Unknowns in health care coverage worry those who may need it

Unknowns in health care coverage worry those who may need it


An asthma attack landed Denise Crawford in the hospital last month, with a $10,000 bill.

Health insurance to pay for her inhalers would help prevent that from happening again, she said.

Inhalers "are too expensive with no insurance," said Crawford, 51, of DeForest, who is unemployed.

Zachary Donner, who has type 1 diabetes and is also uninsured, isn't sure how he'll keep paying for insulin, test strips and other supplies.

"It's pretty stressful," said Donner, 20, of Columbus, who delivers pizzas and plans to attend Madison Area Technical College next year.

Crawford and Donner said they hope Wisconsin expands Medicaid coverage through the 2010 federal health reform law. They also might be helped by the law's health insurance exchanges — virtual marketplaces for people without employer coverage to buy private insurance beginning in 2014, in many cases with government subsidies.

The health law, which requires most people to get insurance, says states must apply to set up exchanges by Friday or the federal government will operate them. The states that apply by Friday have until Dec. 14 to submit details, the Obama administration announced last Friday in a letter to governors.

Gov. Scott Walker, who opposed the law, said he would wait until after last week's election to decide whether to set up a state-run exchange or expand Medicaid, the state-federal health plan for the poor.

With Republicans' hopes of repealing the law all but gone after President Barack Obama's re-election and the Democrats' continued control of the U.S. Senate, the state faces key decisions on how to implement it.

The administration is discussing how to proceed, Walker said last week.

State-run exchange preferred by some groups

The Wisconsin Hospital Association, Wisconsin Manufacturers and Commerce and both of the state's health insurance associations support a state-run exchange.

"Wisconsin is better served by an exchange that is fashioned specifically for Wisconsin," said Phil Dougherty, senior executive officer of the Wisconsin Association of Health Plans.

In some states, Dougherty said, two or three insurance companies cover 80 percent of the private market. In Wisconsin, 18 companies do.

A state-run exchange would help maintain that competitive market, he said.

Al Wearing, marketing director for Group Health Cooperative of south-central Wisconsin, said a federal-run exchange might allow only statewide carriers to participate.

"In a state like Wisconsin, with lots of regional carriers, that could be very problematic for all of us," Wearing said.

Madison-based Group Health's service area is Dane County.

The state stopped work on an exchange in January but can meet Friday's deadline if necessary, said J.P. Wieske, spokesman for the Office of the Commissioner of Insurance. It would take some effort, however.

"If we decide to move forward on an exchange, it will be a lot of intensive work," Wieske said.

Wisconsin's exchange would cover about 250,000 people, according to the Wisconsin Council on Children and Families.

States developing exchanges face many questions, said Heather Howard, director of the State Health Reform Assistance Network.

Among them: What will the exchange's website look like? How will its call center work? Who will decide which applicants must buy private insurance and which qualify for Medicaid? Who gets subsidies and how much? Will the exchange be independent or part of a government agency? Will its board include consumers or allow insurance company representatives?

Bobby Peterson, head of ABC for Health, a Madison nonprofit that helps people get health care, said he's skeptical of any plan the Walker administration assembles by Friday.

"It's not something you can just throw together 10 days after the election," Peterson said.

Putting the essential elements together by Friday could at least let the state keep its options open, however, he said.

No deadline on Medicaid expansion

The Medicaid expansion, made optional by the U.S. Supreme Court ruling in June that upheld most of the federal law, has no set deadline.

About 170,000 people in Wisconsin, most of them adults with no dependent children, could gain coverage. The federal government would initially pick up all of the tab, with states eventually paying a small portion.

Dennis Smith, secretary of the state Department of Health Services, wouldn't say last week if he will pursue the Medicaid expansion. Earlier this year, he said he's trying to control costs in the state's current Medicaid program before considering an expansion.

Crawford hasn't had health insurance for more than 20 years. She's on the waiting list for the BadgerCare Plus Core Plan for childless adults, part of Medicaid. Until early this year, she worked at a convenience store.

With $233 a week from unemployment, she can't afford more than $100 a month for the inhalers her doctor prescribed, she said. She sometimes uses inhalers belonging to her partner, who is on BadgerCare.

Crawford ended up at Meriter Hospital for four days last month after an asthma attack. She isn't sure how she'll pay the $10,000 bill.

"Anything right now would be helpful," she said of insurance health reform might bring.

Donner's parents are disabled from back injuries and on Medicare, the federal health plan for seniors and the disabled. He can't get coverage through them like young adults can through parents with private insurance.

His father, Allyn Donner, started working again this month as an on-call communications technician. That will help pay for Zachary's diabetes supplies and might eventually lead to private coverage for both of them, Allyn Donner said.

He's worried the work won't be steady enough to quality for insurance, however, or that his back will go out again.

He said Zachary hasn't seen his regular doctor for a year and was hospitalized three times during that period at Columbus Community Hospital for complications from diabetes. The hospital's charity care program took care of those bills.

"It's tearing me apart," Allyn Donner said. "Everybody needs coverage."


Capital W: Plug in to Wisconsin politics

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