Health Reform Facts: Wisconsin

DEMOGRAPHY
The Patient Protection and Percent of Population in the Wisconsin by Race / Ethnic Group 2
Affordable Care Act (ACA) was
enacted on March 23, 2010.
Successful implementation
requires cooperation between key
stakeholders, federal and state 3.7
5.1
agencies, and reform advocacy 6.1
organizations. Because the fifty White (Non Hispanic)
states vary greatly, each state’s
Black
implementation process will be
unique. Hispanic
Other*
In 2009, Wisconsin had an
estimated population of 85.1
5,654,774.1 While the state’s
population is primarily White,
there are communities with
substantial racial diversity, which
will present Wisconsin with * Others include American Indian & Alaska Native, Asian, and Native Hawaiian and
varying challenges as it strives to other Pacific Islanders.
implement health reform that
works for all residents.
WISCONSIN AND THE UNINSURED: HOW WILL THE AFFORDABLE CARE ACT HELP?
While 91% of all Wisconsin residents have health insurance, roughly 493,000 individuals remain
uninsured, 3 including 5.8% of Wisconsin ’s children 4 and 10.1% of the state’s working population. 5

ACA is designed to address these concerns by providing affordable access to health insurance coverage
to those individuals who would otherwise be unable to obtain coverage, and to extend current benefits
and services provided by Medicaid (a federal and state funded public insurance program that provides
health insurance coverage for low-income and disabled individuals and families).
NEW BENEFITS UNDER ACA: ITS EFFECT IN WISCONSIN

Insurance ACA establishes new requirements for private health insurers in order to make health care
Coverage plans more accessible to the public. These requirements include the following:

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National Coalition on Health Care July 2010
  Effective Immediately: Plans must cover certain preventive health services, such as
vaccines and screenings, without a co-pay.
 Effective September 2010:
o Insurers will not be allowed to drop any insured person because he/she gets
sick or develops a chronic health condition. In addition, ACA allows individuals
to renew health insurance coverage regardless of their health status.
o Individuals up to the age of 26 can choose to be covered under their parents’
insurance plan.
 Effective January 2014:
o Under the “guaranteed issue” provision, an insurer must accept every employer
and individual in the state that applies for coverage.
o Insurers cannot exclude people from coverage if they have a pre-existing
condition (e.g., asthma, diabetes, or any other long-term condition) or past
illness. An estimated one out of every four Wisconsin residents has a pre-
existing condition and will benefit from this provision. 6
o All insurers will be required to offer a coverage package that offers essential
benefits.
Effective Immediately: ACA makes tax credits available to qualifying small businesses to
Small
help them afford coverage for their employees. These tax credits could total up to 50% of
Business
a business’ health insurance premiums. In 2008, Wisconsin had over 100,000 small
Assistance
employers,7 which represented over 76% of the state’s employers.8
Effective January 2014: ACA requires that states create an insurance market “exchange” –
Health
a marketplace where people will be able to compare and shop for health insurance. This
Insurance
will make access to health plans easier and more efficient. U.S. citizens, legal immigrants,
Exchanges
and small businesses will be able to purchase insurance through these exchanges.
Effective July 2010: High-risk pools are designed to provide health insurance coverage to
High-Risk people who were previously uninsurable due to a pre-existing condition. Wisconsin
Insurance already operates its own high-risk pool and has indicated to HHS that it intends to operate
Pools ACA's federally funded high-risk pool as well. 9 The details of its high-risk proposal are
forthcoming.
Effective January 2014: ACA contains provisions that would create new eligibility
requirements for Medicaid. For example, adults under the age of 65 earning less than
133% of the federal poverty level, may be eligible to apply regardless of whether they
Expansion have children. It is estimated that approximately 205,000 Wisconsin residents may be able
of eligible to join Medicaid.10
Medicaid

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National Coalition on Health Care July 2010
 IMPLEMENTATION CHALLENGES IN WISCONSIN

Successful implementation of ACA will require a joint effort among local, state, and federal agencies, as
well as many non-governmental organizations. The State of Wisconsin will face several challenges:
 Budget – Wisconsin has a structural budget deficit of 2.3 billion dollars. 11 Since some of the
implementation costs are likely to require state dollars as well as federal dollars, Wisconsin's budget
situation severely ties the hands of state lawmakers and regulators as they attempt to implement
ACA.
 Health Care Workforce – With the potential increase of Wisconsin's insured population, it is
important that primary care physicians and other necessary health care professionals are engaged
in health care reform. ACA provides grants and loan forgiveness to health care professionals; this
will help Wisconsin ensure that it has an appropriate supply of doctors, nurses, social workers, and
other professionals to cover the increased demand.

1
U.S. CENSUS BUREAU. STATE AND COUNTY QUICKFACTS (2010), available at http://quickfacts.census.gov/qfd/states/55000.html (last accessed
June 2010). These figures are from 2009.
2
Ibid. These figures are from 2008.
3
THE KAISER FAMILY FOUNDATION, statehealthfacts.org. Data Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured
estimates based on the Census Bureau's March 2008 and 2009 Current Population Survey (CPS: Annual Social and Economic
Supplements), available at http://www.statehealthfacts.org:/comparetable.jsp?ind=125&cat=3 (last accessed June 2010).
4
THE KAISER FAMILY FOUNDATION, statehealthfacts.org. Data Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured
estimates based on the Census Bureau's March 2008 and 2009 Current Population Survey (CPS: Annual Social and Economic
Supplements), available at http://www.statehealthfacts.org:/comparetable.jsp?ind=127&cat=3 (last accessed June 2010).
5
COVER THE UNINSURED, ROBERT WOOD JOHNSON FOUNDATION, U.S. UNINSURED WORKERS, available at
http://covertheuninsured.org/uninsured_workers#map (last accessed June 2010). These figures are from 2006-2007.
6
GREEN BAY PRESS GAZETTE, Report: 1 in 4 in Wisconsin have pre-existing condition; health care law could help them (N.D), available at
www.greenbaypressgazette.com/article/20100521/GPG0101/5210575/Report-1-in-4-in-Wisconsin-have-pre-existing-condition-health-
care-law-could-help-them (last accessed June 2010).
7
Small businesses include employers with fewer than 50 employees.
8
U.S. DEP’T OF HEALTH & HUMAN SERVS. MEDICAL EXPENDITURE PANEL SURVEY (2008), available at
http://www.meps.ahrq.gov/mepsweb/data_stats/summ_tables/insr/state/series_2/2008/tiia1.pdf. These figures are from 2008.
9
Douglass Trapp, Temporary High Risk Pools to Start in July, AMERICAN MED. NEWS (April 26, 2010), available at http://www.ama-
assn.org/amednews/2010/04/26/gvsa0426.htm (last accessed June 2010).
10
JOHN HOLAHAN & IRENE HEADEN, KAISER COMMISSION ON MEDICAID AND THE UNINSURED, MEDICAID COVERAGE AND SPENDING IN HEALTH REFORM: NATIONAL
AND STATE‐BY‐STATE RESULTS FOR ADULTS AT OR BELOW 133% FPL 41 (2010), available at http://www.kff.org/healthreform/upload/Medicaid-
Coverage-and-Spending-in-Health-Reform-National-and-State-By-State-Results-for-Adults-at-or-Below-133-FPL.pdf (last accessed June
2010).
11
Post-Crescent Editorial Staff, Candidates will need to get specific on state budget cuts, APPLETON POST-CRESCENT (June 13, 2010) available
at http://www.postcrescent.com/article/20100613/APC0602/6130513 (last accessed June 2010).

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