State Views: Wisconsin steps in, steps up on health care

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Sen. Neal Kedzie
Monday, December 23, 2013

Since the Affordable Care Act—or Obamacare—was enacted, many of the health care changes have been confusing. Deadlines have changed, the website is a disaster, and despite the president's promise, millions of Americans might not be able to keep their health insurance or doctors.

In response, the Legislature created a three-month extension for BadgerCare and HIRSP enrollees in order for them to transition to the federal health care exchange. HIRSP insures about 21,000 residents who are unable to find adequate coverage due to their medical conditions, and those who lost employer-sponsored group health insurance coverage.

Through the ACA, which begins Jan. 1, no one will be denied coverage or charged more for coverage due to pre-existing conditions. Thus, the federal exchange will replace HIRSP, which was to sunset Dec. 31. But, due to the problems with the federal program, the Legislature extended HIRSP through March 31, while the federal government deals with its problems.

Under the special session bill, nonpregnant adults on BadgerCare Plus who have income above 100 percent of the federal poverty level will move to the federal health care marketplace beginning April 1. Children in the BadgerCare Plus program in a household with which the household income is above 300 percent of the poverty level (unless they meet a deductible) will also be moved to the federal exchange. All those in BadgerCare Plus will keep their coverage through March 31, as long as they continue to meet program rules.

Those on the BadgerCare Plus Core Plan will be moved to the federal Health Insurance Marketplace starting April 1. To continue receiving Core Plan benefits through March 31, members will need to continue to pay required monthly premiums. Core Plan members who are at or below the new income limit of 100 percent of the federal poverty level for adults will be enrolled in the BadgerCare Plus Standard Plan on April 1 and receive a better benefit package.

The legislation also extends the BadgerCare Plus Basic Plan through March 31. After the BadgerCare Plus Basic Plan ends March 31, individuals will also need to apply for health care through the federal health insurance exchange.

The BadgerCare Plus Benchmark Plan will also end March 31. Benchmark Plan members who meet the new BadgerCare Plus rules will be enrolled in the BadgerCare Plus Standard Plan on April 1 and receive a better benefit package.

These changes do not affect enrollees in Medicaid for the elderly, blind or disabled, or other Medicaid programs. Visit the Department of Health Services' website at dhs.wisconsin.gov for more information.

Wisconsin provides substantial health care coverage for those in need, and for the first time in state history, Wisconsin will provide coverage for everyone living in poverty and give those above that level access to health insurance through the exchanges or the private market. The Legislature and governor are stepping in and stepping up where the federal government has stumbled. We're keeping our promise when others have not.

Sen. Neal Kedzie, R-Elkhorn, represents the 11th Senate District. Readers can reach him at Room 313 South, state Capitol, P.O. Box 7882, Madison, WI 53707-7882; phone 608-266-2635; email Sen.Kedzie@legis.Wisconsin.gov.

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