in late July, the state Office of the Commissioner of Insurance said premiums on the individual market will decrease 3.5 percent next year, based on initial filings by insurers. Without reinsurance, rates would have gone up 7.5 percent, OCI said.

Reinsurance “played the predominant role” in Dean Health Plan’s premium decreases next year of 11.9 percent and 14.8 percent, spokesman Ben Klepzig said.

At Quartz, reinsurance and marketplace stabilization led to reductions of 8.9 percent to 18.7 next year for products encompassing Unity, Gundersen and Physicians Plus, spokeswoman Jennifer Dinehart said.

Critics say Walker’s and Trump’s attacks on the Affordable Care Act in general has raised rates, and insurers don’t have to share their reinsurance savings with consumers.

“More corporate subsidies are not the answer,” Robert Kraig, executive director of the left-leaning Citizen Action of Wisconsin, said in a statement.

Alternative health plans

Association health plans, which allow small employers and sole proprietors to buy insurance together as a large group, were bolstered in June by Trump administration rules to expand the plans.

Unlike marketplace insurance, association health plans don’t have to cover essential benefits — such as maternity care, mental health and prescription drugs — which can make them cheaper.

Wisconsin Manufacturers and Commerce, and Wisconsin Property Taxpayers said this month they will offer association health plans. The Wisconsin Medical Society already has one.

“Containing health care costs for employers has been a problem for businesses for decades,” Kurt Bauer, CEO of WMC, said in a statement, calling its new plan “an important new tool.”

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Wisconsin Manufacturers and Commerce

Attorneys general from 11 states are suing over the expansion of association health plans, saying the plans would “undo critical federal consumer protections.”

It’s not clear how much the plans might lure healthy people from the marketplace. The plans could appeal to the small fraction of marketplace enrollees who make too much to receive subsidies, but many of them might have health conditions requiring full benefits, Friedsam said.

“It’s going to be a niche,” she said. “It’s not going to be this enormously broad group of people.”

Short-term plans, which don’t have to cover essential benefits or take people with pre-existing medical conditions, can now last up to a year instead of three months, and be renewed up to three years, following a Trump administration rule this month.

In Wisconsin, however, the plans can’t be extended beyond 18 months.

Borgerding called them “skinny, bare-bones” plans that leave patients with significant out-of-pocket expenses, which can increase bad debt at hospitals.

Randy Pate, deputy administrator of the federal Centers for Medicare and Medicaid Services, said they offer an “affordable option to many, many people who’ve been priced out of the current market.”

With reinsurance propping up the marketplace and the alternative insurance options potentially threatening it, “you have two divergent philosophical views playing out,” Borgerding said.

Medicaid changes possible

The significant reduction in funding this year for navigators to help people sign up for insurance means some assistance will be provided by phone instead of in person, said Friedsam, who heads up Covering Wisconsin, which has applied for the $200,000 available.

In-person assistance could still be available in 23 counties, she said. In Dane and Milwaukee counties, the level of in-person help should be similar to previous years because of local contributions. They include $50,000 from Public Health Madison and Dane County and $90,000 combined from SSM Health, UW Health and Group Health Cooperative of South Central Wisconsin.

Marketplace enrollment runs Nov. 1 to Dec. 15, with signups for employer coverage at many workplaces coming before then. The election is Nov. 6.

Healthcare.gov

The Healthcare.gov website for the Affordable Care Act marketplace is shown last year. 

Wisconsin submitted its plan to require childless adults to be screened for drugs and work if they are able to the federal government in June 2017. It is expected to be approved soon, Politico reported this month.

Though a federal judge recently blocked Kentucky’s work requirement, the Trump administration has said it would still grant permission to other states.

Walker’s plan to require drug testing if drug screening calls for it will be pared down to making applicants say if they’ve used drugs or are in recovery, Politico reported, citing an anonymous federal official.

Walker didn’t expand Medicaid to cover people who make up to 133 percent of the federal poverty level, for which the federal government paid 100 percent at first and later 90 percent. He limited coverage to people at or below the poverty line, shifting 63,000 adults off Medicaid and allowing 130,000 childless adults onto the program, with the state paying its regular 40 percent share for them.

The state could have saved $1.1 billion in 2014 to 2019 by taking the Medicaid expansion, according to the Legislative Fiscal Bureau. That figure doesn’t account for federal subsidies people just above the poverty level get on the marketplace.

Evers has vowed to pursue the Medicaid expansion.

Capital W: Plug in to Wisconsin politics

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