Health Care For All

Governor Doyle’s Roadmap to Universal Access to Health

Insurance for all Wisconsinites

July, 2009

Overview

Governor Doyle’s Health Care Vision Wisconsin’s Health Care Challenges Wisconsin’s Uninsured Population Governor Doyle’s Seven Point Plan for

Health Care Reform

Governor Doyle’s Health Care Vision

Every Wisconsin resident will have access to affordable health insurance.

Every child will have access to high-quality health care services.

The state must lead the way in meeting these goals.

Governor Doyle’s Health Care Vision

Sound health policy – grounded in research and data – will drive implementation of solutions.

Business community and health care providers work in partnership with the state to improve quality and reduce costs.

Health care costs are lowered and are no longer a drag on Wisconsin’s economy.

Health care programs must be simple and easy to access.

Wisconsin’s Health Care Challenges

Access – While progress has been made, some Wisconsin residents do not have access to affordable health insurance.

Cost – Costs are increasing, both for health care and for insurance coverage.

Quality – Lack of easily accessible information about the quality of care and medical errors are far too common.

Medicaid Financial Stability – State must maintain sustainable financing for Medicaid.

Wisconsin’s Uninsured Population

In 2007, 6 percent of Wisconsin residents were currently uninsured and 5 percent had been without insurance for the entire past year. The percentage uninsured part of the past year shows a

significant decrease from 2006 (5%) to 2007 (4%). The proportion of children (ages 0-17) uninsured all year

decreased from 4 percent in 2006 to 2 percent in 2007. The proportion of children uninsured during part of the year also significantly decreased (from 4% to 3%).

The percent currently uninsured decreased significantly between 2006 (8%) and 2007 (6%).

Wisconsin has the 2nd lowest uninsured rate in the country.

On Wisconsin

Governor Doyle’s Seven Point Plan for Health Care Reform

Other Medicaid programs

4%

Employer Sponsored Insurance

66%

Medicare12%

Other Types of Insurance

2%

Access through BadgerCare Plus

14%

No access to insurance

2%

Point #1: Universal Access

Ensure that 98% of Wisconsin residents have access to affordable health insurance – including all kids

Universal Access: Implementation

Wisconsin continues to expand access to health care during difficult economic times

Phase One: Implemented BadgerCare Plus for children and families in February 2008 In one year, more than 100,000 individuals enrolled,

including 70,000 kids. Made the program simple and easy to access. Streamlined eligibility requirements so more pregnant

women, parents and caretakers were able to become members.

30% of applications received online.

Universal Access: Implementation

Wisconsin continues to expand access to health care during difficult economic times

Phase Two: Implemented BadgerCare Plus Core Plan for adults with no dependent Transitioned General Assistance/General Relief medical

program into the BadgerCare Plus Core Plan on January 1, 2009 (12,500 members).

Implemented the BadgerCare Plus Core Plan statewide on July 15, 2009. Received more than 20,000 applications in three weeks. 82 percent of applications received via online application process.

Innovative benefit/program design that will serve as a national model.

Requires members to receive a physical exam during the first year of the program. This requirement is unique among state Medicaid Programs.

Universal Access: Easy Enrollment

Wisconsin leads nation in simplifying enrollment for health care programs.

Medicaid programs will be simple to understand, to enroll in and to administer.

Implement one-page application form. Apply online via ACCESS, in person, by phone or

through the mail. Non-traditional points of entry: Community-based

organizations like WIC clinics, faith-based organizations, Head Start, etc. 200 partner organizations statewide.

Previous Medicaid Eligibility System

Medicaid/BadgerCare/Healthy Start

Current Medicaid Program

Medicaid/BadgerCare/Healthy Start

Point #2: Family Care

Reform of long-term care system. Utilize managed care principles and community-

based settings to control cost, expand access. Ensures access to community-based long-term care

services for 11,000 Wisconsin seniors and individuals with disabilities.

State is more than half way to statewide implementation.

By the end of 09-11 biennium, Family Care will be operating in 59 counties that include 90% of the state’s population.

Point #3: SeniorCare

Asking Federal Government to extend SeniorCare through December 31, 2011

Highly cost-effective drug program for 90,000 Wisconsin seniors.

Easy-to-understand program. $30 annual enrollment fee and participants are enrolled for 12

months. No donut hole. Most drugs are covered and SeniorCare is accepted at all

pharmacies. Co-pays are based upon income and have remained

unchanged since September 2002. Wisconsin negotiates drug prices to save money for

members.

Point #4: Health Care Quality Reform

Wisconsin is transforming its Medicaid programActive purchaser of quality health care

Holding Medicaid and BadgerCare Plus HMOs accountable for health outcomes (P4P).

Implementing new quality measurement system (HEDIS).

Implementing innovative benefit/program design linked to quality improvement (Core Plan).

Increased oversight of HMO network capacity and utilization control procedures.

Performance-based RFP for managed care in Milwaukee/SE Wisconsin. Goal to significantly improve quality, lower costs.

Point #5: Decrease Smoking

Raised the cigarette tax per pack by $1.00 in 07-09 budget.

Raised the cigarette tax by per pack $0.75 in 09-11 budget.

Increase taxes on other tobacco products. Use new revenue to enhance funding for health

care, including tobacco control programs. For each 10% increase in the price of cigarettes,

youth smoking rates decline by 6.5% and adult rates by 2%.

Point #6:Hospital Assessment

Reforms hospital rates to reward hospitals providing high-quality services to Medicaid members.

Substantially increases hospital rates. Almost triples the average fee-for-service outpatient rate. Inpatient rates will also substantially increase. Net gain for Wisconsin hospitals is approximately $200

million per year.

Revenue state gains support Medicaid program and will allowed statewide implementation of the BadgerCare Plus Core Plan.

Point #7:BadgerChoice

Proposal to reform health care for small businesses. Creates a connector for businesses to purchase insurance.

Creates a pool of more than 300,000 employees giving small businesses big business bargaining power.

Anticipated Outcomes: Significantly lowers annual health care costs through insurance

market changes and subsidy. Reduces volatility in the market. Makes small group insurance market more transparent.

Not included in Governor Doyle’s 09-11 biennial budget. Wisconsin positioned well for national health care reform

options.

Governor Doyle’s Seven Point Plan for Health Care Reform Summary Wisconsin has a historic opportunity to ensure that

every resident—especially every child—has access to affordable health insurance.

Governor Doyle’s plan builds on past successes, leads the nation in health care innovation.

Working together, we can ensure that every individual in Wisconsin has access to affordable health insurance and high quality care.

National reform efforts will have an impact on Wisconsin - Hopefully a positive impact.

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