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Dan Schwartzer, WAHU Executive Vice President

Updated July 29, 2008

 

Wisconsin’s legislative session runs over a two year period, with the session starting in January of the odd numbered years and ending around May of the even numbered years.  The time between the end of a session and the beginning of one is spent by most legislators trying to get re-elected and challengers trying to unseat incumbents.  For lobbying organizations like WAHU, this time of year is typically spent working with all of the candidates for office trying to educate what will be the next year’s legislature about our industry and the value of the insurance agent.  This year is anything but typical.

 

As you know, we are still recovering from what was one of the most difficult legislative sessions – engaged in countless reform measures as well as the 600 pound gorilla known as Healthy Wisconsin.  For much of the 2007-2008 session, our industry educated legislators against the possibility of a government takeover of our health care, which would eliminate the job of the insurance agent.  While successful in defeating Healthy Wisconsin, we have all known full well this proposal will be back again next session and our association and industry have been working hard to prepare for the debate once again.  Since the introduction of Healthy Wisconsin and even throughout this summer, all of us have feared the threat of this government take over and believed it would be the end of our industry.  Yet, is it possible we have focused on the wrong threat?  Is it possible we may have mistakenly diverted our attention from what might be a more realistic and viable threat to our industry?

 

While we are all correct to be very concerned with Healthy Wisconsin, there is a high probability that such a proposal would be challenged in the courts relative to ERISA preemption.  Even in today’s hostile environment about this sacred cow, many experts still believe such a challenge would succeed.  If this is true and Healthy Wisconsin pans out to be nothing more than a diversion of our attention, then what is the real threat to our industry?  Many years ago, the Federal Government created the State’s Children Health Insurance Plan, otherwise known as SCHIP.  In Wisconsin, like many other states, we dramatically altered the intent of SCHIP and instead, created an unnecessary expansion of our Medicaid system.  SCHIP was supposed to provide assistance to uninsured children who met a certain poverty level so they may become part of the insured population.  Even our own association was supportive of the concept (although we disagreed with an expansion of Medicaid and instead offered a proposal to provide vouchers for these children).  Instead, when our state adopted the SCHIP plan, otherwise know in Wisconsin as BadgerCare, we expanded the program to also include coverage for the uninsured parents.  We developed a government run health care system for Wisconsin residents who meet certain income requirements (up to 185% of the federal poverty level), all through our Medicaid system. 

 

As we all began to accept the program, it was expanded to what is known now as BadgerCare Plus.  BadgerCare Plus includes three phases.  The first phase, which has already been implemented, provides the same coverage as BadgerCare, but it raises the income levels for the parents up to 300% of the federal poverty level and provides for government run health insurance to all children in Wisconsin with NO income requirements.  That means a couple earning $500,000 per year can get taxpayer subsidized, government run, health insurance for their children.  It is important to note that it is the programs intention that only children who have been uninsured for the last 12 months are allowed into the program.  However, the advertising and solicitation materials make any mention of the requirement.  More importantly, how would the state determine if the applicant falsely answered the question.  The point we are making here is even with the best of intentions of trying to avoid crowd out, there is no question that children who were previously insured in the private market will be getting coverage under BadgerCare Plus.


The second phase of the expansion will include coverage for childless adults.  The state has submitted its waiver request to the Department of Health and Human Services and is waiting for approval.  This phase would provide taxpayer subsidized, government run, health insurance for any childless adult who meets certain income requirements.  Remember that Medicaid and SCHIP were intended for children. 

 

The third phase is a bit more difficult to explain as it is still just a proposal and would need legislative approval.  From what has been discussed and from what we know, the third phase would do the following:

  • Create a “connector” style government program for all small group employers and their employees
  • Potentially increase our small group reform from 2 – 50 employees, up to 2 – 100 employees
  • Provide subsidies for employers who signed up on the connector program with the state
  • Health plans participating in the connector program might have to provide community rating
  • Health plans not participating in the program might have to provide community rating

This third phase would be called BadgerChoice and would be connected to the BadgerCare Plus system.  Even without approval of the second phase (childless adults), the state has already developed a central processing hub.  Similar to a call center, any resident of the state calls the BadgerCare Plus processing center.  The center determines which phase the caller might be eligible for, and then processes their application.  With BadgerChoice, the intention is for the center to handle those calls as well. 

 

So what is the threat to our industry?

  • Taxpayer subsidized, government run health insurance for all children in Wisconsin regardless of income and with no real ability to apply any previously uninsured requirement. 
  • Taxpayer subsidized, government run health insurance for adults – first at 185% of the federal poverty level, then up to 300% of the federal poverty level.  Can anyone see the state trying to get approval for up to 400% of the federal poverty level, or 500% or 600%? 
  • Taxpayer subsidized, government run health insurance for any employer and their employees (groups 2 – 100).  Even if a private market still exists, what employer wouldn’t sign up for their group health insurance with the state if it is less expensive than the private market (and it will be if it is taxpayer subsidized)? 
  • The BadgerCare Plus central hub that provides all of the services that insurance agents provide.

Excluding any resident who is not employed with an employer who has over 100 employees and operates a self funded employee benefit plan, the threat is an incremental government run health insurance system for all residents, and without the ability for anyone to challenge an ERISA preemption.

 

Perhaps this is a good time to remember that WAHU supports affordable health insurance coverage for all Wisconsin residents.  We merely oppose doing this through a government run health care system.  We supported vouchers when BadgerCare was created and we still support the voucher concept today.  Perhaps this is also a good time to remember the tale of the frog.  Placed in a pot of boiling water, the frog will leap out to save itself.  Placed in a pot of tepid water that is then slowly and gradually heated until coming to a full boil, the frog will stay in the pot unaware of the increase in heat and will boil itself to death.

 

Because of the popularity of BadgerCare, no one has noticed, let alone challenged, this slow and incremental expansion of a government run health insurance system known as Healthy Wisconsin, err, I mean, BadgerCare Plus.    

 

 
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